Treating opioid use disorder in primary care settings is cost effective and improves medical outcomes, a clinical review from the US has concluded.
Opioid use disorder (OUD) is a common problem that contributes to morbidity and mortality worldwide, the research published by the BMJ yesterday pointed out, but it is treatable and can be effectively managed in primary care settings. The paper is part of BMJ’s State of the Art Reviews series, for which articles are predominantly written by US authors but commissioned on their relevance to academics and specialists in the US and internationally.
‘Treating OUD in primary care settings is cost effective and improves medical outcomes, particularly in patients with HIV and the hepatitis C virus (HCV),’ the ‘Treatment of opioid use disorder in primary care’ review said.
It added: ‘Treatment with pharmacotherapy [with medication] is the mainstay of OUD treatment, and evidence strongly supports its integration into primary care settings.’
Although, it added: ‘More research is needed on the role of behavioural interventions in supporting pharmacotherapy.’
Evidence is strongest for the effectiveness of the opioid agonists buprenorphine and methadone, which in randomised controlled trials were shown to decrease illicit opioid use and mortality, the review said.
It also said withdrawal management and medication tapers – slowly reducing the addictive substance over time – were found to be ineffective. They were also associated with relapse and death.
Opioids are powerful analgesics that are derived from the opium poppy plant and can be used in the treatment of acute and cancer pain. However, they have associated side effects and risks, including addiction. Nurses can help ensure these medicines are administered safely.
The authors were Megan Buresh, Robert Stern and Darius Rastegar. All associate professors at the Johns Hopkins University in Balitmore.