Treating opioid addiction in primary care

This issue covers treating opioid addiction in primary care, counseling lifestyle habits to prevent cognitive dementia, and low back pain.

We've covered the opioid epidemic quite a bit over the past few years, discussing such angles as medical education, legislation, and safe prescribing. Our story in this issue highlights yet another aspect of this national emergency: outpatient treatment for opioid addiction, which experts report is available, effective, and highly underused. Staff writer Mollie Durkin outlines the currently available therapies and the training needed to prescribe them, talks to addiction medicine specialists and primary care physicians about why such efforts are so vital, and provides a list of resources for training, mentorship, and more.

Two recent reports on dementia, one from the National Academies of Sciences, Engineering and Medicine and one from the Lancet Commission on dementia, have suggested that certain strategies, if adopted early enough, can help prevent or delay onset of the condition later in life. The data to support the potential interventions vary, however, and randomized controlled trials can't ethically be done. Given those caveats, what can physicians tell patients who may ask what they can do to slow or prevent cognitive decline? Our story in this issue reviews the new recommendations and offers expert tips on counseling patients about brain health.

Low back pain, both acute and chronic, is a common plague for patients. A recent guideline from ACP recommends several nonpharmacologic treatments that may provide relief, but often patients have to adjust to realistic expectations about how much physicians can help them. Our story offers advice on treating both types of low back pain, including assessing red and yellow flags, determining when imaging and medications are warranted, and helping patients come to terms with what “better” might look like over the long term for their condition.

In diabetes news, recent research has questioned self-monitoring of blood glucose levels. Among patients with type 2 diabetes who did not use insulin, a study found that such outcomes as glycemic control, health-related quality of life, and adverse events did not differ between those who monitored their glucose levels and those who did not. Of course, glucose self-monitoring is not one-size-fits-all and remains a vital part of diabetes management, especially in patients with type 1 diabetes or those with type 2 diabetes controlled with insulin. However, some experts believe it may be time for a more individualized approach, with patient preferences and issues like cost playing a larger role. Read our story to learn more.

Do you treat opioid addiction in your practice? How often do patients ask about strategies to combat dementia? Let us know.


Jennifer Kearney-Strouse
Executive Editor