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Opioid Use Disorder: Medical Treatment Options - American Family Physician

Oct 1, 2019 - Opioid use disorder is highly prevalent and can be fatal. At least 2.1 million Americans 12 years and older had opioid use disorder in 2016, and approximately 47,000 Americans died from opioid overdoses in 2017. Opioid use disorder is a chronic relapsing condition, the treatment of ...

American Family Physician : Article

https://www.aafp.org/afp/2019/1001/p416.html

Urine Drug Tests: Ordering and Interpreting Results - American Family Physician

Jan 1, 2019 - Urine drug testing is an essential component of monitoring patients who are receiving long-term opioid therapy, and it has been suggested for patients receiving long-term benzodiazepine or stimulant therapy. Family physicians should be familiar with the characteristics and capabilities ...

American Family Physician : Article

https://www.aafp.org/afp/2019/0101/p33.html

Adolescent Substance Use and Misuse: Recognition and Management - American Family ...

Jun 1, 2019 - Adolescent use of illicit substances imposes an enormous burden on individuals, families, and communities. The types of illicit substances adolescents are using have changed drastically over the past decade with decreases in alcohol use (including binge alcohol use) offset by increases ...

American Family Physician : Article

https://www.aafp.org/afp/2019/0601/p689.html

Primary Care for Persons Who Inject Drugs - American Family Physician

Jan 15, 2019 - More than 750,000 persons in the United States inject opioids, methamphetamine, cocaine, or ketamine, and that number is increasing because of the current opioid epidemic. Persons who inject drugs (PWID) are at higher risk of infectious and noninfectious skin, pulmonary, cardiac, ...

American Family Physician : Article

https://www.aafp.org/afp/2019/0115/p109.html

Medications for Alcohol Use Disorder - American Family Physician

Mar 15, 2016 - The U.S. Preventive Services Task Force recommends that clinicians screen adults for alcohol misuse and provide persons engaged in risky or hazardous drinking behaviors with brief behavioral counseling to reduce alcohol misuse. However, only a minority of American adults with high-risk ...

American Family Physician : Article

https://www.aafp.org/afp/2016/0315/p457.html

Buprenorphine Therapy for Opioid Use Disorder - American Family Physician

Mar 1, 2018 - Opioid misuse, including the use of heroin and the overprescribing, misuse, and diversion of opioid pain medications, has reached epidemic proportions in the United States. As a result, there has been a dramatic increase in opioid use disorder and associated overdoses and deaths. ...

American Family Physician : Article

https://www.aafp.org/afp/2018/0301/p313.html

Outpatient Management of Alcohol Withdrawal Syndrome - American Family Physician

Nov 1, 2013 - Approximately 2% to 9% of patients seen in a family physician’s office have alcohol dependence. These patients are at risk of developing alcohol withdrawal syndrome if they abruptly abstain from alcohol use. Alcohol withdrawal syndrome begins six to 24 hours after the last intake of ...

American Family Physician : Article

https://www.aafp.org/afp/2013/1101/p589.html

Stimulant and Designer Drug Use: Primary Care Management - American Family Physician

Jul 15, 2018 - Approximately 10% of the U.S. population 12 years and older reported using illicit substances in 2015. This article reviews the clinical effects and treatment of persons who use cocaine, methamphetamines, 3,4-methylenedioxymethamphetamine (MDMA), synthetic cannabinoids, and synthetic ...

American Family Physician : Article

https://www.aafp.org/afp/2018/0715/p85.html

Substance Abuse - American Family Physician

Oct 1, 2019 - Advertisement AFP BY TOPIC Substance Abuse Editors' Choice of Best Available Content PRINT COMMENTS ADD TO FAVORITES REMOVE FAVORITE This page will be removed from your Favorites Links. Are you sure? SHARE This collection features the best content from...

American Family Physician : AFP By Topic

https://www.aafp.org/afp/topicModules/viewTopicModule.htm?topicModuleId=27

Opioid Epidemic - Key Resources - American Family Physician

Oct 1, 2019 - Advertisement AFP BY TOPIC Opioid Epidemic - Key Resources Editors' Choice of Best Available Content PRINT COMMENTS ADD TO FAVORITES REMOVE FAVORITE This page will be removed from your Favorites Links. Are you sure? SHARE This collection features the best...

