TY - JOUR
KW - Analgesics, Opioid/administration & dosage/adverse effects
KW - Buprenorphine/administration & dosage/adverse effects
KW - Chronic Disease/therapy
KW - Evidence-Based Medicine
KW - Female
KW - Humans
KW - Male
KW - Mass Screening/methods
KW - Methadone/administration & dosage/adverse effects
KW - Naltrexone/administration & dosage/adverse effects
KW - Narcotic Antagonists/administration & dosage/adverse effects
KW - Opiate Substitution Treatment/methods
KW - Opioid-Related Disorders/diagnosis/drug therapy
KW - Pregnancy
AU - D. Coffa
AU - H. Snyder
A1 - 
AB - Opioid use disorder is highly prevalent and can be fatal. At least 2.1 million Americans 12 years and older had opioid use disorder in 2016, and approximately 47,000 Americans died from opioid overdoses in 2017. Opioid use disorder is a chronic relapsing condition, the treatment of which falls within the scope of practice of family physicians. With appropriate medication-assisted treatment, patients are more likely to enter full recovery. Methadone and buprenorphine are opioid agonists that reduce mortality, opioid use, and HIV and hepatitis C virus transmission while increasing treatment retention. Intramuscular naltrexone is not as well studied and is harder to initiate than opioid agonists because of the need to abstain for approximately one week before the first dose. However, among those who start naltrexone, it can reduce opioid use and craving. Choosing the correct medication for a given patient depends on patient preference, local availability of opioid treatment programs, anticipated effectiveness, and adverse effects. Discontinuation of pharmacotherapy increases the risk of relapse; therefore, patients should be encouraged to continue treatment indefinitely. Many patients with opioid use disorder are treated in primary care, where effective addiction treatment can be provided. Family physicians are ideally positioned to diagnose opioid use disorder, provide evidence-based treatment with buprenorphine or naltrexone, refer patients for methadone as appropriate, and lead the response to the current opioid crisis.
AD - University of California-San Francisco, San Francisco General Hospital, San Francisco, CA, USA.; University of California-San Francisco, San Francisco General Hospital, San Francisco, CA, USA.
BT - American Family Physician
C5 - Education & Workforce; Opioids & Substance Use
CP - 7
CY - United States
IS - 7
JF - American Family Physician
LA - eng
M1 - Journal Article
N2 - Opioid use disorder is highly prevalent and can be fatal. At least 2.1 million Americans 12 years and older had opioid use disorder in 2016, and approximately 47,000 Americans died from opioid overdoses in 2017. Opioid use disorder is a chronic relapsing condition, the treatment of which falls within the scope of practice of family physicians. With appropriate medication-assisted treatment, patients are more likely to enter full recovery. Methadone and buprenorphine are opioid agonists that reduce mortality, opioid use, and HIV and hepatitis C virus transmission while increasing treatment retention. Intramuscular naltrexone is not as well studied and is harder to initiate than opioid agonists because of the need to abstain for approximately one week before the first dose. However, among those who start naltrexone, it can reduce opioid use and craving. Choosing the correct medication for a given patient depends on patient preference, local availability of opioid treatment programs, anticipated effectiveness, and adverse effects. Discontinuation of pharmacotherapy increases the risk of relapse; therefore, patients should be encouraged to continue treatment indefinitely. Many patients with opioid use disorder are treated in primary care, where effective addiction treatment can be provided. Family physicians are ideally positioned to diagnose opioid use disorder, provide evidence-based treatment with buprenorphine or naltrexone, refer patients for methadone as appropriate, and lead the response to the current opioid crisis.
PP - United States
PY - 2019
SN - 1532-0650; 0002-838X
SP - 416
EP - 425
EP - 
T1 - Opioid Use Disorder: Medical Treatment Options
T2 - American Family Physician
TI - Opioid Use Disorder: Medical Treatment Options
U1 - Education & Workforce; Opioids & Substance Use
U2 - 31573166
VL - 100
VO - 1532-0650; 0002-838X
Y1 - 2019
Y2 - Oct 1
ER -