RT Journal Article SR Electronic T1 Opioid use disorder in primary care JF Canadian Family Physician JO Can Fam Physician FD The College of Family Physicians of Canada SP e194 OP e206 VO 65 IS 5 A1 Christina Korownyk A1 Danielle Perry A1 Joey Ton A1 Michael R. Kolber A1 Scott Garrison A1 Betsy Thomas A1 G. Michael Allan A1 Nicolas Dugré A1 Caitlin R. Finley A1 Rhonda Ting A1 Peter (Ran) Yang A1 Ben Vandermeer A1 Adrienne J. Lindblad YR 2019 UL http://www.cfp.ca/content/65/5/e194.abstract AB Objective To summarize the best available evidence regarding various topics related to primary care management of opioid use disorder (OUD).Data sources MEDLINE, Cochrane Library, Google, and the references of included studies and relevant guidelines.Study selection Published systematic reviews and newer randomized controlled trials from the past 5 to 10 years that investigated patient-oriented outcomes related to managing OUD in primary care, diagnosis, pharmacotherapies (including buprenorphine, methadone, and naltrexone), tapering strategies, psychosocial interventions, prescribing practices, and management of comorbidities.Synthesis From 8626 articles, 39 systematic reviews and an additional 26 randomized controlled trials were included. New meta-analyses were performed where possible. One cohort study suggests 1 case-finding tool might be reasonable to assist with diagnosis (positive likelihood ratio of 10.3). Meta-analysis demonstrated that retention in treatment improves when buprenorphine or methadone are used (64% to 73% vs 22% to 39% for control), when OUD is treated in primary care (86% vs 67% in specialty care, risk ratio [RR] of 1.25, 95% CI 1.07 to 1.47), and when counseling is added to pharmacotherapy (74% vs 62% for controls, RR = 1.20, 95% CI 1.06 to 1.36). Retention was also improved with naltrexone (33% vs 25% for controls, RR = 1.35, 95% CI 1.11 to 1.64) and reduced with medication-related contingency management (eg, loss of take-home doses as a punitive measure; 68% vs 77% for no contingency, RR = 0.86, 95% CI 0.76 to 0.99).Conclusion There is reasonable evidence that patients with OUD should be managed in the primary care setting. Diagnostic criteria for OUD remain elusive, with 1 reasonable case-finding tool. Methadone and buprenorphine improve treatment retention, while medication-related contingency methods could worsen retention. Counseling is beneficial when added to pharmacotherapy.