American Family Physician : AFP By Topic

https://www.aafp.org/afp/topicModules/viewTopicModule.htm?topicModuleId=106

Urine Drug Screening: A Valuable Office Procedure - American Family Physician

Mar 1, 2010 - Urine drug screening can enhance workplace safety, monitor medication compliance, and detect drug abuse. Ordering and interpreting these tests requires an understanding of testing modalities, detection times for specific drugs, and common explanations for false-positive and ...

American Family Physician : Article

https://www.aafp.org/afp/2010/0301/p635.html

A Primary Care Approach to Substance Misuse - American Family Physician

Jul 15, 2013 - Substance misuse is common among patients in primary care settings. Although it has a substantial health impact, physicians report low levels of preparedness to identify and assist patients with substance use disorders. An effective approach to office-based treatment includes a coherent...

American Family Physician : Article

https://www.aafp.org/afp/2013/0715/p113.html

Common Misperceptions About Buprenorphine Prescribing for Opioid Use Disorder - ...

Oct 1, 2019 - The antidote to the opioid use disorder epidemic is the thoughtful use of evidence-based medicine and an honest understanding of what we know—and what we don't know—about caring for people with substance use disorders.

American Family Physician : Editorials

https://www.aafp.org/afp/2019/1001/p396.html

Lofexidine (Lucemyra) for Treatment of Opioid Withdrawal Symptoms - STEPS - American ...

Mar 15, 2019 - Lofexidine has been shown to be as effective as clonidine at controlling some of the symptoms of withdrawal from opioid use. It may have a small additional benefit for maintaining abstinence in patients switched to buprenorphine or methadone for long-term maintenance.

American Family Physician : STEPS

https://www.aafp.org/afp/2019/0315/p392.html

Methamphetamine Abuse - American Family Physician

Oct 15, 2007 - Methamphetamine is a stimulant commonly abused in many parts of the United States. Most methamphetamine users are white men 18 to 25 years of age, but the highest usage rates have been found in native Hawaiians, persons of more than one race, Native Americans, and men who have sex with ...

American Family Physician : Article

https://www.aafp.org/afp/2007/1015/p1169.html

Counseling Parents and Adolescents About Marijuana - Editorials - American Family ...

Jul 15, 2018 - Physicians are increasingly likely to be asked by adolescents or their parents whether recreational marijuana use is safe. Although many adults view marijuana as benign, there are major concerns about its use in adolescents because all illicit drug use, including marijuana, may have ...

American Family Physician : Editorials

https://www.aafp.org/afp/2018/0715/p80.html

Implantable Buprenorphine (Probuphine) for Maintenance Treatment of Opioid Use Disorder...

May 15, 2018 - Implantable buprenorphine is an expensive alternative for patients on a stable dosage of transmucosal buprenorphine. Based on current research and guidance, implantable buprenorphine should not be used as initial treatment for opioid dependence or as a substitute for medication-assisted...

American Family Physician : STEPS

https://www.aafp.org/afp/2018/0515/p668.html

Injectable Extended-Release Naltrexone Effective for Opioid Use Disorder - POEMs - ...

Jun 15, 2018 - Injectable extended-release naltrexone administered every four weeks is similar in efficacy to daily oral buprenorphine/naloxone for the treatment of opioid use disorder. Patients using extended-release naltrexone reported higher satisfaction with treatment and were more likely to ...

American Family Physician : POEMs

https://www.aafp.org/afp/2018/0615/p819.html

Treating Opioid Use Disorder as a Family Physician: Taking the Next Step - Editorials -...

Mar 1, 2018 - An AHRQ review showed that there are different ways in which buprenorphine-based MAT can be safely and effectively delivered in primary care settings.

American Family Physician : Editorials

https://www.aafp.org/afp/2018/0301/p302.html

Adolescent Substance Use and Abuse: Recognition and Management - American Family Physician

Feb 1, 2008 - Substance abuse in adolescents is undertreated in the United States. Family physicians are well positioned to recognize substance use in their patients and to take steps to address the issue before use escalates. Comorbid mental disorders among adolescents with substance abuse include ...

American Family Physician : Article

https://www.aafp.org/afp/2008/0201/p331.html

Interventions for Tobacco Cessation in Patients Being Treated for or Recovering from ...

