Treating Opioid Use Disorder in General Practice — Diagnosis, Harm Reduction, and Medications

In this Double Take video from the New England Journal of Medicine and NEJM Knowledge+, L.J. Punch (the T St. Louis, a harm-reduction program), Sarah Bagley (Boston Medical Center), Jennifer Foreman (Randolph Health Medical Group), and Scott Hadland (Massachusetts General Hospital for Children) review how primary care providers can best care for patients with opioid use disorder. They guide clinicians on how to diagnose the disorder, build trust with patients, offer counseling on harm reduction, and use medications to treat addiction and withdrawal symptoms. They also emphasize the importance of reducing stigma to improve therapeutic alliances with this patient population. To learn more about the latest practices for assessing and managing acute and chronic pain, current guidelines for the appropriate use of opioids for pain management, and evidence-based strategies for recognizing and treating opioid use disorder, participate in a free NEJM Knowledge+ Pain Management and Opioids program, available at https://knowledgeplusoffers.nejm.org/oud-double-take/. For further reading on stigma reduction, review the following articles: Stigma Reduction to Combat the Addiction Crisis — Developing an Evidence Base (McGinty and Barry, in the April 2, 2020, issue), and Stigma as a Fundamental Hindrance to the United States Opioid Overdose Crisis Response (Tsai et al., in the November 26, 2019, issue of PLOS Medicine). For further reading on alternative dosing of buprenorphine and naloxone, review the following articles: Low-Dose Initiation of Buprenorphine in Hospitalized Patients on Full Agonist Opioid Therapy: A Retrospective Observational Study (Schult et al, in the November 12, 2023, issue of the Journal of Addiction Medicine), and Microinduction of Buprenorphine/Naloxone: A Review of the Literature (Ahmed et al., in the December 30, 2020, issue of the American Journal on Addictions).