Between knowledge and representations: obstacles to the management of opioid use disorder in general practice ; Entre connaissances et représentations : les freins de la prise en charge du trouble de l’usage des morphiniques en médecine générale

Background: General practitioners play a central role in identifying and managing opioid use disorder, particularly in the context of acute and chronic pain and the increasing use of opioid analgesics, for which they are the main prescribers. However, in recent years, there has been a decline in investment and interest among general practitioners in this issue, despite older generations being highly involved in illicit opioid use (heroin). This lack of interest could be explained by a lack of knowledge and misperceptions about this issue, notably due to inadequate initial training. Methods: An analytical cross-sectional observational study was conducted through a self-administered questionnaire sent to general medicine interns in France. It assessed their knowledge and perceptions based on their levels of training in addictology through two typical clinical cases involving a legal and an illegal opioid. Results: 120 questionnaires were analyzed. Trained interns feel more comfortable regarding addictions in general and opioid addictions than non-trained interns. There is a linear relationship between the overall score and the training (p=0.05); belonging to the trained group leads to a 1.361 increase in the overall score obtained. Non-trained interns have more negative representations, especially in the case of the illicit opioid. Conclusions: Interns who received additional training in addictology during their externship or internship had better results than those who did not receive such training. Although statistically significant, the differences were nevertheless modest to be clinically decisive. However, the "trained" interns judged themselves more capable in terms of knowledge and skills to manage opioid addiction, although this ability was considered inferior to that for type 2 diabetes. Their perceptions of patients dependent on opioids were more often associated with notions of chronic pathology and empathy, which are necessary for a good understanding and management of this condition. These differences ...