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Experts Advocate for Wider Use of Academic Medicine in Overdose Prevention

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Key Takeaways

  • Opioid overdoses have increased significantly during the pandemic and reached a historic high in 2020.
  • Health leaders are calling for wider use of academic medicine to combat the opioid crisis.
  • Addiction medicine was only recognized as a specialty in 2016.

Opioid overdoses reached a national high in 2020 during the COVID-19 pandemic, and the numbers have continued to rise. Leaders from the National Institute on Drug Abuse and Addiction (NIDA) are now calling for broader use of academic medicine in overdose prevention.

Academic medicine refers to a multifaceted clinical approach that combines things like research, education, and exploration of new technologies into a person’s treatment. It includes refining substance use treatment, offering more specific training for physicians, combatting stigmas around addiction and substance use, and removing policies that bar patients from care.

Carlos Blanco, MD, PhD, director of NIDA’s Division of Epidemiology, Services and Prevention Research, says that academic medicine could help tear down current barriers that prevent many people from accessing life-saving care.

“A lot of people tend to see people with opioid use disorder and other substance use disorders as a moral failure, as vice or as something that we should not do, as opposed to a medical disorder,” Blanco tells Verywell.

Academic medicine is common in many renowned medical centers, but less so in the specific treatment of addictions. According to a recent paper by Blanco and other NIDA leaders, 42% of addiction treatment facilities offer certain initial treatment, while only 18% of people with opioid use disorder (OUD) receive any treatment at a specialty facility.

Blanco says OUD is a common disorder that “can hit anybody in any family.” 

“We as a nation have an obligation to really help everybody who has a disorder the same way that we help people who have obesity, or diabetes, or cardiovascular disease,” he says.

Stigma around substance disorders creates a two-fold problem in which some physicians are afraid to treat the patients and some patients are afraid to seek clinical help, he adds. This can result in clinicians not treating patients correctly or with dignity.

In the past, stigmas around other conditions have led to bad outcomes. For instance, epilepsy has been wrongly associated with witchcraft and the misconception remains in some places today. As society progressed, stigmas around epilepsy have been reduced in the United States and physicians are better equipped to treat patients, Blanco says.

Currently, not all healthcare centers include addiction medicine in their standard training. This means many doctors in the field are ill-equipped to handle patients struggling with substance use disorder. People who work with addiction may can also earn substantially less money than other healthcare professionals, Blanco adds.

Policy barriers around certain harm reduction medications—like methadone, which is used for OUD—can affect access to care, Blanco says.

Methadone is subject to a unique third tier regulation that establishes specific standards for how and when it can be used to treat OUD. Under current laws, patients receiving methadone must initially take the drug under physician supervision. If the patient needs one dose per day, that means they will need to plan for travel time and transportation methods on a daily basis. Some of these in-person barriers have been lifted due to the pandemic.

What Is Methadone?

Methadone is a synthetic opioid that can be prescribed for pain management or as medication-assisted treatment (MAT) to treat opioid use disorder. Some clinics administer methadone to help people wean off substances, like heroin, without experiencing extreme withdrawal. Its use is controversial in the harm reduction community because it is a type of opioid itself.

Joseph DeSanto, MD, an addiction specialist at BioCorRx, pursued a career in addiction medicine after getting sober from opioids in 2012.

He says addiction medicine was not a particularly popular choice. The American Medical Association recognized addiction medicine as a "self-designated specialty" in 1990 and the American Board of Medical Specialties officially recognized it as a medical subspecialty in 2016, according to the American Society of Addiction Medicine. Still, using his own recovery as reference, he saw value in the job.

“The first time I ever met an addiction doc—which is what inspired me to go into addiction medicine—was the guy that helped me get sober,” DeSanto says.

In his recovery, DeSanto considered his addiction specialists people he could trust. He strives to form trusting relationships with his own patients, with the hope of saving lives. But he says this end-goal isn’t always obvious at first.

“You don't get to see the benefits, the fruits of your labor, in the beginning,” DeSanto says. “It’s people who get sober, they build on it, then they go out and do good things, they help other people get sober, stay sober.”

What This Means For You

Aug 31 is International Overdose Awareness Day. This year, health authorities are focused on expanding access to prevention, treatment, and harm reduction efforts.

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  1. Centers for Disease Control and Prevention. Provisional Drug Overdose Death Counts. Updated August 11, 2021.

  2. Roberts LW. Academic medicine in the time of covid-19. Academic Medicine. 2020;95(8):1123-1124. doi.10.1097/ACM.0000000000003500. Published August, 2020.

  3. Volkow ND, McLellan T, Blanco C. How academic medicine can help confront the opioid crisisAcademic Medicine. 2021;Publish Ahead of Print. doi:10.1097/ACM.0000000000004289

  4. Bodey C. “Epilepsy is pathognomonic of witchcraft”: parental perspectives on childhood epilepsy and their treatment choices in South West UgandaArchives of Disease in Childhood. 2012;97(Suppl 1):A47-A47. doi:10.1136/archdischild-2012-301885.116