Nuts and Bolts of Opioid Use Disorder Management in the Primary Care Setting - CME Paid Option-Lecture 8 Nuts & Bolts of OUD Recording

Video Transcription

Video Summary

In this lecture, Dr. Josh Bloom, an addiction medicine specialist, emphasizes the critical role primary care plays in assessing and managing opioid use disorder (OUD), especially through buprenorphine-based medication-assisted therapy. Primary care settings offer long-term relationships, convenience, reduced stigma, and greater access compared to specialty clinics, especially in rural areas. Comprehensive patient assessment includes detailed substance use history, co-occurring psychiatric disorders, social factors, physical exam, and lab testing (urine toxicology, pregnancy, hepatitis, CBC, LFTs). Buprenorphine, a partial opioid agonist with a ceiling effect on respiration, is highlighted as a safe and effective treatment, with induction protocols differing in the pre- and post-fentanyl eras due to fentanyl's pharmacology. Microdosing strategies allow gradual transition for patients unable to endure withdrawal. Long-acting injectable buprenorphine (Sublocade, Brixadi) improve adherence and dosing flexibility. Harm reduction is stressed: treatment continuation despite ongoing substance use, no discharge for diversion concerns, and naloxone prescribing to prevent overdose. Urine toxicology testing aids monitoring but has interpretation challenges, with false positives/negatives common and many opioids not detected on standard screens; results should prompt conversation, not punishment. Team-based care and patient-centered approaches enhance success. Overall, integrating OUD treatment into primary care with attention to assessment, medication protocols, harm reduction, and careful monitoring is key to addressing the overdose crisis.

Keywords

opioid use disorder

primary care

buprenorphine

medication-assisted therapy

harm reduction

urine toxicology

long-acting injectable buprenorphine

team-based care