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