Primary Care Patient and Clinician Perspectives on Safer Use Strategies for Opioids and/or Stimulants: A Mixed-Method Study.

Abstract

Introduction: Safer use strategies (SUS) are behaviors before, during, and after drug use to moderate use and/or mitigate unwanted consequences. As treatment of substance use disorders becomes more common in primary care, offering SUS in primary care merits exploration.

Method: We explored acceptability and use of SUS in primary care using a convergent parallel mixed-method design consisting of patient and clinician semi-structured interviews and surveys. Participants were recruited from primary care clinics involved in a multi-state practice research network. Patients with lifetime stimulant and/or opioid and any SUS use were eligible. All clinicians were eligible. Qualitative data were analyzed using a rapid assessment procedure. Quantitative data were analyzed descriptively.

Results: Participants included patients (n = 10) and clinicians (n = 12) from multiple disciplines. More than half of patients indicated that every SUS surveyed should be offered in primary care. Patients reported using multiple SUS to stay safer, reduce consequences, and limit use. Clinicians reported that offering SUS to primary care patients is acceptable and supported SUS use by sharing informational resources (e.g., safer injection practices) and tangible resources (e.g., naloxone, medication for opioid use disorder [MOUD]). Some strategies recommended by patients were not currently being systematically offered (e.g., fentanyl test strips). Several clinicians expressed willingness to discuss SUS with patients but wanted more training and resources to facilitate SUS discussions to support patient goals.

Conclusion: Offering SUS to primary care patients is acceptable to patients and clinicians. Clinicians supported some SUS use, though more SUS and harm reduction training and resources were desired. Providing SUS to patients who use stimulants and/or opioids could enhance patient-centered primary care, especially in clinics offering MOUD. More research is needed to optimize SUS support in primary care settings.