Nov 1, 2017 - Pharmacotherapy alone and pharmacotherapy plus counseling are effective for tobacco cessation among patients being treated for or recovering from alcohol and substance use disorders. Counseling interventions without pharmacotherapy are not effective for tobacco cessation among patients ...

American Family Physician : Cochrane for Clinicians

https://www.aafp.org/afp/2017/1101/p572.html

How Family Physicians Can Combat the Opioid Epidemic - Editorials - American Family ...

Sep 15, 2017 - Family physicians must commit to responsible prescribing of opioid medications. The decision to initiate opioid therapy should be a careful and deliberate one, especially in patients who are at risk of addiction.

American Family Physician : Editorials

https://www.aafp.org/afp/2017/0915/p357.html

Management of Chronic Pain and Opioid Misuse: A Position Paper from the AAFP - Practice...

Apr 1, 2017 - Overprescribing, misuse, diversion, and dependence on opioids have occurred as a result of external pressures, physician behavior, inadequate evidence, and pharmacologic development. Family physicians could play an important role in alleviating these problems; therefore, the American ...

American Family Physician : Practice Guidelines

https://www.aafp.org/afp/2017/0401/p458.html

Chronic Pain Management and Opioid Misuse: Guidance for Family Physicians - Editorials ...

Apr 1, 2017 - Family physicians are committed to advancing population and community health, and we must take the lead in reducing opioid misuse and overdose before outside entities mandate practice strategies that may not be patient-centered.

American Family Physician : Editorials

https://www.aafp.org/afp/2017/0401/p420.html

Buprenorphine Maintenance vs. Placebo for Opioid Dependence - Medicine by the Numbers -...

Mar 1, 2017 - Buprenorphine causes lower physical dependence, milder withdrawal symptoms, and is less likely to cause an overdose than methadone in the treatment of opioid dependence.

American Family Physician : Medicine by the Numbers

https://www.aafp.org/afp/2017/0301/od1.html

Alpha-adrenergic Agonists for the Management of Opioid Withdrawal - Medicine by the ...

Jan 1, 2017 - Alpha-adrenergic agonists were more efficacious than placebo in the management of opioid withdrawal, but are best reserved as an alternative to methadone.

American Family Physician : Medicine by the Numbers

https://www.aafp.org/afp/2017/0101/od1.html

Rural Opioid Use Disorder Treatment Depends on Family Physicians - Graham Center Policy...

Oct 1, 2016 - The nation's growing opioid use disorder epidemic disproportionately impacts rural areas, where physicians who can prescribe buprenorphine are scarcest. Among physicians approved to prescribe buprenorphine, family physicians (FPs) are the most likely to work in rural areas.

American Family Physician : Graham Center Policy One-Pagers

https://www.aafp.org/afp/2016/1001/p546.html

CDC Develops Guideline for Opioid Prescribing - Practice Guidelines - American Family ...

Jun 15, 2016 - A recently released guideline aims to establish patient-centered approaches to initiating, managing, and discontinuing opioid use. The recommendations from the Centers for Disease Control and Prevention (CDC) emphasize the serious risks and harms associated with opioids.

American Family Physician : Practice Guidelines

https://www.aafp.org/afp/2016/0615/p1042.html

Family Medicine: An Underutilized Resource in Addressing the Opioid Epidemic? - Graham ...

Sep 1, 2016 - Opioid overdose rates have tripled since 2000, and although overprescribing of opioids by physicians is widely accepted as a causal factor, the physician's role in providing medication-assisted treatment for opioid use disorder is less appreciated. Despite a clear willingness to ...

American Family Physician : Graham Center Policy One-Pagers

https://www.aafp.org/afp/2016/0901/p350.html

Club Drugs: MDMA, Gamma-Hydroxybutyrate (GHB), Rohypnol, and Ketamine - American Family...

Jun 1, 2004 - Club drugs are substances commonly used at nightclubs, music festivals, raves, and dance parties to enhance social intimacy and sensory stimulation. The most widely used club drugs are 3,4-methylenedioxymethamphetamine (MDMA), also known as ecstasy; gamma-hydroxybutyrate (GHB); ...

American Family Physician : Article

https://www.aafp.org/afp/2004/0601/p2619.html

Managing Opioid Addiction with Buprenorphine - American Family Physician

May 1, 2006 - Legislation has enabled physicians to treat opioid-dependent patients with an office-based maintenance program using buprenorphine, a partial mu-opioid receptor agonist. Clinical studies indicate buprenorphine effectively manages opioid addiction. Buprenorphine is more effective than ...

