Use of Pharmacotherapies in the Treatment of Alcohol Use Disorders and Opioid Dependence in Primary Care

Abstract

Substance-related and addictive disorders are chronic relapsing conditions that substantially impact public health. Effective treatments for these disorders require addressing substance use/dependence comprehensively as well as other associated comorbidities. Comprehensive addressing of substance use in a medical setting involves screening for substance use, addressing substance use directly with the patient, and formulating an appropriate intervention. For alcohol dependence and opioid dependence, pharmacotherapies are available that are safe and effective when utilized in a comprehensive treatment paradigm, such as medication assisted treatment. In primary care, substance use disorders involving alcohol, illicit opioids, and prescription opioid abuse are common among patients who seek primary care services. Primary care providers report low levels of preparedness and confidence in identifying substance-related and addictive disorders and providing appropriate care and treatment. However, new models of service delivery in primary care for individuals with substance-related and addictive disorders are being developed to promote screening, care and treatment, and relapse prevention. The education and training of primary care providers utilizing approved medications for the treatment of alcohol use disorders and opioid dependence in a primary care setting would have important public health impact and reduce the burden of alcohol abuse and opioid dependence.

Disparities in pharmacotherapy for alcohol use disorder in the context of universal health care: a Swedish register study

“…Lower rates of pharmacotherapy for foreign‐born (compared to Swedish‐born) AUD patients may be due to a variety of factors, including lower integration with primary or specialty/psychiatric care , as well as communication challenges that may reduce the likelihood that a physician would initiate the detailed discussions that should accompany prescription of AUD pharmacotherapy . There may also be unique barriers to using AUD pharmacotherapy by foreign‐born (or other ethnic minority) patients, such as distrust of health‐care providers , and this deserves further study.…”

“…Finally, given our case definition of AUD, these findings represent patients with more severe AUD who have developed physical health problems due to prolonged heavy drinking. Future research should examine whether physical health problems are related to prescriptions for and adherence to AUD pharmacotherapies, as some medications are contraindicated for patients with severe hepatic issues (although others are not) .…”

“…In sensitivity analyses, we generated additional adjusted models, with the first using only cases with incident AUD during the study period (thus excluding all cases with an AUD registration prior to 1 July 2005), because newly diagnosed patients may have higher adherence to pharmacotherapy , and the second used only cases without co‐occurring DUD, because naltrexone is used for treatment of opioid dependence as well as AUD . Finally, we assessed associations between neighborhood deprivation and other indicators of disadvantaged social status with picking up prescriptions for each of the pharmacotherapies separately.…”

“…Pharmacotherapies and medication‐assisted therapy (combining pharmacotherapy with psychotherapy) can be an important part of the continuum of care for AUD. Several approved medications can reduce the risk of relapse .…”

Incorporating services for common mental disorders and substance use disorders for people living with HIV along the HIV treatment cascade

“…SUDs can be addressed in a health care setting with interventions, such as screening and brief interventions with recovery management to reduce harmful use, as well as by therapies such as cognitive-behavioral therapy (CBT)/ motivational enhancement therapy (MET), or through pharmacotherapy and medical management [46][47][48][49][50][51][52]. For people living with HIV with opioid dependence, treatment with medication assisted treatment (MAT) in HIV primary care improves the HIV-related outcomes of mortality, quality of life, retention in care, and antiretroviral treatment adherence [53].…”