February 9, 2021, 8:10 am Michael Devitt — With the number of opioid-related drug overdose deaths increasing, and with the COVID-19 pandemic continuing to disrupt the lives of millions of Americans, it’s essential that family physicians have the resources needed to care for patients with conditions such as opioid use disorder. Toward that end the Academy, through an unrestricted grant from Indivior PLC, has created a new guide, Treating Opioid Use Disorder as a Chronic Condition: A Practice Manual for Family Physicians, available for free download to all AAFP members.
“This manual we hope will provide basic information and access to further reading and resources to increase physician comfort level in treating this disease,” said Susan McDowell, M.D., a faculty physician and substance use educator at the Mountain Area Health Education Center Family Medicine Residency at Asheville, N.C., and part of the team that provided content and edited the manual.
“My hope is folks will read this and realize that OUD is a treatable disease within the realm of family practice,” McDowell added. “Treating OUD has been one of the most rewarding parts of my career thus far and it is unfortunate there are so many barriers, misconceptions and stigma around treatment for this community of people who desperately need medical care.”
The manual’s publication comes in the wake of considerable evidence that suggests the COVID-19 pandemic has had an adverse effect on opioid use in the United States. Provisional data from the CDC released in December 2020, for example, showed that while the number of drug overdose deaths increased 18.2% between June 2019 and May 2020, the largest increase occurred from March 2020 to May 2020 — a time that aligned with the implementation of most COVID-19 mitigation practices throughout the country. The CDC, in a Health Alert Network advisory issued Dec. 17, 2020, also listed synthetic opioids as the primary factor for the increase in drug overdose deaths during that time.
Treating Opioid Use Disorder as a Chronic Condition is divided into five main sections, each of which covers an aspect of OUD.
Screening for OUD discusses approaches and validated screening tools clinicians can use to identify patients in need of treatment, along with recommendations on the type of language to use when talking with patients about OUD and ways to address stigma and health disparities.
Diagnostic Criteria and Assessment gives a brief overview of the Diagnostic and Statistical Manual of Mental Disorders (5th ed.) criteria and classification of OUD.
Treating OUD offers detailed assessments of methadone, buprenorphine and naltrexone, including a lengthy table that compares the dosage, adverse effects, contraindications and other pertinent information for each drug. The section also provides guidance on the treatment of patients who are pregnant and/or breastfeeding, followup care, unexpected return to opioid use and behavioral health interventions.
Preparing Your Practice discusses the requirements clinicians need to obtain a medication-assisted treatment waiver from the Substance Abuse and Mental Health Services Administration, along with guidance on how to determine what services to offer and how to manage workflow to successfully integrate OUD screening and/or treatment into practice.
Payment and Coding features tables containing OUD-related ICD-10 and CPT codes to improve efficiency and ensure that practices are properly reimbursed for their services.
The manual also features links to more than 40 resources on opioid use laws, OUD treatment, implementing treatment into practice, use of electronic visits and other topics, and references to more than 50 scientific reports, position papers and policy statements.
McDowell, whose practice combines patient care with education and community outreach around substance use disorders, told AAFP News that she hopes the information in the manual will help to standardize the treatment of OUD.
“I have learned from the other authors and the staff at the AAFP as we worked on creating this manual,” she said. “It was nice to get perspectives from others across the country on how they treat OUD.”
McDowell added that the manual brings together many of the Academy’s resources on the topic and serves as an excellent “one-stop shop” for FPs looking for something that’s easily accessible and usable.
Asked if there was one item that FPs could take from the manual and find useful, McDowell replied that clinicians should understand that OUD “is a medical disease with evidenced-based treatment options that work and that can be prescribed by family physicians.”
McDowell often encounters patients with OUD in her practice. In those instances, she said that approaching OUD like any other illness and letting patients know that the illness is not who they are can be helpful.
“The most effective way to communicate with a patient is to be open and inquisitive without being judgmental,” said McDowell. “This can sometimes feel a bit foreign the first few times as you ask folks about their use history but it will quickly become more routine. Patients will appreciate you giving them a safe space to share their story without feeling judged.”
It’s also important, McDowell said, to address issues such as stigma and bias.
“It has been my experience that people who use drugs often have a lot of shame around their disease and have sometimes not had great interactions with the medical community,” McDowell said. “We as family physicians can change this by doing what we do best: meeting the patient where they are and providing a safe space. I feel lucky to have a job where every day I have the privilege to listen, truly hear patients’ stories, and use my training and knowledge to make their lives more healthy and fulfilled.”
The OUD practice manual is just one part of a wealth of Academy resources available on the topic. Others include