Primary Care–Based Models for the Treatment of Opioid Use Disorder

Korthuis, P. Todd; McCarty, Dennis; Weimer, Melissa; Bougatsos, Christina; Blazina, Ian; Zakher, Bernadette; Grusing, Sara; Devine, Beth; Chou, Roger

doi:10.7326/m16-2149

Cited by 241 publications

(214 citation statements)

References 43 publications

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“…Korthuis, et al (45) reviewed implementation models of MAT in primary care settings and found four key components: (1) the type of medication used, (2) provider and community educational interventions, (3) coordination and integration of OUD treatment with other medical and psychological needs, and (4) adjunctive psychosocial counseling. While these components were identified in the “eye” of Western science, they also can be viewed through the “second eye” of Indigenous worldviews.…”

Section: Discussionmentioning

confidence: 99%

“…Korthuis et al (45) suggest the need for provider and community interventions to educate the community, families, patients and practitioners using a variety of methods. Among the many topics to be covered should be discussions of OUD as a chronic disorder that requires extended and ongoing treatment (51) and reducing SUD and treatment related stigma (52, 53).…”

Section: Discussionmentioning

confidence: 99%

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Future directions for medication assisted treatment for opioid use disorder with American Indian/Alaska Natives

Venner

Donovan

Campbell

et al. 2018

Addictive Behaviors

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The U.S. is experiencing an alarming opioid epidemic, and although American Indians and Alaska Natives (AI/AN) are especially hard hit, there is a paucity of opioid-related treatment research with these communities. AI/ANs are second only to Whites in the U.S. for overdose mortality. Thus, the National Institute on Drug Abuse convened a meeting of key stakeholders to elicit feedback on the acceptability and uptake of medication assisted treatment (MAT) for opioid use disorders (OUDs) among AI/ANs. Five themes from this one-day meeting emerged: (1) the mismatch between Western secular and reductionistic medicine and the AI/AN holistic healing tradition; (2) the need to integrate MAT into AI/AN traditional healing; (3) the conflict between standardized MAT delivery and the traditional AI/AN desire for healing to include being medicine free; (4) systemic barriers; and (5) the need to improve research with AI/ANs using culturally relevant methods. Discussion is organized around key implementation strategies informed by these themes and necessary for the successful adoption of MAT in AI/AN communities: (1) type of medication; (2) educational interventions; (3) coordination of care; and (4) adjunctive psychosocial counseling. Using a community-based participatory research approach is consistent with a “two eyed seeing” approach that integrates Western and Indigenous worldviews. Such an approach is needed to develop impactful research in collaboration with AI/AN communities to address OUD health disparities.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Future directions for medication assisted treatment for opioid use disorder with American Indian/Alaska Natives

Venner

Donovan

Campbell

et al. 2018

Addictive Behaviors

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“…9 • The studies are short-term (ie, 12 weeks to 6 months). Given the remitting-relapsing but chronic nature of substance dependence, and studies showing high rates of relapse with discontinuation of B/BN treatment, 10 longer studies are needed to gauge the longitudinal value of a given model/intervention.…”

Section: Methods Shortcomingsmentioning

confidence: 99%

Medication-Assisted Treatment Should Be Part of Every Family Physician’s Practice: No

Hill

2017

Ann Fam Med

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To read or post commentaries in response to this article, see it online at http://www.AnnFamMed.org/content/15/4/309. Key words: buprenorphine, naloxone drug combination; opioid, opiate substitution therapy; opioid-related disorders; prescribing patterns, physician, primary health careSubmitted September 7, 2016; submitted, revised, March 21, 2017; accepted March 31, 2017. References 1. Lawlor J. Drug overdose deaths in Maine now averaging one a day.Portland Press Herald. November 14, 2016. T he magnitude and tragedy of the national opioid epidemic has prompted The Office of National Drug Control Policy and the US Department of Health and Human Services to prioritize increasing access to medication-assisted treatment. POINT/COUNTERPOINT1,2 The Drug Addiction Treatment Act of 2000 3 enables physicians who complete an 8-hour online course to prescribe schedule III, IV, and V opiates, including buprenorphine/buprenorphine naloxone (B/BN) for opioid use disorders in settings other than outpatient treatment centers such as methadone maintenance clinics. Despite the potential for great expansion, use of B/BN remains limited. [4][5][6] The need to expand the reach of medicationassisted treatment across the country has led many policy makers, academics, and some physicians to suggest that primary care physicians be at the front lines of this effort. While the number and geographic distribution of primary care physicians makes them likely candidates to deliver the care, there are a number of other factors that make this a poor decision for both primary care physicians and patients. ventions including abstinence efforts and Alcoholics Anonymous/Narcotics Anonymous/sponsors, other nonagonist pharmacotherapies, addiction counseling, intensive outpatient treatment, partial hospitalization, residential programs, and other forms of rehabilitation, perhaps even court-ordered treatment with mandatory accountability and urine toxicology screenings. The opioid-dependent patient population being considered for buprenorphine treatment in primary care settings therefore represents a more severe and treatmentresistant population that requires specialist intervention. Just as primary care doctors will routinely treat mild to moderate forms of diabetes and hypertension but will refer the more severely ill patients to endocrinologists or nephrologists for expert consultation and treatment, so too should opiate-dependent patients requiring maintenance with agonists/mixed agonist-antagonists be referred to or seen by specialists in addiction medicine or addiction psychiatry-and not in a primary setting by generalists, or registered nurses with little training on addiction and the use of buprenorphine. SPECIALIZED TREATMENT REQUIRED COMORBID PSYCHIATRIC ILLNESSFurther complicating the care of many opioid-addicted patients is the fact that they are much more likely than the general population to suffer from comorbid psychiatric disorders. In one study 7 it was estimated that co-occurring disorders were quite common: mood disorders (40% t...

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“…A narrative review identified models for integrating treatment of opioid use disorder in primary care [52]. Several of these primary care-based models, including office-based opioid treatment, nurse-facilitated treatment, Project Extension for Community Healthcare Outcomes (ECHO), “hub and spoke” and “one-stop shop” are particularly salient for use in rural areas where substance use disorder treatment services are limited.…”

Section: Models Of Care For Medication Treatmentsmentioning

confidence: 99%

Implementing Treatment of Opioid-Use Disorder in Rural Settings: a Focus on HIV and Hepatitis C Prevention and Treatment

et al. 2018

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Purpose of review: To describe the epidemiology opioid use disorder in the rural United States as it pertains to HIV and hepatitis C transmission and treatment resources. Recent findings: Heroin and fentanyl analouges have surpassed prescription opioids in their availability in rural opioid markets adding to HIV and hepatitis C (HCV) and overdose risks. Only 18% of rural individuals live in towns with inpatient services which are of limited quality and utiity. Opioid treatment programs that provide methadone are not located in rural areas and only 3% of the primary care providers have the ability to prescribe buprenorphine. National models and resources have been established but lack implementation in rural areas leading to ongoing HIV and HCV transmission and overdose. Summary: Addressing the adverse impact of opioids in the rural U.S. will require a concerted effort to implement effective treatments according to national standards.

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Primary Care–Based Models for the Treatment of Opioid Use Disorder

Cited by 241 publications

References 43 publications

Future directions for medication assisted treatment for opioid use disorder with American Indian/Alaska Natives

Future directions for medication assisted treatment for opioid use disorder with American Indian/Alaska Natives

Medication-Assisted Treatment Should Be Part of Every Family Physician’s Practice: No

Implementing Treatment of Opioid-Use Disorder in Rural Settings: a Focus on HIV and Hepatitis C Prevention and Treatment

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