Interdisciplinary Management of Opioid Use Disorder in Primary Care

Cantone, Rebecca E.; Fleishman, Joan; Garvey, Brian; Gideonse, Nicholas

doi:10.1370/afm.2184

Cited by 12 publications

(14 citation statements)

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“…Nonetheless, a greater number of physicians are receiving training in addiction medicine and addiction psychiatry, and increasingly, primary care physicians are incorporating addiction treatment into their practice. 34,35 New educational guidelines and curricula are being developed, presenting an opportunity to teach medical, nursing, and pharmacy trainees about MOUDs. The nursing role in the treatment of OUDs is becoming central and training is appropriately increasing.…”

Section: Challenges and Opportunities In The Usmentioning

confidence: 99%

Methadone Matters: What the United States Can Learn from the Global Effort to Treat Opioid Addiction

et al. 2019

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In the midst of an opioid epidemic, mortality related to opioid overdose continues to rise in the US. Medications to treat opioid use disorder, including methadone and buprenorphine, are highly effective in reducing the morbidity and mortality related to illicit opioid use. Despite the efficacy of these life-saving medications, the majority of people with an opioid use disorder lack access to treatment. This paper briefly reviews the evidence to support the use of medications to treat opioid use disorder with a specific focus on methadone. We discuss the current state of methadone therapy for the treatment of opioid use disorder in the US and present logistical barriers that limit its use. Next, we examine three international pharmacy-based models in which methadone dispensing to treat opioid use disorder occurs outside of an opioid treatment facility. We discuss current challenges and opportunities to incorporate similar methods of methadone dispensing for the treatment of opioid use disorder in the US. Finally, we present our vision to integrate pharmacybased methadone dispensing into routine opioid use disorder treatment through collaboration between clinicians and pharmacies to improve local access to this life-saving medication. KEY WORDS: methadone; opioid use disorder; opioids.

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Section: Challenges and Opportunities In The Usmentioning

confidence: 99%

Methadone Matters: What the United States Can Learn from the Global Effort to Treat Opioid Addiction

et al. 2019

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“…It used buprenorphine-containing medications and naltrexone, and added masters-level behavioral health providers to the primary care team to work with patients on improving coping skills, relapse prevention, and resilience strategies, with the goal of holistically addressing the complex psychosocial needs of patients with OUD. 23 In both clinics, behavioral health providers had specific training in working with patients with substance use disorders (SUDs). Medical and behavioral health providers at these clinics also trained in and practice trauma-informed care and a harm reduction approach to treatment.…”

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confidence: 99%

Predictors of Medication-Assisted Treatment Initiation for Opioid Use Disorder in an Interdisciplinary Primary Care Model

et al. 2019

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Introduction: Medication-assisted treatment (MAT) for opioid use disorder (OUD) is underused in primary care. Little is known about patient demographics associated with MAT initiation, particularly among models with an interdisciplinary approach, including behavioral health integration. We hypothesize few disparities in MAT initiation by patient characteristics after implementing this model for OUD. Methods: Electronic health record data were used to identify adults with ≥1 primary care visit in 1 of 2 study clinics in a Pacific Northwest academic health system between September 1, 2015 and August 31, 2017 (n = 23,372). Rates of documented OUD diagnosis were calculated. Multivariate logistic regression estimated odds ratios of MAT initiation, defined as ≥1 electronic health record order for buprenorphine or naltrexone, by patient covariates. Results: Seven percent of the study sample had an OUD diagnosis. Of those patients, 32% had ≥1 MAT order. Patients with documented psychiatric diagnoses or tobacco use had higher odds of initiating MAT (odds ratio [OR] = 1.62, P = .0003; OR = 2.46, P < .0001, respectively). Uninsured, Medicaid, and Medicare patients had lower odds than those commercially insured (OR = 0.53, 0.38, and 0.31, respectively; P < .0001). Patients who were older, of a race/ethnicity other than non-Hispanic white, had documented diabetes, and had documented asthma or chronic obstructive pulmonary disease showed lower odds of initiation. Discussion: MAT initiation varied by patient characteristics, including disparities by insurance coverage and race/ethnicity. The addition of behavioral health did not eliminate disparities in care, but higher odds of initiation among those with a documented psychiatric diagnosis may suggest this model reaches some vulnerable populations. Additional research is needed to further examine these findings.

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“…[28][29][30] There have also been very promising local models including the integration of behavioral health clinicians on site. 31 Further studies are needed to specifically examine the effectiveness of these and other buprenorphine treatment models in rural areas where patients are not only traveling much longer distances to reach treatment but may also differ in many other aspects including views about behavioral and mental health treatment. 32 The present study also provides some of the first data across US prescribers on buprenorphine treatment practices during the induction and maintenance periods.…”

Section: Discussionmentioning

confidence: 99%

Comparing Buprenorphine-Prescribing Physicians Across Nonmetropolitan and Metropolitan Areas in the United States

Lin

Knudsen

2019

Ann Fam Med

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PURPOSE Although there is a tremendous need to increase the use of buprenorphine for the treatment of opioid use disorder in rural areas, little is known about current rural/urban differences in treatment practices. We aimed to examine physician characteristics, treatment practices, and concordance with treatment guidelines among buprenorphine prescribers across different locations of practice. METHODS A national random sample of buprenorphine physician prescribers was surveyed (n = 1,174, response rate = 33%) from July 2014 to January 2017. Analyses examined buprenorphine treatment across locations of practice (categorized as nonmetropolitan, small metropolitan, and large metropolitan). RESULTS Among buprenorphine prescribers surveyed, 11.2% (n = 132) practiced in nonmetropolitan/rural areas, 32.5% (n = 382) in small metropolitan areas, and 56.2% (n = 660) in large metropolitan areas. Buprenorphine prescribers in nonmetropolitan areas were much more likely to be primary care physicians, accept Medicaid, and less likely to work in an individual practice. Overall, buprenorphine prescribers across the rural/urban continuum were similar in many of their treatment practices, including induction, frequency of visits, dosing, and use of psychosocial treatment, which were generally consistent with buprenorphine treatment recommendations. CONCLUSIONS There are important differences in characteristics of buprenorphine prescribers in nonmetropolitan areas compared with more urban areas, including the fact that the majority of nonmetropolitan physicians are primary care physicians. Although treatment access in rural areas is an ongoing challenge, buprenorphine treatment practices are similar. Understanding buprenorphine prescribers and their treatment practices may help inform tailored strategies to address treatment needs in different locations.

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Interdisciplinary Management of Opioid Use Disorder in Primary Care

Cited by 12 publications

References 0 publications

Methadone Matters: What the United States Can Learn from the Global Effort to Treat Opioid Addiction

Methadone Matters: What the United States Can Learn from the Global Effort to Treat Opioid Addiction

Predictors of Medication-Assisted Treatment Initiation for Opioid Use Disorder in an Interdisciplinary Primary Care Model

Comparing Buprenorphine-Prescribing Physicians Across Nonmetropolitan and Metropolitan Areas in the United States

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