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Treatment of opioid use disorder in primary care
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Treatment of opioid use disorder in primary care
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Journal Article
Treatment of opioid use disorder in primary care
2021
Overview
AbstractOpioid use disorder (OUD) is a common, treatable chronic disease that can be effectively managed in primary care settings. Untreated OUD is associated with considerable morbidity and mortality—notably, overdose, infectious complications of injecting drug use, and profoundly diminished quality of life. Withdrawal management and medication tapers are ineffective and are associated with increased rates of relapse and death. Pharmacotherapy is the evidence based mainstay of OUD treatment, and many studies support its integration into primary care settings. Evidence is strongest for the opioid agonists buprenorphine and methadone, which randomized controlled trials have shown to decrease illicit opioid use and mortality. Discontinuation of opioid agonist therapy is associated with increased rates of relapse and mortality. Less evidence is available for the opioid antagonist extended release naltrexone, with a meta-analysis of randomized controlled trials showing decreased illicit opioid use but no effect on mortality. Treating OUD in primary care settings is cost effective, improves outcomes for both OUD and other medical comorbidities, and is highly acceptable to patients. Evidence on whether behavioral interventions improve outcomes for patients receiving pharmacotherapy is mixed, with guidelines promoting voluntary engagement in psychosocial supports, including counseling. Further work is needed to promote the integration of OUD treatment into primary care and to overcome regulatory barriers to integrating methadone into primary care treatment in the US.
Publisher
BMJ Publishing Group LTD
Subject
/ Analgesics, Opioid - therapeutic use
/ COVID-19
/ Drug use
/ Fentanyl
/ Heroin
/ Humans
/ Narcotic Antagonists - therapeutic use
/ Opiate Substitution Treatment - methods
/ Opioid-Related Disorders - diagnosis
/ Opioid-Related Disorders - drug therapy
/ Opioid-Related Disorders - epidemiology
/ Opioid-Related Disorders - therapy
/ Opioids
/ Overdose
/ Patients
/ Primary Health Care - methods
/ Psychiatric Rehabilitation - methods
