More than 27 million Americans currently use illicit drugs (including nonmedical use of prescription drugs), and seven million of them meet the criteria for a substance use disorder. Of those, 1.9 million people have disorders related to non-medical use of prescription pain relievers. The human and economic toll of illicit drug use is substantial and rising; in particular, rates of fatal overdoses involving opioids have tripled and fatal overdoses involving sedatives have quintupled since 1999. Despite increasingly effective treatments, only about 10%-20% receive any treatment, a shortfall that reflects patient, health system, financial, and regulatory barriers. But an overarching reason for the continuing failure to address this outsize need is the longstanding separation between care for substance use disorders and the rest of the health care system. Primary care physicians (PCPs) and other primary care providers are on the front lines of the health care system and of the opioid epidemic. They provide first-line therapies for chronic pain, and account for 50% of all prescription opioids dispensed. The Centers for Disease Control and Prevention (CDC) recently targeted new opioid prescribing guidelines to PCPs, recognizing their central role in managing chronic pain. Despite a growing consensus about the need to address illicit drug use disorders in primary care, few PCPs do so today. This issue brief discusses the role of primary care teams in identifying illicit drug use disorders in their patients, the continuum of treatments that they can offer, and opportunities for successful collaboration and integration with specialists.
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