Nuts and Bolts of Opioid Use Disorder Management in the Primary Care Setting-FREE No CME-Nuts and Bolts of Opioid Use Disorder Management in the Primary Care Setting

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Video Summary

Lecture 8 of the COMPASS Opioid Stewardship Program explains how primary care clinicians can assess and manage opioid use disorder (OUD), emphasizing buprenorphine-based treatment, harm reduction, and urine toxicology interpretation. Primary care is positioned to close the treatment access gap because clinicians have longitudinal relationships, experience managing chronic relapsing conditions, and can provide more convenient, less stigmatizing care than specialty programs—especially in rural areas. Comprehensive assessment includes full substance-use history (especially alcohol/benzodiazepines due to overdose risk), pattern/route of use, prior treatment attempts, consequences, psychiatric comorbidity and suicidality, social supports, physical exam for intoxication/withdrawal, and key labs (pregnancy test, STI/hepatitis testing, CBC, LFTs), without delaying treatment initiation. Buprenorphine’s partial agonist “ceiling effect” improves safety while reducing cravings/withdrawal and blocking other opioids. Induction differs in the fentanyl era: patients should wait longer and start lower doses to reduce precipitated withdrawal; microdosing can transition patients who can’t tolerate abstinence. Long-acting injectable buprenorphine (e.g., Sublocade, Brixadi) may help adherence/diversion concerns. Follow-up focuses on retention (often ≥1 year), counseling referral, naloxone prescribing, and avoiding discontinuation for ongoing substance use or diversion concerns. Urine testing should be collaborative, confirm unexpected immunoassay results with definitive testing, and include fentanyl and buprenorphine/metabolites due to frequent false negatives on standard panels.

Keywords

opioid use disorder (OUD)

primary care opioid stewardship

buprenorphine treatment

buprenorphine induction fentanyl era

microdosing (low-dose induction)

long-acting injectable buprenorphine (Sublocade, Brixadi)

harm reduction and naloxone prescribing

urine toxicology interpretation (fentanyl, buprenorphine metabolites)