Treatment of Opioid Use Disorder in Primary Care: A Practical Solution to an Urgent Need
UR Medicine Recovery Center of Excellence has developed comprehensive training on the treatment of opioid use disorder (OUD) in primary care to prepare providers and staff to deliver evidence-based care to patients.
OUD is a chronic disease that affects the structure and function of the brain.1 Provisional data from the CDC indicate there were 75,673 overdose deaths from opioids in a 12-month period ending in April 2021.2 Heroin use can reduce lifespan by decades.3 With the right treatment, however, the outlook can improve substantially. Evidence-based medications for opioid use disorder (MOUD), such as buprenorphine, can increase retention in treatment, reduce non-medical drug use, and reduce overdose deaths from opioids by 50-70%.4
Buprenorphine prevents opioid withdrawal and blocks opioid euphoria. In primary care settings, it can reduce medical morbidity associated with OUD, improve treatment outcomes, and lower the overall cost of care.5 As a 2018 New England Journal of Medicine article, “Primary Care and the Opioid Crisis—Myths and Realities,” states: “To have any hope of stemming the overdose tide, we have to make it easier to obtain buprenorphine than to get heroin and fentanyl.”6
More than 80% of those with OUD have not received MOUD treatment in the last year or more, despite evidence of its efficacy.7 In rural communities this gap is even greater, attributable to a limited number of providers of buprenorphine and other MOUD,8 long travel times to providers, stigma, and lack of anonymity in small, rural communities that can all present barriers to treatment.9 Rural communities also face barriers to evidence-based provision of MOUD that are observed more generally, for example challenges in disseminating evidence-based decision tools in real-world practices.10 Nonetheless, these barriers are not insurmountable if addressed strategically and collaboratively among rural partners.11 Most rural physicians regularly see patients who have OUD and believe that, as their physician, they should be offering them treatment.12 Indeed, primary care practices in rural communities are well positioned to offer office-based buprenorphine treatment.13
Making MOUD available through primary care offices in rural communities removes the hardship of travel distance for patients. It can help address health inequity and provide a measure of privacy to reduce the stigma that can inhibit patients from visiting behavioral health facilities. Patients being treated in primary care offices are generally stable and in well-established recovery, and they are prescribed buprenorphine as a long-term medication for a chronic disease. If the need arises for more intensive treatment, the primary care provider can refer the patient back to a treatment program.
To help primary care offices prepare to provide MOUD, we have developed comprehensive training that carries continuing education credits. It has been developed through a pilot program in the Appalachian region of New York State and includes some details specific to that region. The bulk of the content, however, applies to the work of primary care practices throughout the U.S.
Preview of Introductory Presentation: Overview of Substance Use Disorder and Primary Care-Based MOUD
Welcome everyone I'm Michele Lawrence
the co-principal investigator at the
Recovery Center of Excellence at the
University of Rochester
and today we're going to be talking a
little bit about the treatment of opioid
use disorder in primary care this is a
general overview of substance use
disorder
I'm going to turn it over to my
colleague Holly Russell
to
provide the first part of this talk
Thank you Michele
I'm Dr. Holly Russell I am a family
doctor and I'm an Assistant Professor of
Family Medicine at the Department of
Family Medicine at the University of
Rochester
and part of the Recovery Center of
Excellence team
Today we're going to be talking to you
about the basics of treating opioid use
disorder and primary care
Our objectives are
to review approaching opioid use
disorder as a chronic disease
to review the evidence-based treatments
for opioid use disorder
to outline a strategy to improve access
to pharmacotherapy for opioid use
disorder
to gain insight on how to overcome some
barriers in treating opioid use disorder
in primary care
we'll provide you with some information
on local treatment programs and the
referral process
we'll go over the levels of care and
treatment for substance use disorder
and hopefully will help you understand a
little more the role of peers in
treating opioid use disorder and
recovery process
Training Topics:
These educational modules are available at no cost and carry continuing education credits. To receive credit, please register on the module site within the links below in the "Credit" column. Modules can also be viewed on this site without continuing education credit.
