Management of opioid addiction in primary care: a pragmatic approach prioritising wellbeing not ideology

Abstract

It would have been impossible to work in the substance misuse field for the past few years and have failed to notice the debate raging around ‘recovery’. Recovery in substance misuse owes much to the development of the same concept in mental health services. Anyone involved in addiction may understandably embrace it, but it’s important that the discussions and ideology around recovery don’t distract general practice from developing the full potential of a primary care based substance misuse service. Some of the key points on recovery were laid out in a BJGP editorial by Rushforth and Wright. They also stated that: ‘emphasising the concept of wellbeing rather than “cure” in the treatment of drug dependence is crucial to avoid the new centrally-driven recovery agenda being taken to mean that services should only look to support a drug-free status’ .1 The latest milestone in the debate was the report from the Recovery-Orientated Drug Treatment Group, chaired by Dr John Strang of the National Addiction Centre.2 The aim of the group was to guide the drug treatment field on the proper and optimal use of medications to aid recovery. Importantly, the report accepts the importance of opiate substitution therapy, while suggesting a framework to blend this with alternative and additional strategies. It should draw a line under the recovery debate, and primary care must look to the future. …