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Reducing the Health Consequences of Opioid Addiction in Primary Care

      Abstract

      Addiction to prescription opioids is prevalent in primary care settings. Increasing prescription opioid use is largely responsible for a parallel increase in overdose nationally. Many patients most at risk for addiction and overdose come into regular contact with primary care providers. Lack of routine addiction screening results in missed treatment opportunities in this setting. We reviewed the literature on screening and brief interventions for addictive disorders in primary care settings, focusing on opioid addiction. Screening and brief interventions can improve health outcomes for chronic illnesses including diabetes, hypertension, and asthma. Similarly, through the use of screening and brief interventions, patients with addiction can achieve improved health outcome. A spectrum of low-threshold care options can reduce the negative health consequences among individuals with opioid addiction. Screening in primary care coupled with short interventions, including motivational interviewing, syringe distribution, naloxone prescription for overdose prevention, and buprenorphine treatment are effective ways to manage addiction and its associated risks and improve health outcomes for individuals with opioid addiction.

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      Linked Article

      • Screening and Brief Intervention for Opioid Addiction in Primary Care Is Not Evidence Based
        The American Journal of MedicineVol. 126Issue 11
        • Preview
          Bowman et al1 assert that brief intervention in patients identified by screening in primary care will have efficacy. They also recommend annual screening and motivational interviewing. They conclude that “screening all patients … is critical.”1 No data support these assertions and recommendations.
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      • Comments on Reducing the Health Consequences of Opioid Addiction
        The American Journal of MedicineVol. 126Issue 11
        • Preview
          No discussion of overdose deaths caused by opioids1 would be complete without pointing out the exceptional risk posed by methadone. The Centers for Disease Control and Prevention notes that “while methadone accounts for only 2 percent of painkiller prescriptions in the United States, it is involved in more than 30 percent of prescription painkiller overdose deaths” and that “six times as many people died of methadone overdoses in 2009 as died in 1999.”2 It appears that any effort to slow the rising number of opioid overdose deaths will require special attention to reducing the risk posed by methadone.
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