American Family Physician : Article

https://www.aafp.org/afp/2006/0501/p1573.html

The Opioid Epidemic: AMA’s response - Editorials - American Family Physician

Jun 15, 2016 - With Lembke article and opioid PG

American Family Physician : Editorials

https://www.aafp.org/afp/2016/0615/p975.html

Effectiveness, Adverse Effects, and Safety of Medical Marijuana - Editorials - American...

Nov 15, 2015 - Increasingly, physicians across the country are being asked about medical marijuana. Although marijuana has been around for centuries, there is no consensus on its safety and effectiveness.

American Family Physician : Editorials

https://www.aafp.org/afp/2015/1115/p856.html

Primary Care Behavioral Interventions to Reduce Illicit Drug and Nonmedical ...

Jun 15, 2015 - J.P. is a 16-year-old white female nonsmoker who presents for a sports clearance physical. She is in good overall health, excels academically, and plays water polo at school. During the patient history, she mentions that she and three friends were suspended from school for drinking ...

American Family Physician : Putting Prevention into Practice

https://www.aafp.org/afp/2015/0615/p865.html

Outpatient Detoxification of the Addicted or Alcoholic Patient - American Family Physician

Sep 15, 1999 - Outpatient detoxification of patients with alcohol or other drug addiction is being increasingly undertaken. This type of management is appropriate for patients in stage I or stage II of withdrawal who have no significant comorbid conditions and have a support person willing to monitor ...

American Family Physician : Article

https://www.aafp.org/afp/1999/0915/p1175.html

Primary Care Behavioral Interventions to Reduce Illicit Drug and Nonmedical ...

Mar 1, 2015 - The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of primary care–based behavioral interventions to prevent or reduce illicit drug or nonmedical pharmaceutical use in children and adolescents. This recommendation applies to ...

American Family Physician : U.S. Preventive Services Task Force

https://www.aafp.org/afp/2015/0301/od2.html

Buprenorphine Maintenance vs. Methadone Maintenance or Placebo for Opioid Use Disorder ...

Feb 1, 2015 - At dosages greater than 2 mg per day, buprenorphine maintains treatment retention better than placebo. When flexible dosing (doses adjusted based on patient symptoms) is used, the effectiveness of buprenorphine is comparable to that of methadone in suppressing opioid use.

American Family Physician : Cochrane for Clinicians

https://www.aafp.org/afp/2015/0201/p165.html

Gamma-Hydroxybutyrate (GHB): A Newer Drug of Abuse - American Family Physician

Dec 1, 2000 - Gamma-hydroxybutyrate (GHB) is an illicitly marketed substance that has recently gained popularity among body builders and party attendees as a drug of abuse. GHB is a depressant that acts on the central nervous system. It is purported as a strength enhancer, euphoriant and aphrodisiac ...

American Family Physician : Article

https://www.aafp.org/afp/2000/1201/p2478.html

Recognition and Prevention of Inhalant Abuse - American Family Physician

Sep 1, 2003 - Inhalant abuse is a prevalent and often overlooked form of substance abuse in adolescents. Survey results consistently show that nearly 20 percent of children in middle school and high school have experimented with inhaled substances. The method of delivery is inhalation of a solvent ...

American Family Physician : Article

https://www.aafp.org/afp/2003/0901/p869.html

After Detoxification: Levels of Treatment for Alcohol Dependence - Editorials - ...

Nov 1, 2013 - Detoxification is just the tip of the iceberg, and the postdischarge treatment program is key in determining whether patients will abstain from alcohol.

American Family Physician : Editorials

https://www.aafp.org/afp/2013/1101/p576.html

Uncommon Adverse Effects of Commonly Abused Illicit Drugs - Editorials - American ...

Jul 1, 2013 - Illicit drug use should be considered in the differential diagnosis of many clinical presentations, because the list of known deleterious effects is growing. There are an increasing number of case reports involving uncommon adverse effects of commonly abused illicit drugs.

American Family Physician : Editorials

https://www.aafp.org/afp/2013/0701/p10.html

Common Problems in Patients Recovering from Chemical Dependency - American Family ...

