Principles of Integrating Opioid Use Disorder Treatment in Primary Care

Integration of opioid use disorder (OUD) treatment in primary care is crucial for expanding access to care. The availability of medications for OUD – in particular, buprenorphine – is the starting point for OUD treatment. Multidisciplinary treatment teams that consist of waivered primary care providers and care coordinators are common to integration. Initial assessments are anchored in confirming a diagnosis of OUD, determining patient readiness and goals for treatment, and planning for the care of comorbid conditions. Polysubstance use is not a contraindication to OUD treatment in primary care. Sublingual buprenorphine, the most widely used medication for OUD in primary care, can be safely initiated in patients using unobserved treatment initiation strategies. Maintaining patients in OUD treatment entails modifying or intensifying treatment according to patient needs. Additional psychosocial counseling beyond the scope of primary care–based OUD treatment should be offered but not required. Finally, a patient-centered approach to utilizing toxicology tests and addressing diversion is essential to integrating OUD treatment in primary care.