Primary Care versus Specialty Care Management of Opioid Use Disorder

• Author / Creator

  Perry, Danielle Alyssa

• With the rise of opioid use over the past several decades, both medicinal and recreational, the incidence of opioid use disorder has also increased. Opioid use disorder, previously described as “opioid abuse or dependence” in the DSM IV, can lead to loss of family, employment or life. While first-line pharmacotherapy management of opioid use disorder has been well described in guidelines with initiation of long-acting opioid agonists, the optimal setting of treatment has not been well defined. Traditionally, patients living with opioid use disorder have been treated in specialty care centers, settings equipped specifically for those living with opioid or other drug dependence. However, the possibility of treatment in a primary care setting has not been thoroughly explored.
  The objective of this research was to identify if treatment of opioid use disorder in primary care was equivalent or superior to treatment in a designated specialty care setting. A systematic review was conducted in order to identify randomized controlled trials that compared these two treatment settings. Seven relevant databases were searched and after dual title/abstract and full-text review, studies were included if they enrolled patients with opioid use disorder and compared opioid agonist therapy in a primary care and specialty care setting. Six trials of 493 patients conducted in two countries met inclusion criteria. Meta-analyses were conducted on our two primary outcomes: opioid abstinence and treatment retention. The proportion of opioid-abstinent patients was significantly higher in primary care (55%) compared to patients in specialty care (34%; p=0.04). Rates of retention were not statistically significant between groups, although trended in favour of primary care (80% versus 63%; p=0.08). Individual studies found higher patient satisfaction more often in primary care (77%) than in specialty care (38%) with 70% of patients reporting preference for treatment in primary care settings (21% specialty care, 9% no preference).
  In conclusion, I found a significant improvement in opioid abstinence for patients being treated in primary care with more patients reporting higher satisfaction and preference for primary care settings. Three of the six included trials enrolled patients who were previously stabilized on opioid agonist therapy in specialty care, and therefore compared treatment maintenance in patients with opioid use disorder during the study period. Regardless of this possible bias favouring specialty care, a non-statistical trend towards benefit in treatment retention in primary care was found. These results suggest that with proper training and support, primary care is equipped to manage patients with opioid use disorder. Future research in this area should focus on patients with opioid use disorder who are less stabilized and include primary care settings more similar to those in Canada.

• Subjects / Keywords

  • opioids
  • primary care
  • family physicians
  • opioid dependence
  • opioid use disorder

• Graduation date

  Spring 2021

• Type of Item

  Thesis

• Degree

  Master of Science

• DOI

  https://doi.org/10.7939/r3-f0rq-s887

• License

  This thesis is made available by the University of Alberta Libraries with permission of the copyright owner solely for non-commercial purposes. This thesis, or any portion thereof, may not otherwise be copied or reproduced without the written consent of the copyright owner, except to the extent permitted by Canadian copyright law.