USPSTF Takes First Step to Address Opioid Use Disorder

Public Comment Sought on Draft Research Plan

January 11, 2019, 08:44 am Chris Crawford – In 2017, an estimated 2.1 million people ages 12 and older had an opioid use disorder (OUD), and opioid use was involved in nearly two-thirds of fatal drug overdoses.

That's according to the U.S. Preventive Services Task Force (USPSTF), which recently posted a draft research plan on preventing OUD that includes a focus on interventions to prevent initiation or minimize use of opioids. The task force invites the public to provide comments on the draft research plan through Jan. 16 at 8 p.m. ET.

This is the first time the USPSTF will be reviewing evidence on prevention of OUD, which is a key step in the multiyear process of issuing a recommendation statement on the topic. Once finalized, the research plan will guide that literature review, to be conducted by an independent research team that will seek input from additional topic experts and develop a draft recommendation statement based on the evidence collected and evaluated.

prescription bottle surrounded by piles of pills, syringe

The draft research plan proposes that the following key questions form the basis of that team's systematic review:

Do interventions to prevent opioid use disorder that are feasible for implementation in or referred from primary care improve patient health outcomes in persons not currently using opioids?
Do interventions to prevent opioid use disorder that are feasible for implementation in or referred from primary care prevent the initiation of unnecessary opioid use, reduce the amount of opioid use, or prevent prescription misuse in persons not currently using opioids?
What are the harms of interventions to prevent opioid use disorder that are feasible for implementation in or referred from primary care in persons not currently using opioids?

Preventing unnecessary opioid use, misuse and OUD in primary care settings -- whether due to prescription or illicit opioids -- is essential to an effective response to the national opioid misuse crisis, the task force said in a news release.

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Hear From a Family Physician Expert

The AAFP's 2019 Family Physician of the Year, Will Cooke, M.D., practices in Austin, Ind., a town of 4,500 residents that the CDC previously called "ground zero" for the worst drug-related HIV outbreak in U.S. history.

Cooke has witnessed the destruction the opioid crisis has caused firsthand and told AAFP News he is encouraged that the USPSTF plans to tackle the issue and offer evidence-based recommendations that specifically focus on preventing opioid use in the first place.

"This is a great approach because that's a point with patients we can be influential," he said. "We can find ways to help patients deal with pain without it always leading to a chronic opioid prescription."

Cooke said he felt community-based research might be most valuable in helping treat patients with OUD, especially looking at ways to help patients deal with pain that will allow them to function in their lives and afford them purpose and meaning without using opioids.

"We want to address people's pain, but we also don't want to contribute to patients becoming dependent on opioids," he said.

Cooke said such a community-based approach should start with examining the social determinants of health that may lead to individuals having substance abuse disorders.

"Social determinants of health that impact our patients' lives can look like addiction but can also appear as mental health issues or diabetes or other medical conditions that are presenting," he said. "We may be missing the deeper picture of social determinants of health that are really impacting communities."

That's where The EveryONE Project's Neighborhood Navigator can help.

Launched last summer, family physicians and their practice teams can use this interactive tool from the AAFP during patient visits to connect them to the social services in their area that can provide help with needs such as food, housing, transportation, employment, and legal or financial issues.

Cooke noted that whatever evidence-based recommendations the USPSTF releases down the road, he sees great benefit in government agencies working together to release consistent recommendations and guidelines.

"That would be more helpful to family physicians and allow us to more successfully implement these recommendations," he said.

There's More to Come

In addition to this new topic, the USPSTF is currently updating its 2008 final recommendation statement on screening for illicit drug use and nonmedical use of prescription drugs among adolescents and adults, including pregnant and postpartum women.

Cooke said he thinks it's vital to be screening for opioid use and said he's personally had success implementing the Substance Abuse and Mental Health Services Administration's evidence-based approach of Screening, Brief Intervention and Referral to Treatment (SBIRT) with his patients, using motivational interviewing for behavior change.

"It's very effective and easy to implement in a primary care office," Cooke said.

He acknowledged, however, that the "referral to treatment" piece of SBIRT can be challenging because many areas of the country still don't have adequate behavioral health and addiction treatment services available.

The EveryONE Project Introduces Neighborhood Navigator
(7/25/2018)