Prior to starting this education series, please complete the following pre-test survey:
https://redcap.urmc.rochester.edu/redcap/surveys/?s=3A8RRKR7M4
|
Training title |
CEL credit |
Non-CEL credit |
|
Overview of Substance Use Disorder and Primary Care-Based MOUD
|
Overview of Substance Use Disorder and Primary Care-Based MOUD
|
Overview of Substance Use Disorder and Primary Care-Based MOUD |
|
Integrating SUD Treatment in Primary Care
|
Integrating SUD Treatment in Primary Care
|
|
|
Practical Applications for Integrating SUD
|
Practical Applications for Integrating SUD
|
|
|
SBIRT
|
|
|
|
SUD and the Growing Hepatitis C Virus Epidemic
|
||
|
Stimulants: The Next Wave of SUD |
||
|
Pregnancy and Reproductive Care for Patients with SUD |
||
|
Alcohol Use Disorder |
||
|
Synthetic Opioids: Navigating a Changing Landscape in the Treatment of Opioid Use Disorder |
Synthetic Opioids: Navigating a Changing Landscape in the Treatment of Opioid Use Disorder |
Synthetic Opioids: Navigating a Changing Landscape in the Treatment of Opioid Use Disorder |
References
[1] National Academies of Sciences, Engineering, and Medicine. (2019). Medications for opioid use disorder save lives. National Academies Press, p. 2.
[2] Centers for Disease Control and Prevention. (2021, November 17). Drug overdose deaths top 100,000 annually [Press release].
[3] Darke, S., Marel, C., Mills, K. L., Ross, J., Slade, T., & Tessson, M. (2016). Years of potential life lost amongst heroin users in the Australian Treatment Outcome Study cohort, 2001-2015. Drug and Alcohol Dependence, 162, 206-210.
[4] Winograd, R. P., Presnall, N., Stringfellow, E., Wood, C., Horn, P., Duello, A., Green, L., & Rudder, T. (2019). The case for a medication first approach to the treatment of opioid use disorder. American Journal of Drug and Alcohol Abuse, 45(4), 333-340.
[5] Deflavio, J., Rolin, S. A., Nordstrom, B. R., & Kazal, L. A. (2015). Analysis of barriers to adoption of buprenorphine maintenance therapy by family physicians. Rural and Remote Health, 15(1), 3019.
[6] Wakeman, S. E., & Barnett, M. L. (2018). Primary Care and the Opioid-Overdose Crisis — Buprenorphine Myths and Realities. New England Journal of Medicine, 379(1), 1-4.
[7] Saloner, B., & Karthikeyan, S. (2015). Changes in substance abuse treatment use among individuals with opioid use disorders in the United States, 2004-2013. JAMA, 314(14), 1515–1517; Substance Abuse and Mental Health Services Administration. (2020). Key substance use and mental health indicators in the United States: Results from the 2019 National Survey on Drug Use and Health. Center for Behavioral Health Statistics and Quality, p. 55.
[8] Lister, J. J., Weaver, A., Ellis, J. D., Himle, J. A., & Ledgerwood, D. M. (2020). A systematic review of rural-specific barriers to medication treatment for opioid use disorder in the United States. American Journal of Drug and Alcohol Abuse, 46(3), 273–288.
[9] Blanco, C., Ali, M.M., Beswick, A., Drexler, K. Hoffman, C., Jones, C.M., Wiley, T.R.A., & Coukell, A. (2020). The American opioid epidemic in special populations: Five examples. NAM Perspectives. Discussion Paper, National Academy of Medicine, pp. 5-6.
[10] Rossom, Sperl-Hillen, J. M., O’Connor, P. J., Crain, A. L., Nightingale, L., Pylkas, A., Huntley, K. V., & Bart, G. (2021). A pilot study of the functionality and clinician acceptance of a clinical decision support tool to improve primary care of opioid use disorder. Addiction Science and Clinical Practice, 16(1), 1-37.
[11] Health Resources and Services Administration (HRSA). (2019). A guide for rural health care collaboration. U.S. Department of Health and Human Services, 2019.