Substance Use Disorders: Treatment Recommendations

Substance use disorders have been regarded as a moral failing for centuries.
Substance use disorders have been regarded as a moral failing for centuries.

The American College of Physicians (ACP) has released a position paper in the Annals of Internal Medicine, in which they maintained their position that substance use disorder is a treatable, chronic medical condition.1 In addition, the ACP offered recommendations on the following issues:

  • Access to  substance use disorder treatments
  • Legal status of marijuana
  • Status of the opioid epidemic
  • Insurance coverage for treating substance use disorders
  • Education and the workforce Public health interventions

Sue S. Bornstein, MD, and colleagues from the Health and Public Policy Committee of the ACP, “charged with addressing issues that affect the health care of the U.S. public and the practice of internal medicine and its Subspecialties,” reviewed studies available in PubMed and Google Scholar, as well as reports, surveys, news articles, and policy documents, dealing with the prevention and treatment of substance use disorder. Committee members then issued the following recommendations:

1. Substance use disorder is a chronic medical condition, and should be treated like one.

  • Evidence-based public and individual health initiatives should be expanded to help prevent, treat, and promote recovery.
  • All appropriate and effective methods for reducing substance use are supported by the ACP, including education, prevention, diagnosis, and treatment.
  • ACP supports medical research on this topic.
  • ACP recognizes the importance of addressing the stigma surrounding substance use disorder.

2. For those with substance use disorder who sell or possess illegal substances, treatment programs should be implemented as an alternative to incarceration or other criminal penalties.

3. Policymakers and researchers should carefully assess whether removing or reducing criminal penalties for non-violent crimes involving illegal substances would provide benefits to individuals and to society. In particular, the following questions should be investigated:

  • Does the relative risk of drugs to individuals and society outweigh the potential effect decriminalization or legalization would have on society?
  • Does criminalization act as a barrier to preventing and treating substance use disorders?
  • How does criminalization affect those with substance use disorders, including potential adverse effects based on race, socioeconomic status, or ethnicity?
  • Does decriminalization or legalization have an impact on the incidence of substance use disorders?
  • In states that have decriminalized or legalized marijuana, are policies aimed at minimizing adverse health impacts (especially regarding children and adolescents) effective?

4. Clinicians and other stakeholders (including medical and behavioral health professionals, public health officials, government programs, patient advocacy groups, insurance plans, and law enforcement) should cooperate to address the epidemic of prescription drug misuse.

  • Clinicians should implement and follow evidence-based guidelines for managing pain.
  • Naloxone access should be expanded to opioid users, law enforcement, and emergency medical personnel.
  • Lawmakers and insurance companies should consider lifting limits imposed on doctors who are treating patients with buprenorphine or methadone (limits on how many patients doctors can treat, prior authorization rules, lifetime limits on buprenorphine, restrictions on office-based methadone treatment, etc.)
  • Buprenorphine training and mentorship should be made widely available to clinicians.

5. Health insurance should be required to cover mental health and substance use disorders.

6. The workforce of professionals who are qualified to treat substance use disorders should be expanded.

7. Training for treating substance use disorders should be included in continuing medical education.

8. The effectiveness of public health interventions looking to combat substance use disorder (eg, syringe exchange programs, safe injection sites) should be analyzed.  

“Substance use disorders have been regarded as a moral failing for centuries, a mindset that has helped establish a harmful and persistent stigma affecting how the medical community confronts addiction,” wrote committee members. “We now know more about the nature of addiction and how it affects brain function, which has led to broader acceptance of the concept that substance use disorder is a disease, like diabetes, that can be treated.”

Working to more effectively treat those with substance use disorder is now even more important due to the opioid epidemic.

Conclusion

“Physicians can help guide their patients toward recovery by becoming educated about substance use disorders, proper prescribing practices, consulting prescription drug monitoring programs to reduce opioid misuse, and assisting patients in their treatment,” the researchers wrote.

“Policymakers can mitigate the effects of drug use by permitting harm reduction strategies, such as syringe exchange programs; supporting initiatives to increase the behavioral health workforce; testing evidence-based prevention and stigma-reduction programs; and encouraging treatment of substance use disorders among the incarcerated and diversion programs for those with nonviolent drug arrests,” they concluded.

Disclosures can be viewed at https://www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M16-2953

 

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Reference

  1. Crowley R, Kirschner N, Dunn AS, Bornstein SS. Health and public policy to facilitate effective prevention and treatment of substance use disorders involving illicit and prescription drugs: an American College of Physicians position paper [published online March 28, 2017]. doi:10.7326/M16-2953
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