SAFE GC Coalition: Substance Use Prevention in Primary Care

According to the National Institute on Drug Abuse (NIDA), the opioid epidemic continues with nearly 110,000 people dying from drug overdoses last year alone. Effective treatments for opioid and other drug use disorders are available but growing numbers of people are dying from fentanyl even in the absence of a substance use disorder—for instance, young people overdosing on fentanyl-contaminated counterfeit pills. In such a diverse drug landscape, treatment, while crucial, is insufficient to address the overdose crisis. Increased focus on prevention of drug experimentation and escalation of drug use to addiction are fundamental to avert these kinds of tragic outcomes.

Recent research has identified primary care practices as an underutilized setting for substance use prevention, where providers can deliver brief prevention interventions and referral to other prevention or treatment services as indicated. However, there can be challenges in these settings, including provider stigma, staff that may already be overworked and lack the knowledge to screen or intervene effectively, and the reality that most prevention interventions are not currently reimbursed by medical insurance.

Since addiction risk is highest with earlier substance initiation, youth have long been a key focus of substance use prevention, but interventions are typically implemented in school and family settings, not in pediatricians’ offices. However, a precedent for extremely effective primary-care-based prevention in this age group—indeed, one of the greatest success stories in medicine—is routine vaccination. Building on their success delivering human papillomavirus vaccination to 9- to 12-year-olds during the COVID pandemic, a team of pediatricians affiliated with the Yale Schools of Medicine and Public Health and Fair Haven Community Health Care won a prize for a project aimed at making personalized substance use prevention interventions in their large pediatric clinic as “Easy as Vaccination!”. Their project will harness the power of electronic health records, machine learning, team-based care, and the existing workflow in their practice to screen and connect primary care patients to evidence-based universal and selective substance use prevention interventions, depending on individual patients’ identified needs and risk factors.

Depression, anxiety, and ADHD are risk factors for substance use in adolescence. Another team of pediatricians associated with the University of Vermont and HealthCentric Advisors implemented a project that uses quarterly follow-up visits for management of these mental health diagnoses to screen for substance use and deliver brief prevention interventions. Based on evidence supporting drug-refusal skills training in this age group, as well as the value of peer-led intervention, the team’s prevention approach uses brief video modules on avoiding substance use, made by local peers.

It is important to make screening and prevention reimbursable as well as easy to implement utilizing existing technology and workflows. A lack of existing prevention services and workforce capacity is a major challenge. NIDA researchers maintain to make headway reducing the burden of substance use and its consequences, such as overdose, greater collaboration must be fostered between prevention researchers and the healthcare providers.

The National Institute on Drug Abuse (NIDA) is a component of the National Institutes of Health, U.S. Department of Health and Human Services. NIDA supports most of the world’s research on the health aspects of drug use and addiction. The Institute carries out a large variety of programs to inform policy, improve practice, and advance addiction science. For more information about NIDA and its programs, visit www.nida.nih.gov.

SAFE is the only alcohol and substance use prevention agency in the City of Glen Cove. Its Coalition is conducting an opioid prevention awareness campaign entitled. “Keeping Glen Cove SAFE,” to educate and update the community regarding opioid use and its consequences. To learn more about the SAFE Glen Cove Coalition please follow us on www.facebook.com/safeglencovecoalition or visit SAFE’s website to learn more about the Opioid Epidemic at www.safeglencove.org.