• Expert Review By: Dr. David Reading, Internist and Addiction Medicine Physician
• Written By: Dr Sarah Valentine

Some housekeeping before we start: The objectives of this CCFP topic use terms such as "user" and "abuser", both of which have significant negative connotations associated with them and can further stigmatize individuals who use substances and those who live with addiction. The more appropriate term, and that which is used in the DSM is "use disorder", eg. someone may have an alcohol use disorder or opioid use disorder, along with the other term "people who use substances" (PWUS).
Caring for patients with substance use disorders is an essential skill for primary care providers. While many people with SUDs present to emergency care, primary care remains the core of treatment of substance use disorders.

• Written By:
  • Vaishvi Patel, a fourth-year medical student from the University of Alberta
  • Ronan Noble an MD/PhD student also from the University of Alberta
• Expert Review By:
  • Dr. Henry Ma, PGY2 FM at UofA

Objectives:

1. In all patients presenting with multiple medical concerns (e.g., complaints, problems, diagnoses), take an appropriate history to determine the primary reason for the consultation.

• In all patients presenting with multiple medical concerns, prioritize problems appropriately to develop an agenda that both you and the patient can agree upon (i.e., determine common ground).

• In a patient with multiple medical complaints (and/or visits), consider underlying depression, anxiety, or abuse (e.g., physical, medication, or drug abuse) as the cause of the symptoms, while continuing to search for other organic pathology.

• Periodically re-address and re-evaluate the management of patients with multiple medical problems in order to:

• simplify their management (pharmacologic and other)

• limit polypharmacy

• minimize possible drug interactions

• update therapeutic choices (e.g., because of changing guidelines or the patient's situation)

• In patients with multiple medical problems and recurrent visits for unchanging symptoms, set limits for consultations when appropriate (e.g., limit the duration and frequency of visits).

Written by Sarah Valentine, FM R2 in Victoria, BC

Expert Review by Dr Jankowski, Addictions physician in Victoria, BC

While this topic doesn't have very many objectives to cover, we're dedicating an entire episode to it given cigarette smoking remains Canada's #1 preventable cause of death and disease (https://www.cmaj.ca/content/197/28/E846). We will also dedicate a little time to the hot button topic that is vaping and review some of the early evidence on health outcomes.