PT  - JOURNAL ARTICLE
AU  - Christina Korownyk
AU  - Danielle Perry
AU  - Joey Ton
AU  - Michael R. Kolber
AU  - Scott Garrison
AU  - Betsy Thomas
AU  - G. Michael Allan
AU  - Nicolas Dugré
AU  - Caitlin R. Finley
AU  - Rhonda Ting
AU  - Peter (Ran) Yang
AU  - Ben Vandermeer
AU  - Adrienne J. Lindblad
TI  - Opioid use disorder in primary care
DP  - 2019 May 01
TA  - Canadian Family Physician
PG  - e194--e206
VI  - 65
IP  - 5
4099  - http://www.cfp.ca/content/65/5/e194.short
4100  - http://www.cfp.ca/content/65/5/e194.full
SO  - Can Fam Physician2019 May 01; 65
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.