Nov 15, 2003 - Chemical dependency is a common, chronic disease that affects up to 25 percent of patients seen in primary care practices. The treatment goal for patients recovering from chemical dependency should be to avoid relapse. This requires physicians to have an open, nonjudgmental attitude and...

American Family Physician : Article

https://www.aafp.org/afp/2003/1115/p1971.html

Management of Withdrawal Syndromes and Relapse Prevention in Drug and Alcohol Abuse - ...

Jul 1, 1998 - The primary care physician is in a good position to diagnose, manage and intervene with patients who are undergoing the process of treatment and recovery from alcohol and drug disorders. Medications such as benzodiazepines are effective in the treatment of withdrawal syndromes, and ...

American Family Physician : Article

https://www.aafp.org/afp/1998/0701/p139.html

Recognition of Alcohol and Substance Abuse - American Family Physician

Apr 1, 2003 - Ten percent of the population abuses drugs or alcohol, and 20 percent of patients seen by family physicians have substance-abuse problems, excluding tobacco use. These patients can be identified by relying on regular screening or a high index of suspicion based on

American Family Physician : Article

https://www.aafp.org/afp/2003/0401/p1529.html

Addiction: Part I. Benzodiazepines-Side Effects, Abuse Risk and Alternatives - American...

Apr 1, 2000 - Benzodiazepines are widely prescribed for a variety of conditions, particularly anxiety and insomnia. They are relatively safe and, with overdose, rarely result in death. However, used chronically, benzodiazepines can be addicting. These agents are often taken in combination with other ...

American Family Physician : Article

https://www.aafp.org/afp/2000/0401/p2121.html

Opioid Abuse and Pain Management - Editorials - American Family Physician

Oct 1, 2012 - Chronic nonmalignant pain affects a significant number of Americans. Concurrent with the increased need for pain management is a considerable increase in the use of prescription pain relievers for nonmedical purposes. Nonmedical use of prescription pain relievers is now the second most ...

American Family Physician : Editorials

https://www.aafp.org/afp/2012/1001/p600.html

Abuse of Over-the-Counter Medications Among Teenagers and Young Adults - Editorials - ...

Oct 1, 2011 - In recent years, recognition of over-the-counter (OTC) medication abuse by patients—especially teenagers and young adults—has increased.1 Abuse is defined as the use of a drug to experience psychoactive effects instead of for its medical indication. OTC medications are easily abused ...

American Family Physician : Editorials

https://www.aafp.org/afp/2011/1001/p745.html

Addiction: Part II. Identification and Management of the Drug-Seeking Patient - ...

Apr 15, 2000 - The medications most often implicated in prescription drug abuse are opioid analgesics, sedative-hypnotics and stimulants. Patients with acute or chronic pain, anxiety disorders and attention-deficit disorder are at increased risk of addiction comorbidity. It is important to ask ...

American Family Physician : Article

https://www.aafp.org/afp/2000/0415/p2401.html

Methadone Therapy for Opioid Dependence - American Family Physician

Jun 15, 2001 - The 1999 Federal regulations extend the treatment options of methadone-maintained opioid-dependent patients from specialized clinics to office-based opioid therapy (OBOT). OBOT allows primary care physicians to coordinate methadone therapy in this group with ongoing medical care. This ...

American Family Physician : Article

https://www.aafp.org/afp/2001/0615/p2404.html

An Approach to Drug Abuse, Intoxication and Withdrawal - American Family Physician

May 1, 2000 - The symptomatic effects of drug abuse are a result of alterations in the functioning of the following neurotransmitters or their receptors: acetylcholine, dopamine, gamma-aminobutyric acid, norepinephrine, opioids and serotonin. Anticholinergic drugs antagonize acetylcholine receptors. ...

American Family Physician : Article

https://www.aafp.org/afp/2000/0501/p2763.html

Marijuana: Medical Implications - American Family Physician

Dec 1, 1999 - Over 50 percent of people will use marijuana sometime in their life. While intoxication lasts two to three hours, the active ingredient in marijuana, delta-9-tetrahydro-cannabinol, can accumulate in fatty tissues, including the brain and testes. Adverse effects from marijuana use ...

