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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 reduce non-medical opioid use and overdose deaths from opioids, as well as increase retention in treatment, by 50-70%.4

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Treatment of OUD

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

 

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

 

Integrating SUD Treatment in Primary Care

Practical Applications for Integrating SUD

 

Practical Applications for Integrating SUD

 

Practical Applications for Integrating SUD

SBIRT

 

SBIRT

 

SBIRT

SUD and the Growing Hepatitis C Virus Epidemic

 

SUD and the Growing Hepatitis C Virus Epidemic

SUD and the Growing Hepatitis C Virus Epidemic

 

     The full curriculum will be released in the coming months.

 
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, 2001-2015Drug and Alcohol Dependence162, 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 disorderAmerican Journal of Drug and Alcohol Abuse45(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 StatesAmerican Journal of Drug and Alcohol Abuse46(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 examplesNAM 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 disorderAddiction Science and Clinical Practice16(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.

[12]  DeFlavio et al. (2015).

[13]  Wakeman et al. (2018).