Over the course of the next year, I will share progress on a new book that is being developed as a response to a growing opioid epidemic but also to facilitate full integration of behavioral health and harm reduction into the daily routine of primary care. I have assembled a national team of creative practitioners who will join me along the way. More on that as we progress. So, for now, let’s begin our journey of humanizing primary care with a simple thought.

Primary care patients come to Integrated Services for Behavioral Health with a unique combination of strengths and challenges-- physical, mental and emotional. Most times, physicians and nurse practitioners can treat routine infections effectively. And the medicines we prescribe can be very helpful for chronic conditions like diabetes, hypertension, asthma, and depression. But our own common sense, combined with the broad perspectives of some of the best thought leaders in healthcare, tell us that our patient’s health status depends greatly on everyday habits, lifestyle, and community life; in other words, all the stuff that happens between clinic visits.

Unfortunately, the scope, pace, and unpredictability of primary care practice seldom allow for an in-depth conversation about people’s lives. But we can begin to change the way we relate to our patients, here and now, even before payment reform reorients all of the primary care more in the direction of health and human behavior. As physicians, nurses, counselors, and social workers, we can all learn more about shared opportunities for incremental practice redesign. We can build cross-systems teams to integrate behavioral health with primary care. And we can adapt relevant behavioral methods, such as collaborative harm reduction, to map out easy-to-take steps toward relationship-based primary care practices.

The opioid epidemic is a great reason to get started immediately, but implementing and sustaining a collaborative harm reduction approach can also help with the entire spectrum of harmful substance use, and with patient care in general.

A couple of lines from an old song seem as good a place as any to begin our year-long conversation about a new way to think about our patients and to develop a fresh, more relationship-oriented approach to the practice of collaborative harm reduction for primary care. A new approach is required for a time when we all struggle to understand the growing opioid epidemic. Chicago singer/songwriter, Michael Peter Smith, wrote these lines years ago but Steve Goodman made them popular sometime later in a sweet little song that was inspired by Edgar Lee Master’s Spoon River Anthology (Masters, 1916). The words are, “You know and I know there never was a reason to hurt. When all of our lives were entwined, to begin with, here in Spoon River”.

Sentimental, to be sure. But these simple lines are also quite sensible. Whether we know it or not, in primary care practice, we all work together in various relationship configurations seeking specific clinical outcomes for patients. But also to achieve more generalized community goals for health and well-being. So, the ideas, skills, and values we need to create a more personal, family friendly and community oriented way of doing primary care come from some remarkably universal sensibilities.

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