Most opioid replacement prescribing takes place in primary care settings and the GP is powerfully placed to be a catalyst in the recovery journey. What if we placed prescribing at the heart of a fully recovery-oriented system of care?
SMMGP highlights the Public Health England guidance, a supplement to previous guidance, which calls on all treatment providers to continue to “re-orient their delivery of care to provide active and visible support for recovery from the point of entry to treatment, during treatment and after exit…” The document also reminds practitioners “that successful recovery also relies on support from others, including mutual aid, employment and housing services.”
The guidance is to hold strategic reviews at least every six months. In these meetings the recovery care plan is reviewed, progress measured, and gains in recovery capital quantified. Tools can be used (e.g.TOP, drug testing and independent corroboration). Although not mentioned here, GPs might also want to employ more recovery-focussed tools.
Bill White also points to a new set of care standards published by the American Society of Addiction Medicine and highlights one key phrase: “Recovery check-ups by addiction specialist physicians, just as those by primary care physicians or other providers, may promote sustained recovery and prevent relapse” (p. 13).
White lauds this small but important development in guidance:
“Imagine a day when everyone entering recovery will have an addiction-trained primary care physician and an addiction medicine specialist as sustained resources through the long-term recovery process. On that day, we will have finally escaped acute care models of medical intervention that have treated addiction like it was a broken arm or a bacterial infection. On that day, addiction recovery and addiction medicine will have come of age in America.”
And, I should say, the UK too. He finishes:
“Full and sustained recovery should be an expectation of everyone with an alcohol or other drug problem as should the expectation of sustained support of recovery from one’s personal physician.”
Previous guidance stresses the importance of joining clients up to others in recovery and of involving families, elements that many in long term recovery identify as a critical step in their process. Once more GPs are brilliantly positioned to actively link their clients to SMART Recovery, Narcotics Anonymous, Cocaine Anonymous and recovery resources in local communities. Of course, first of all they need to be aware that they are there and secondly, they need to know the importance of the connection. Lastly, they need to use evidenced methods to get their patients along to meetings and recovery resources.
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