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The antidote to the opioid use disorder epidemic is the thoughtful use of evidence-based medicine and an honest understanding of what we know—and what we don't know—about caring for people with substance use disorders.
Family physicians are positioned to diagnose and treat opioid use disorder, a chronic relapsing condition that is highly prevalent and can be fatal. Patients are more likely to enter full recovery after receiving medication-assisted treatment. Methadone, buprenorphine, and naltrexone are opioid agonists and antagonists that can help treat opioid use disorder. Discontinuation of pharmacotherapy increases the risk of relapse; patients should be encouraged to continue treatment as long as necessary.
The types of substances being used by adolescents have changed, with a decrease in alcohol and increase in marijuana and opiod use. Primary care physicians can help adolescents who use illicit substances by applying several available screening tools. A split-visit model encourages confidentiality between the adolescent and the physician while still involving parents in the clinical visit. Evidence-based treatments include interventions and medication-assisted treatment. Motivational interviewing is useful in addressing substance use in this group of patients.
Lofexidine has been shown to be as effective as clonidine at controlling some of the symptoms of withdrawal from opioid use. It may have a small additional benefit for maintaining abstinence in patients switched to buprenorphine or methadone for long-term maintenance.
More than 750,000 persons in the United States inject drugs, a number that is increasing sharply because of the opioid epidemic. Nonjudgmental inquiries about current drug use can uncover information about readiness for addiction treatment and identify modifiable risk factors for complications of drug use. Preventive care such as infectious disease screening and treatment, vaccinations, and harm reduction interventions can reduce morbidity and mortality in persons who inject drugs.
Urine drug testing is an essential component of monitoring patients who are receiving long-term opioid therapy, and it has been suggested for patients receiving long-term benzodiazepine or stimulant therapy. Find out how often to screen patients, how to choose the correct test, and what to consider when a patient has an unexpected result.
Approximately 10% of the U.S. population 12 years and older reported using illicit substances in 2015. This article reviews the clinical effects and treatment of persons who use cocaine, methamphetamines, 3,4-methylenedioxymethamphetamine (MDMA), synthetic cannabinoids, and synthetic cathinones (“bath salts”).
Physicians are increasingly likely to be asked by adolescents or their parents whether recreational marijuana use is safe. Although many adults view marijuana as benign, there are major concerns about its use in adolescents because all illicit drug use, including marijuana, may have negative consequences.
Injectable extended-release naltrexone administered every four weeks is similar in efficacy to daily oral buprenorphine/naloxone for the treatment of opioid use disorder. Patients using extended-release naltrexone reported higher satisfaction with treatment and were more likely to recommend it to others.
Implantable buprenorphine is an expensive alternative for patients on a stable dosage of transmucosal buprenorphine. Based on current research and guidance, implantable buprenorphine should not be used as initial treatment for opioid dependence or as a substitute for medication-assisted treatments other than transmucosal buprenorphine.