The role of stigma in U.S. primary care physicians’ treatment of opioid use disorder

•National survey of U.S. primary care physicians.•PCPs reported high levels of stigmatizing attitudes related to opioid use disorder.•Stigma negatively associated with likelihood of prescribing OUD medications.•Stigma negatively associated with support for increasing access to OUD medication. To characterize primary care physicians’ (PCPs) attitudes and beliefs about people with opioid use disorder (OUD) and to understand the association between PCPs’ stigmatizing attitudes and their OUD treatment practices, beliefs about treatment effectiveness, and support for policies designed to improve access to OUD medications. We conducted a national postal survey of U.S. PCPs from January to August 2019. Survey items measured respondents’ attitudes, beliefs, and current treatment practices. Data were analyzed using descriptive statistics and logistic regression. Of the original 1000 PCPs in the survey sample, 668 were deemed eligible to participate in the study. The survey was completed by 361 PCPs for an adjusted response rate of 54 %. PCPs reported high levels of stigmatizing attitudes. Less than 30 % of PCPs reported that they were willing to have a person taking medication for OUD as a neighbor or marry into their family, even if that person was being treated with medication. Greater stigma was associated with an 11 percentage point lower likelihood that PCPs prescribed OUD medication and lower support for policies intended to increase access to OUD medication. Addressing OUD stigma among PCPs is a public health priority in addressing the ongoing opioid crisis.