A Patient-Centered Approach to Opioid Use Disorders


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Explore the neurobiological, psychological, psychosocial, and cultural determinants of opioid use disorder, and review approaches to integrated, culturally competent care.

Learning Objective

After studying this article, you should be able to:

  • Take steps to avoid perpetuating racial stigma in the provision of treatment for opioid use disorder

Target Audience

Primary care clinicians


The Psychiatric Consultation Service at Massachusetts General Hospital sees medical and surgical inpatients with comorbid psychiatric symptoms and conditions. During their twice-weekly rounds, Dr Stern and other members of the Consultation Service discuss diagnosis and management of hospitalized patients with complex medical or surgical problems who also demonstrate psychiatric symptoms or conditions. These discussions have given rise to rounds reports that will prove useful for clinicians practicing at the interface of medicine and psychiatry.

To cite: Rustad JK, Stern TA, Eth S. A patient-centered approach to opioid use disorders. Prim Care Companion CNS Disord. 2021;23(2):20f02749.

To share: https://doi.org/10.4088/PCC.20f02749

Read the whole article at psychiatrist.com here: 
A Patient-Centered Approach to Opioid Use Disorders 

© Copyright 2021 Physicians Postgraduate Press, Inc.

Activity summary
Available credit: 
  • 1.00 AMA PRA Category 1 Credit™
  • 1.00 Participation
Activity opens: 
Activity expires: 

CME Background

Articles are selected for credit designation based on an assessment of the educational needs of CME participants, with the purpose of providing readers with a curriculum of CME articles on a variety of topics throughout each volume. Activities are planned using a process that links identified needs with desired results.

CME Objective

After studying this article, you should be able to:

  • Take steps to avoid perpetuating racial stigma in the provision of treatment for opioid use disorder

Statement of Need and Purpose

Because the pandemic has fueled substance use disorders, clinicians need education on treatment strategies. Greater understanding of the causes behind opioid addiction is needed to help clinicians be part of the solution to a multifactorial crisis.

Release, Expiration, and Review Dates

This educational activity was published in April 2021 and is eligible for AMA PRA Category 1 Credit™ through April 30, 2023. The latest review of this material was April 2021.

Disclosure of Off-Label Usage

The authors have determined that, to the best of their knowledge, no investigational information about pharmaceutical agents or device therapies that is outside US Food and Drug Administration–approved labeling has been presented in this article.



Previous presentation

The material in this article is based on a Geisel School of Medicine at Dartmouth/Dartmouth-Hitchcock Department of Psychiatry Virtual Grand Rounds entitled “Understanding and Undermining the Opioid Crisis: A Patient-Centered Approach” presented by Dr Rustad on May 19, 2020.


The authors thank Loretta Grikis, MLS, AHIP, clinical librarian, and Marina Trefethen, PharmD, BCPP, mental health clinical pharmacy specialist, for assistance with literature searches. Ms Grikis and Dr Trefethen have no conflicts of interest related to the subject of this article.

Additional Information

The case vignette is a composite of several patient cases. All information has been de-identified to protect anonymity.

Faculty Affiliation

James K. Rustad, MD*
Department of Psychiatry, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire; White River Junction VA Medical Center, Hartford, Vermont; and Burlington Lakeside VA Community Based Outpatient Clinic, Burlington, Vermont

Theodore A. Stern, MD
Department of Psychiatry, Massachusetts General Hospital, and Harvard Medical School, Boston, Massachusetts

Spencer Eth, MD
Departments of Forensic Psychiatry and Addiction Psychiatry, University of Miami Miller School of Medicine, and Miami VA Healthcare System, Miami, Florida

*Corresponding author: James K. Rustad, MD, Geisel School of Medicine at Dartmouth, Dartmouth-Hitchcock Medical Center, One Medical Center Drive, Lebanon, New Hampshire 03756 (james.k.rustad@dartmouth.edu).

Financial Disclosure

All individuals in a position to influence the content of this activity were asked to complete a statement regarding all relevant personal financial relationships between themselves or their spouse/partner and any commercial interest. The CME Institute has resolved any conflicts of interest that were identified. In the past year, Marlene P. Freeman, MD, Editor in Chief of The Journal of Clinical Psychiatry, has received research funding from JayMac and Sage; has been a member of the advisory boards for Otsuka, Alkermes, and Sunovion; has been a member of the Independent Data Safety and Monitoring Committee for Janssen; has been a member of the Steering Committee for Educational Activities for Medscape; and, as a Massachusetts General Hospital (MGH) employee, works with the MGH National Pregnancy Registry, which is sponsored by Teva, Alkermes, Otsuka, Actavis, and Sunovion, and works with the MGH Clinical Trials Network and Institute, which receives research funding from multiple pharmaceutical companies and the National Institute of Mental Health. No member of the CME Institute staff reported any relevant personal financial relationships.

Dr Stern is an employee of the Academy of Consultation-Liaison Psychiatry and has received royalties from Elsevier and the Massachusetts General Hospital Psychiatry Academy. Drs Rustad and Eth have no personal affiliations or financial relationships with any commercial interest to disclose relative to the article.

Accreditation Statement

The CME Institute of Physicians Postgraduate Press, Inc., is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.

Credit Designation

The CME Institute of Physicians Postgraduate Press, Inc., designates this journal-based CME activity for a maximum of 1.00 AMA PRA Category 1 Credit™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Note: The American Nurses Credentialing Center (ANCC) and the American Academy of Physician Assistants (AAPA) accept certificates of participation for educational activities certified for AMA PRA Category 1 Credit™ from organizations accredited by the ACCME.

Available Credit

  • 1.00 AMA PRA Category 1 Credit™
  • 1.00 Participation


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