The University of Cincinnati pilot embeds substance use disorder care directly into an internal medicine resident clinic, addressing the stark reality that only 23% of the 48.4 million Americans with SUD receive any treatment. This observational evaluation of 73 visits over 15 weeks and pre-post surveys of just 11 residents documents clear gains in physician confidence for buprenorphine initiation and harm-reduction counseling, yet lacks randomization or control groups, limiting causal claims. Unlike specialty silos, the model normalizes addiction alongside diabetes management, directly confronting the access barrier that leaves most patients untreated. Related work in the Journal of General Internal Medicine (2022; n=248 primary care providers) similarly found integrated buprenorphine training raised prescribing rates by 40% at six months, though that study also relied on self-report without long-term retention data. A 2023 observational analysis in Addiction (n=1,872 patients across 12 clinics) showed primary-care-embedded OUD treatment reduced 90-day mortality versus referral-only models, but highlighted implementation friction around pharmacist staffing and insurance reimbursement—factors the Cincinnati report does not quantify. The pilot correctly identifies reduced stigma as a mechanism, yet overlooks potential selection bias: patients already engaged in resident clinics may differ systematically from those lost to specialty referral. Future adaptation will hinge on whether these confidence gains translate into sustained prescribing volume post-residency, an outcome the authors themselves flag as unmeasured.