Treat Substance Abuse as Chronic Condition, ACP Says

Veronica Hackethal, MD

March 27, 2017

The American College of Physicians (ACP) has issued a new policy statement with recommendations for preventing and treating substance abuse. The statement, published online March 27 in the Annals of Internal Medicine, emphasizes that substance abuse is a chronic medical condition and should be treated as such.

"Substance use disorders are treatable chronic medical conditions, like diabetes and hypertension, that should be addressed through expansion of evidence-based public and individual health initiatives to prevent, treat, and promote recovery," Nitin S. Damle, MD, MACP, said in an ACP news release. Dr Damle is president of the ACP.

The new policy will be discussed at the ACP Internal Medicine meeting, which opens in San Diego, California, on March 30.

Hospitalizations for opioid use disorder nearly doubled between 2002 and 2012, according to the statement.

ACP emphasizes that substance abuse heavily burdens society, places the health of individuals and families in jeopardy, disrupts communities, and drains healthcare resources. Although substance abuse is common among the general US population, prison populations suffer from even higher rates of the problem.

Unfortunately, access to treatment remains limited. In 2014, 22.5 million Americans needed treatment for substance abuse, but only 18% received it. In comparison, 77% of those with hypertension received treatment, as did 73% of those with diabetes and 71% of those with major depression.

To develop the policy statement, the ACP's Health and Public Policy Committee reviewed relevant material from PubMed, Google Scholar, news articles, policy documents, websites, and other sources. The committee also based recommendations on input from other ACP committees and nonmember experts.

The statement provides both clinical and health policy recommendations. It focuses on illicit drugs and misuse of prescription drugs, especially opioids. In the context of the paper, "illicit drugs" refers to marijuana, cocaine, heroin, hallucinogens, and inhalants. Although many states have legalized or decriminalized marijuana, the authors categorize it as illicit because federal law still prohibits it. Likewise, the ACP recognizes that alcohol and tobacco use pose serious problems to public health problems, but considered them outside the scope of the article.

To combat the growing problem of prescription drug abuse, the ACP recommends:

  • that physicians familiarize themselves with evidence-based guidelines about pain management and controlled substances, and follow them as deemed appropriate;

  • expanding access of naloxone for overdose prevention to opioid users, law enforcement, and emergency medical personnel;

  • expanding access to medical-assisted treatment and lifting barriers that limit access to medications for treating opioid use disorder such as methadone, buprenorphine, and naltrexone;

  • improved training in the treatment of substance use disorders, including buprenorphine-based treatment; and

  • establishing a National Prescription Drug Monitoring program and improving existing monitoring programs.

"Physicians can help guide their patients towards recovery by becoming educated about substance use disorders and proper prescribing practices, consulting prescription drug monitoring systems to reduce opioid misuse, and assisting patients in their treatment," Dr Damle said in the news release

He also strongly encourages prescribers to check Prescription Drug Monitoring Programs in their own and neighboring states before writing prescriptions for controlled substances.

Other ACP recommendations emphasize addressing stigma about substance abuse in the general population and medical community. The ACP recommends treatment through individual and public health interventions, rather than heavy reliance on criminalization and imprisonment.

The group also calls for health insurance coverage of mental health conditions and evidence-based treatment of substance use disorders, as well as upholding parity rules. Moreover, they recommend expansion of the professional workforce that treats substance abuse and embedding training for such treatment throughout medical education.

Finally, the ACP calls for studies that evaluate the effectiveness of public health interventions targeted at substance abuse, such as syringe exchange programs and safe injection sites.

The study was supported by the ACP. The authors have disclosed no relevant financial relationships.

Ann Intern Med. Published online March 27 2017.

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