During the CDC’s Vital Signs Town Hall on coordinating the clinical and public health responses to opioid overdoses treated in EDs, U.S. Surgeon General Jerome Adams, MD, MPH, stressed the importance of recognizing that substance use disorder is a chronic disease that must be treated with the same skill, compassion, and urgency that clinicians use to treat other chronic health conditions. He noted that providers can play a role in ending the stigma associated with opioid addictions.
“Make no mistake about it: It exists among our colleagues as well as amongst the general public. I have seen it in my practice and in my day-to-day life,” said Adams, who recounted some of his own experiences with addiction in his family. “Help everyone, especially patients and families, understand that this is a chronic illness and it impacts the brain. Recovery is possible, as is recurrence.”
Adams called on healthcare professionals to make sure they put support in place to help patients recover. “All healthcare professionals, including physicians, physician assistants, nurse practitioners, dentists, social workers, therapists, pharmacists, and more, can play a role in addressing substance misuse and substance disorders not only by directly providing healthcare services, but also by promoting prevention strategies and supporting the infrastructure changes needed to better integrate care for substance use disorders into general healthcare and other treatment settings,” he said.
To that end, Adams encouraged clinicians to consider providing medication-assisted treatment (MAT) in their own settings or to help connect patients in need of these services to a MAT provider. “Make sure you are aware of the evidence-based treatment programs and recovery supports in your community because we know [clinicians] can’t do it alone, and don’t expect [them] to do it alone,” he said. “But we do expect [clinicians] to be able to refer individuals to appropriate resources in their communities to help them recover.”
Adams made clear that he recognizes that finding a MAT provider who can deliver treatment when it is needed is an ongoing challenge for frontline providers. Indeed, he noted that only one in three specialty addiction treatment facilities even offers MAT as an option for patients with opioid use disorder. But he stressed that the science is clear about the fact that MAT works.
Consequently, when referring a patient with a substance use disorder to an addiction treatment provider, it is important for clinicians to make sure they are sending this person to a reputable provider, Adams advised. How can one be sure a provider is reputable? Adams noted that clinicians should look for the following elements:
- personalized diagnosis, assessment, and treatment planning;
- access to FDA-approved medicines;
- effective behavioral health interventions delivered by trained professionals;
- long-term disease management;
- coordinated care for other co-occurring diseases, such as HIV, hepatitis, or diabetes;
- recovery support services such as mutual groups and community services that can provide continuing emotional and practical support for recovery.
In addition to referring patients to appropriate treatment, Adams called on clinicians to raise awareness about the warning signs of opioid abuse and the availability of naloxone.
“Offer to co-prescribe naloxone to those taking opioids to manage chronic pain and to those who may be at risk or know someone at risk for an opioid overdose,” he said. “Make sure you are aware of the ‘standing order’ laws and legal protections for prescribers and bystanders ... who administer naloxone when encountering an overdose situation in your state.”
There are too many stories about people dying from overdoses because bystanders either didn’t know how to access naloxone or they were worried about the legal ramifications if they moved to administer the drug, Adams observed.
Finally, Adams urged clinicians to think about prevention. “Start low and go slow when prescribing,” he said. “Be cautious in prescribing opioids, benzodiazepines, and other medicines that, [with alcohol], can cause respiratory depression.”
Further, Adams stressed that clinicians need to help patients understand the benefits of alternatives to opioids, and how to safely store and dispose of opioid medications.
Adams added that clinicians should make sure they understand and are using the CDC Guideline for Prescribing Opioids for Chronic Pain (). “This really is the best practice and the key to helping us overcome the opioid epidemic,” he said. “Unfortunately, there are still too many of our colleagues — individuals we work with on a day-to-day basis — who aren’t utilizing the guideline.”