Refer, then follow up
Both studies’ findings are not surprising, Dr. Peter D. Friedmann said in an interview.
"Drugs are much more reinforcing than alcohol or tobacco, and so are their effects on behavior," said Dr. Friedmann, an internist at the Providence (R.I.) Veterans Affairs Medical Center. "This makes it much more difficult to extinguish drug use and its associated behaviors; that needs much more than just a brief counseling intervention."
Patients struggling with substance abuse need – and deserve – more than such a brief addressing of their problem, said Dr. Friedmann, also professor of health services, policy, and practice at Brown University, also in Providence. Medical treatment is a good first step and feasible for a primary care physician to administer in the office. Unfortunately, such treatment is only available for opiate misuse.
Extensive counseling, however, is beyond the purview of these doctors, he said, so expert referral with follow-up is a must.
"But we can’t simply refer and say, ‘Come back to me in 2 or 3 months, and we’ll see where you are.’ If we refer someone to a cardiologist, we follow up, we make sure the patient got there, and we expect a note back from the cardiologist," Dr. Friedmann said. "That doesn’t happen with drug referrals."
Dr. Friedmann acknowledged that there is scant literature supporting this kind of primary care. But that doesn’t mean it’s not helpful, or that it shouldn’t be done, he said.
"We do a lot of things in medicine for which there is no randomized, controlled evidence of effect. We do it because it’s our professional duty," he explained. "If we are confronted with someone who is struggling with this problem, even if it’s hard to find the evidence, it is part of our obligation to help."
The National Institute on Drug Abuse sponsored Dr. Roy-Byrne’s study. He had no financial disclosures, although several of his coauthors reported relationships with pharmaceutical companies. NIDA also supported Dr. Saitz’s study; he had no relevant disclosures.
Dr. Friedmann disclosed that he has received research support (medication only) from Alkermes and has been a speaker for Orexo.
On Twitter @alz_gal