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.
Highlights
Substance-related and addictive disorders are chronic conditions estimated to occur in one in five patients in primary care [1, 2]
There is a national public health crisis related to opioid misuse and abuse that has a high impact on the health care system that requires primary health care providers to assume an even greater important role in providing evidence-based effective prevention, care, and treatment [7]
Overdose prevention education and naloxone prescribing complement the strategies employed in primary health care
Summary
Substance-related and addictive disorders are chronic conditions estimated to occur in one in five patients in primary care [1, 2]. Keeping in view the high prevalence and associated morbidity and mortality of chronic drug and alcohol dependence [16], the impact of unidentified substance-related and addictive disorders on the management of comorbid conditions such as diabetes, heart disease, and liver disease [23], the natural history of substance-related and addictive disorders [4], and the availability of effective pharmacotherapies, the primary care health professional may give serious consideration to applying the same or similar screening and brief intervention strategies to all substance-related and addictive disorders It would be good clinical practice, from the point of view of efficiency and utility, to implement and maintain a screening and brief intervention process that is comprehensive addressing alcohol use disorders, and tobacco and other substances use and misuse [17]. An important consideration in this assessment is the common occurrence of fatal opioid overdose by patients in maintenance treatment on relapse to illicit opioid use [27]
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