Treatment of opioid use disorder in primary care

Abstract

Opioid 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.

Buprenorphine treatment retention and comorbidities among patients with opioid use disorder in a primary care setting

“…1 Providing buprenorphine in primary care provides an ideal opportunity to optimize the overall health of OUD patients with comprehensive care that simultaneously addresses OUD and other health comorbidities such as hypertension, human immunodeficiency virus (HIV), hepatitis C virus (HCV), and diabetes. 2 Prior research favors integrating treatment with primary care over segregated addiction treatment models, with evidence to support greater satisfaction, lower associated medical costs, and higher retention among patients seen in comprehensive primary care. [2][3][4] Even so, less than half of patients prescribed buprenorphine remain in treatment for a year or more, 4,5 which suggests the treatment could be further optimized and emphasizes the importance of identifying risk factors for attrition.…”

“…2 Prior research favors integrating treatment with primary care over segregated addiction treatment models, with evidence to support greater satisfaction, lower associated medical costs, and higher retention among patients seen in comprehensive primary care. [2][3][4] Even so, less than half of patients prescribed buprenorphine remain in treatment for a year or more, 4,5 which suggests the treatment could be further optimized and emphasizes the importance of identifying risk factors for attrition.…”

“…Treatment of opioid use disorder (OUD) with buprenorphine, a medication prescribed directly from a clinician's office, has been associated with decreased opioid use and reduced mortality among persons with OUD 1 . Providing buprenorphine in primary care provides an ideal opportunity to optimize the overall health of OUD patients with comprehensive care that simultaneously addresses OUD and other health comorbidities such as hypertension, human immunodeficiency virus (HIV), hepatitis C virus (HCV), and diabetes 2 . Prior research favors integrating treatment with primary care over segregated addiction treatment models, with evidence to support greater satisfaction, lower associated medical costs, and higher retention among patients seen in comprehensive primary care 2–4 .…”

Current and Future Therapeutic Options in Pain Management: Multi-mechanistic Opioids Involving Both MOR and NOP Receptor Activation

“…Based on these observations, ketamine could be considered a good adjuvant during methadone treatment, while antidepressants should be avoided for reducing the risk of serotonin syndrome [ 16 ]. The good oral bioavailability, the long half-life, the lack of active metabolites, and the low tolerance potential makes methadone suitable for the treatment of heroin and other opioid dependencies [ 17 ]. However, because of its long half-life and the potential risk of respiratory depression, closer medical monitoring is needed compared with other drugs, such as buprenorphine.…”

Heroin Regulates Orbitofrontal Circular RNAs

“…Opioid overdose and deaths continue to rise in the United States, where nearly 190 people die every day from opioid intoxication [1]. Commonly used current pharmacological therapies to manage opioid dependence include buprenorphine and methadone, which both target the mu-opioid receptor [2,3]. However, chronic opioid use induces neurobiological adaptations which extend far beyond the opioid receptor [4].…”