HealthSeptember 15, 2022

Treating substance use disorders should be a top healthcare priority

Despite substance use disorders rising dramatically in the wake of the COVID-19 pandemic, addiction is a highly treatable condition.Dr. Wakeman wearing orange shirt with textured blazer, stethoscope worn on neck

In this Q&A, Dr. Wakeman, author of recently published Pocket Addiction Medicine, discusses the challenges and treatability of these disorders.

Q. While addiction assessment and treatment may not be taught well outside of specialty addiction fellowships, how can trainees, practicing physicians, and other healthcare providers better educate themselves for today’s addiction challenges? What educational resources are available for healthcare providers?

The morbidity and mortality related to untreated substance use disorder and the harms of punitive drug policy are rising dramatically. This is the public health and social justice crisis of our times. Just as we did with HIV, and now are having to do with COVID, physicians and other clinicians need to ensure they are educated and comfortable diagnosing and treating alcohol and drug use disorders to address the current crisis. Incorporating addiction medicine training into all levels of medical education and approaching it as we would educate any other complex, treatable health condition, is critical. I remember as a medical student and resident carrying my Pocket Medicine everywhere and finding it an essential resource to learning the fundamentals of medicine. I am thrilled to now have that same resource available for students, trainees, and practicing clinicians to better care for patients with substance use disorder.

Q. What are the most challenging types of cases/addictions for healthcare providers to assess and treat?

The most challenging clinical scenarios are when clinicians are trying to care for patients with substance use disorder without actually identifying or treating it. Unfortunately, this has been the status quo in medicine — to treat the acute consequences such as overdose or infection or liver failure without addressing the actual underlying condition of addiction. Addiction is a highly treatable condition and there are so many effective ways clinicians can partner with patients to improve their health and quality of life through treatment and harm reduction.

Q. What are the most evidence-backed treatments in addiction medicine, particularly for opioid use disorder and alcohol use disorder?

There are effective, approved medication treatments for both alcohol and opioid use disorder, which are underutilized. For opioid use disorder, medication is the only treatment that has been shown to reduce mortality. These are lifesaving medications, and far more effective than medications we use for many chronic conditions like cardiovascular disease. Trying to treat opioid use disorder without using medication as a cornerstone of therapy would be like managing diabetes without making insulin available. These are crucial tools in our toolbox. For alcohol use disorder, medications can reduce heavy drinking and improve remission rates. Importantly, they can be effectively offered in primary care and other medical settings, just like medications for opioid use disorder.

Q. What are the expected outcomes using current treatment methods for addiction?

With effective treatments, remission rates for most types of substance use disorder are similar to the expected remission rates for other chronic health conditions, like hypertension or diabetes. For example, a study that followed people with prescription opioid use disorder who were treated with buprenorphine found that after three-and-a-half years 92% of people no longer met criteria for severe opioid use disorder and two-thirds were completely abstinent.

Q. How has the pandemic affected the cases, assessment, and treatment of addiction disorders?

The COVID-19 pandemic has worsened the overdose crisis, with the worst year in history in 2021 when more than 100,000 Americans died from drug overdose. In addition, just as COVID has been a painful reminder of the health harms of racism, we are seeing worsening racial disparities in overdose death rates. One driver of drug-related deaths is the poisoning of the illicit drug supply with vast penetration of illicitly manufactured fentanyl. This makes it even more urgent for healthcare providers to use every single touchpoint with patients with substance use disorder as an opportunity for engagement, harm reduction, and treatment initiation. Resources like Pocket Addiction Medicine make the knowledge needed to offer lifesaving care available quickly right at clinicians’ fingertips.

Look inside Pocket Addiction Medicine
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Q. What inspired you specialize in addiction medicine?

In medical school I was envisioning a career caring for people living with HIV and I initially wanted to pursue specialization in infectious diseases. I was fortunate to meet an incredible mentor who was an ID doctor who also practiced addiction medicine and I got exposed to and inspired by his work. I came to see the fascinating breadth of addiction medicine and how it brings together medicine, psychiatry, public health, and policy work. Importantly, it is a pathway to fight for social justice. It is also one of the most rewarding areas of medicine. I am privileged to partner with my patients, who are the most resilient, amazing human beings, and I get to see people get better, which is not true in every medical specialty.

Q. What do you find most challenging and most rewarding in your profession?

Getting to care for, learn from, and partner with people who use drugs and people with substance use disorder is by far the most rewarding part of this work. I also have the most amazing colleagues, many of whom are authors of chapters in Pocket Addiction Medicine, and who are mission driven. I am also stimulated and motivated by the tremendous need for change in our clinical approaches, policies, and regulations related to substance use and addiction. There is a lot of work to do, and it makes my job feel impactful and meaningful. The most challenging part is the enduring stigma and misinformation out there. Despite growing awareness that this is a public health issue, many people have been impacted by societal stigma and continue to hold and maintain discriminatory and harmful views towards substance use. Countering that misinformation and pushing for change is tough but so important.

Q. What advice would you give to a medical student/resident looking to specialize in addiction medicine?

There is no better field in all of medicine! Find mentors who inspire and uplift you. Approach each clinical encounter with curiosity and humility and realize that our patients are our best teachers. Challenge yourself to identify stigma and discrimination and speak out when you see it. One good gut check is to wonder whether we would approach a patient with a different health condition the same way. If the answer is no, you have most probably identified an area of stigma. 

Sarah E. Wakeman, MD, is the Medical Director for Substance Use Disorder at Mass General Brigham, Medical Director for the Mass General Hospital Substance Use Disorder Initiative, program director of the Mass General Addiction Medicine fellowship, and an Associate Professor of Medicine at Harvard Medical School. She received her AB from Brown University and her MD from Brown Medical School. She completed residency training in internal medicine and served as Chief Medical Resident at Mass General Hospital. She is a diplomate and fellow of the American Board of Addiction Medicine and board certified in Addiction Medicine by the American Board of Preventive Medicine.

Learn More About Pocket Addiction Medicine
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