Primary care for opioid use disorder

Mannelli, Paolo; Wu, Li‐Tzy

doi:10.2147/sar.s69715

Cited by 7 publications

(2 citation statements)

References 16 publications

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“…There is variability in regulations for treatment programs, payment models, and provider training structures which may limit or enhance the ability of health systems to provide high quality multidisciplinary, coordinated care with the most cost-effective, efficacious OUD interventions. As the US allocates funding towards expanding MAT access, programs receiving such funding would benefit from considering the intervention models found to support MAT implementation in prior studies [ 93 ]. By evaluating not only patient efficacy, but also structural characteristics of primary care models for delivering MAT, this review provides key insights for PCPs and researchers about ways to build upon existing resources and personnel to more effectively deliver OUD treatment.…”

Section: Discussionmentioning

confidence: 99%

Primary care models for treating opioid use disorders: What actually works? A systematic review

et al. 2017

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Section: Discussionmentioning

confidence: 99%

Primary care models for treating opioid use disorders: What actually works? A systematic review

et al. 2017

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“… 16 17 Increased prevalence of OUD is associated with increased wait times for inpatient and outpatient mental health and addiction services in many parts of North America. 18–20 As a result, community-based mental health and primary care facilities have been confronted with an increased need for evidence-based OUD treatments such as opioid agonist treatment (OAT)(eg, methadone, buprenorphine/naloxone), 19 21 in addition to harm reduction services (eg, providing naloxone kits), and drug user education services. 22 23 Although regulations have been changing rapidly, not all clinicians can prescribe OAT, which limits access to treatment for many individuals with OUD, 24 particularly in rural areas.…”

Section: Introductionmentioning

confidence: 99%

Patient engagement, treatment preferences and shared decision-making in the treatment of opioid use disorder in adults: a scoping review protocol

et al. 2018

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IntroductionOpioid use disorder (OUD) is characterised by the fifth Edition of the Diagnostic and Statistics Manual as a problematic pattern of opioid use (eg, fentanyl, heroin, oxycodone) that leads to clinically significant impairment. OUD diagnoses have risen substantially over the last decade, and treatment services have struggled to meet the demand. Evidence suggests when patients with chronic illnesses are matched with their treatment preferences and engaged in shared decision-making (SDM), health outcomes may improve. However, it is not known whether SDM could impact outcomes in specific substance use disorders such as OUD.Methods and analysisA scoping review will be conducted according to Arksey and O’Malley’s framework and by recommendations from Levac et al. The search strategy was developed to retrieve relevant publications from database inception and June 2017. MEDLINE, EMBASE, PsycINFO, Cochrane Database for Controlled Trials, Cochrane Database for Systematic Reviews and reference lists of relevant articles and Google Scholar will be searched. Included studies must be composed of adults with a diagnosis of OUD, and investigate SDM or its constituent components. Experimental, quasi-experimental, qualitative, case–control, cohort studies and cross-sectional surveys will be included. Articles will be screened for final eligibility according to title and abstract, and then by full text. Two independent reviewers will screen excluded articles at each stage. A consultation phase with expert clinicians and policy-makers will be added to set the scope of the work, refine research questions, review the search strategy and identify additional relevant literature. Results will summarise whether SDM impacts health and patient-centred outcomes in OUD.Ethics and disseminationScoping review methodology is considered secondary analysis and does not require ethics approval. The final review will be submitted to a peer-reviewed journal, disseminated at relevant academic conferences and will be shared with policy-makers, patients and clinicians.

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DSM-5 substance use disorders among adult primary care patients: Results from a multisite study

McNeely

Subramaniam

et al. 2017

Drug and Alcohol Dependence

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Background There are limited data about the extent of DSM-5 substance use disorders (SUDs) among primary care patients. Method This study analyzed data from a multisite validation study of a substance use screening instrument conducted in a diverse sample of 2,000 adults aged ≥18 years recruited from five primary care practices in four states. Prevalence and correlates of 12-month DSM-5 SUDs were examined. Results Overall, 75.5% of the sample used any substance, including alcohol (62.0%), tobacco (44.1%), or illicit drugs/nonmedical medications (27.9%) in the past 12 months (marijuana 20.8%, cocaine 7.3%, opioids 4.8%, sedatives 4.1%, heroin 3.9%). The prevalence of any 12-month SUD was 36.0% (mild disorder 14.2%, moderate/severe disorder 21.8%): tobacco 25.3% (mild 11.5%, moderate/severe 13.8%); alcohol 13.9% (mild 6.9%, moderate/severe 7.0%); and any illicit/nonmedical drug 14.0% (mild 4.0%, moderate/severe 10.0%). Among past 12-month users, a high proportion of tobacco or drug users met criteria for a disorder: tobacco use disorder 57.4% (26.1% mild, 31.3% moderate/severe) and any drug use disorder 50.2% (14.3% mild, 35.8% moderate/severe); a lower proportion of alcohol users (22.4%) met criteria for alcohol use disorder (11.1% mild, 11.3% moderate/severe). Over 80% of adults with opioid/heroin use disorder met criteria for a moderate/severe disorder. Younger ages, male sex, and low education were associated with increased odds of having SUD. Conclusion These findings reveal the high prevalence of SUDs in primary care and underscore the need to identify and address them.

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Primary care for opioid use disorder

Cited by 7 publications

References 16 publications

Primary care models for treating opioid use disorders: What actually works? A systematic review

Primary care models for treating opioid use disorders: What actually works? A systematic review

Patient engagement, treatment preferences and shared decision-making in the treatment of opioid use disorder in adults: a scoping review protocol

DSM-5 substance use disorders among adult primary care patients: Results from a multisite study

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