American Family Physician : Article

https://www.aafp.org/afp/1999/1201/p2583.html

Health Issues in Men: Part II. Common Psychosocial Disorders - American Family Physician

Jul 1, 2000 - During screening examinations and, when appropriate, other health-related visits, family physicians should be alert for signs and symptoms of common psychosocial disorders in men. Health issues of concern include alcohol and substance abuse, domestic violence, midlife crisis and ...

American Family Physician : Article

https://www.aafp.org/afp/2000/0701/p117.html

Screening for Illicit Drug Use: Recommendation Statement - U.S. Preventive Services ...

Sep 15, 2009 - The U.S. Preventive Services Task Force (USPSTF) concludes that the current evidence is insufficient to assess the balance of benefits and harms of screening adolescents, adults, and pregnant women for illicit drug use.

American Family Physician : U.S. Preventive Services Task Force

https://www.aafp.org/afp/2009/0915/p623.html

Screening for Illicit Drug Use - Putting Prevention into Practice - American Family ...

Sep 15, 2009 - Case study: An 18-year-old woman visits your office for routine prenatal care. She is in the first trimester of pregnancy and has had no notable medical problems. The physical examination is normal, and she expresses no concerns.

American Family Physician : Putting Prevention into Practice

https://www.aafp.org/afp/2009/0915/p629.html

Treating Opioid Dependency and Coexistent Chronic Nonmalignant Pain - Editorials - ...

Nov 15, 2008 - Advertisement << Previous article Next article >> Nov 15, 2008 Issue Editorials Treating Opioid Dependency and Coexistent Chronic Nonmalignant Pain RICHARD D. BLONDELL, MD, and LISHAM ASHRAFIOUN, BS, State University of New York at Buffalo, Buffalo, New York Am Fam Physician. 2008...

American Family Physician : Editorials

https://www.aafp.org/afp/2008/1115/p1132.html

Buprenorphine: Effective Treatment of Opioid Addiction Starts in the Office - ...

May 1, 2006 - Advertisement << Previous article Next article >> May 1, 2006 Issue Editorials Buprenorphine: Effective Treatment of Opioid Addiction Starts in the Office DAVID A. FIELLIN, M.D., Yale University School of Medicine, New Haven, Connecticut Am Fam Physician. 2006 May 1;73(9):1513-1514....

American Family Physician : Editorials

https://www.aafp.org/afp/2006/0501/p1513.html

Screening for Inhalant Abuse in Children and Adolescents - Editorials - American Family...

Sep 1, 2003 - Advertisement << Previous article Next article >> Sep 1, 2003 Issue Editorials Screening for Inhalant Abuse in Children and Adolescents MICHAEL T. LYNSKEY, PH.D., Washington University School of Medicine, St. Louis, Missouri Am Fam Physician. 2003 Sep 1;68(5):811-812. Related...

American Family Physician : Editorials

https://www.aafp.org/afp/2003/0901/p811.html

Prescribing Syringes to Injection Drug Users: What the Family Physician Should Know - ...

Jul 1, 2003 - Advertisement << Previous article Next article >> Jul 1, 2003 Issue Editorials Prescribing Syringes to Injection Drug Users: What the Family Physician Should Know JOSIAH D. RICH, M.D., M.P.H. LYNN TAYLOR, M.D. MEENAKSHI MEHROTRA RACHEL MASON, M.D. MICHELLE STOZEK, M.D. SHARON...

American Family Physician : Editorials

https://www.aafp.org/afp/2003/0701/p45.html

Screening and Intervening for Patients with Substance Use Disorders - Editorials - ...

Apr 1, 2003 - Advertisement << Previous article Next article >> Apr 1, 2003 Issue Editorials Screening and Intervening for Patients with Substance Use Disorders DANIEL C. VINSON, M.D., M.S.P.H., University of Missouri School of Medicine, Columbia, Missouri Am Fam Physician. 2003 Apr...

American Family Physician : Editorials

https://www.aafp.org/afp/2003/0401/p1443.html

Methadone Maintenance - Editorials - American Family Physician

Jun 15, 2001 - Advertisement << Previous article Next article >> Jun 15, 2001 Issue Editorials Methadone Maintenance SHARON STANCLIFF, M.D. AIDS Institute, New York State Department of Health New York, New York Am Fam Physician. 2001 Jun 15;63(12):2335-2336. Related Article The development of...

American Family Physician : Editorials

https://www.aafp.org/afp/2001/0615/p2335.html

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