Street drugs

August 2010

FocusStreet drugs

Opioid dependence

Management in general practice

Volume 39, No.8, August 2010 Pages 548-552

Matthew Frei

Background

Addiction to opioids, or opioid dependence, encompasses the biopsychosocial dysfunction seen in illicit heroin injectors, as well as aberrant behaviours in patients prescribed opioids for chronic nonmalignant pain.

Objective/s

To outline the management of opioid dependence using opioid pharmacotherapy as part of a comprehensive chronic illness management strategy.

Discussion

The same principles and skills general practitioners employ in chronic illness management underpin the care of patients with opioid dependence. Opioid pharmacotherapy, with the substitution medications methadone and buprenorphine, is an effective management of opioid dependence. Training and regulatory requirements for prescribing opioid pharmacotherapies vary between jurisdictions, but this treatment should be within the scope of most Australian GPs.

Doctors have managed addiction to opioids with substitution medications since the 1960s,1 and currently around 41 000 Australians are part of opioid pharmacotherapy programs.2 The primary care sector is an integral part of the treatment of alcohol and other drug disorders, including opioid dependence. While the numbers of heroin dependent Australians may have fallen since the estimated 74 000 at the end of the last century,3 an increase in amounts of opioids prescribed for persisting pain disorders4 means the recognition and management of opioid dependence should be an essential skill for general practitioners.

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Correspondence afp@racgp.org.au

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