Department of Internal Medicine, Rhode Island Hospital, Providence, USA.
Am J Med. 2013 Jul;126(7):565-71. doi: 10.1016/j.amjmed.2012.11.031. Epub 2013 May 8.
Addiction to prescription opioids is prevalent in primary care settings. Increasing prescription opioid use is largely responsible for a parallel increase in overdose nationally. Many patients most at risk for addiction and overdose come into regular contact with primary care providers. Lack of routine addiction screening results in missed treatment opportunities in this setting. We reviewed the literature on screening and brief interventions for addictive disorders in primary care settings, focusing on opioid addiction. Screening and brief interventions can improve health outcomes for chronic illnesses including diabetes, hypertension, and asthma. Similarly, through the use of screening and brief interventions, patients with addiction can achieve improved health outcome. A spectrum of low-threshold care options can reduce the negative health consequences among individuals with opioid addiction. Screening in primary care coupled with short interventions, including motivational interviewing, syringe distribution, naloxone prescription for overdose prevention, and buprenorphine treatment are effective ways to manage addiction and its associated risks and improve health outcomes for individuals with opioid addiction.
处方阿片类药物成瘾在初级保健环境中很普遍。处方阿片类药物使用的增加在很大程度上导致了全国范围内的过量用药的平行增加。许多最容易成瘾和过量用药的患者与初级保健提供者经常接触。在这种情况下，常规成瘾筛查的缺乏导致了治疗机会的错失。我们回顾了初级保健环境中针对成瘾障碍的筛查和简短干预的文献，重点关注阿片类药物成瘾。筛查和简短干预可以改善包括糖尿病、高血压和哮喘在内的慢性疾病的健康结果。同样，通过使用筛查和简短干预，成瘾患者可以获得更好的健康结果。一系列低门槛的护理选择可以减少阿片类药物成瘾者的不良健康后果。初级保健中的筛查加上简短干预，包括动机访谈、注射器分发、纳洛酮预防过量用药处方和丁丙诺啡治疗，是管理成瘾及其相关风险并改善阿片类药物成瘾者健康结果的有效方法。
