Chair's Message – Opioid Use Disorder and Hepatitis C
Whenever a gap in clinical services is identified, it is often family physicians who come forward to fill that gap. Two treatment areas that are currently receiving increasing attention from Family Medicine are Opioid Use Disorder and Chronic Hepatitis C management.
There is no doubt we are in the midst of an opioid use epidemic with increasing morbidity and mortality. Outpatient treatment of Opioid Use Disorder with Buprenorphine is becoming more common in Family Medicine, and with good reason. It is a treatment that can be easily learned, and does not require a special licence. A recent article in Canadian Family Position documents evidence of effective treatment of Opioid Use Disorder by primary care practitioners with adequate clinical support and training.1 Patients treated for Opioid Use Disorder in primary care were more likely to be retained in treatment programs, reach abstinence from street opioids, and be more satisfied with their care in a primary care practice setting. Continuity of care with family physicians increases the likelihood of success with treatment. Rather than avoiding the management of this condition, family physicians should take advantage of pain and addiction mentorship programs and online training to become more comfortable with managing Opioid use Disorder in their own practices.
Chronic Hepatitis C infection is a tremendous burden on our healthcare system because of its prevalence and its progressive nature. This disorder is often first identified by family physicians who then refer for specialist care. Despite referral many people never receive treatment for a variety of reasons, including complex and difficult treatment regimens. Increasingly these people need to be monitored in Family Medicine.
While the monitoring can be complex, there are tools and flowsheets available to assist and guide decision-making.2 Counseling patients about their options and preventive care guidelines is often better received from their own family physician. Close contact with their primary care provider may lead to more patients receiving treatment. Treatment of Hepatitis C is now much more effective and is accomplished with oral medication, targeted at the virus infection directly, with much better cure rates of over 90 per cent. It is becoming more feasible for monitoring and treatment of Hepatitis C to take place in primary care.
Practice is constantly changing and Family Medicine needs to keep up its history and tradition of adaptability, and being there for our patients whenever we can.
As always I welcome your feedback and questions at swetmore@uwo.ca or via Twitter @DOCSJW.
1 Perry D, Orrantia E, Garrison S. Treating opioid use disorder in primary care. Can Fam Physician 2019; 65: 117.
2 von Aesch Z, Steele LS, Shah H. Primary care flowsheet for Hepatitis C virus. Can Fam Physician 2016; 62: e384-92.
