Organization of primary care and early MOUD discontinuation

More than 5 million individuals in the United States currently live with opioid use disorder (OUD) [ 1 ]. In response to the growing need for treatment, primary care physicians (PCPs) increasingly prescribe buprenorphine, [ 2 , 3 ] a first-line FDA-approved medication for OUD (MOUD) [ 4 , 5 ]. Primary care offers advantages as a treatment setting for MOUD, including a more private and less stigmatizing environment compared to specialty substance use treatment clinics [ 6 , 7 , 8 ]. However, retention rates vary across clinics, with some studies showing up to 50% of patients discontinuing treatment within the first year [ 9 , 10 , 11 , 12 , 13 , 14 ]. Similar rates have been observed in both primary care and specialty clinics [ 15 ]. Discontinuation of MOUD treatment is associated with increased risks of illicit drug use, morbidity, overdose mortality, legal system involvement, and HIV/HCV transmission [ 16 , 17 , 18 , 19 , 20 ].