Substance-related and addictive disorders are chronic relapsing conditions that substantially impact public health. Effective treatments for these disorders require addressing substance use/dependence comprehensively as well as other associated comorbidities. Comprehensive addressing of substance use in a medical setting involves screening for substance use, addressing substance use directly with the patient, and formulating an appropriate intervention. For alcohol dependence and opioid dependence, pharmacotherapies are available that are safe and effective when utilized in a comprehensive treatment paradigm, such as medication assisted treatment. In primary care, substance use disorders involving alcohol, illicit opioids, and prescription opioid abuse are common among patients who seek primary care services. Primary care providers report low levels of preparedness and confidence in identifying substance-related and addictive disorders and providing appropriate care and treatment. However, new models of service delivery in primary care for individuals with substance-related and addictive disorders are being developed to promote screening, care and treatment, and relapse prevention. The education and training of primary care providers utilizing approved medications for the treatment of alcohol use disorders and opioid dependence in a primary care setting would have important public health impact and reduce the burden of alcohol abuse and opioid dependence.
Substance-related and addictive disorders are chronic conditions estimated to occur in one in five patients in primary care [1, 2]. Primary care is an important entry point for all patients suffering from chronic conditions. Primary care health providers are the best positioned to address substance-related and addictive disorders in a comprehensive manner encompassing screening, prevention, diagnosis, disease management, and relapse prevention [3, 4]. However, currently in primary care, there is poor adoption of pharmacotherapies that have demonstrated effectiveness for alcohol use disorders [5, 6]. In addition, there is a national public health crisis related to opioid misuse and abuse that has a high impact on the health care system that requires primary health care providers to assume an even greater important role in providing evidence-based effective prevention, care, and treatment .
At present, primary care patients who are in need of treatment and willing to access treatment are referred to specialty care providers via a process which can seem obscure with barriers and challenges to patient care coordination and follow-up. In this referral system, the patient is often lost in the gap between primary care and specialty treatment systems and fails to engage in care and treatment successfully. Opioid-dependent patients who require and choose pharmacotherapy treatment, such as medication assisted treatment, may find that treatment capacity in their community is inadequate, effectively denying them assess [8, 9]. Consequently patients may undergo detoxification and not enter managed chronic care or may experience a period of psychosocially based treatment after which relapse to substance use is common or, alternatively, fail to be retained in chronic care and treatment due to the unmet need for medication.