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Addressing Host Factors: Primary, Secondary, and Tertiary Prevention of Opioid Dependence

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Opioid Dependence

Abstract

The public health concepts of primary, secondary, and tertiary prevention are increasingly discussed in the context of the opioid abuse epidemic. Primary prevention seeks to avert the onset of disease or injury, secondary prevention comprises screening for/identifying and if possible reversing early effects of the disease or injury state, and tertiary prevention attempts to attenuate the consequences of established disease as well as strive for cure. To continue the infectious disease metaphor used throughout the book, behavioral “immunity” toward opioid-seeking and misuse must be cultivated at every stage of prevention, and the enhancement of motivation for avoidance comprises the strategic goal for both individuals and populations. As individuals are not islands unto themselves, addressing the environment (beyond the concept of vectors as explored in detail previously) is critical. Weaning and discontinuation require careful attention to underlying sources of discomfort and distress and to facilitating resilience and self-efficacy. Substitution (e.g., methadone, buprenorphine) and antagonist (e.g., naltrexone) pharmacotherapies in conjunction with psychosocial-spiritual treatment have been shown to be effective in harm reduction but also in facilitating recovery from addiction. Multidimensional assessment of risk and recovery factors is essential for tactically sound tertiary prevention efforts. Overdose education and naloxone distribution are increasingly championed as effective efforts in reducing mortality.

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  1. Northern Anesthesia & Pain Medicine, LLC, Eagle River, Alaska, USA

    Heath B. McAnally MD, MSPH (Medical Director, Clinical Instructor)

  2. WWAMI Program, University of Washington School of Medicine, Anchorage, Alaska, USA

    Heath B. McAnally MD, MSPH (Medical Director, Clinical Instructor)

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McAnally, H.B. (2018). Addressing Host Factors: Primary, Secondary, and Tertiary Prevention of Opioid Dependence. In: Opioid Dependence . Springer, Cham. https://doi.org/10.1007/978-3-319-47497-7_11

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