Integrating Addiction Care into Everyday Medical Practice

Substance use disorders are among the most common health conditions in the United States, yet sufficient care is out of reach for many in need.  

Meeting the moment requires an all-hands-on-deck approach. Everyone in health care should have at least a general understanding of addiction as a disease, how to screen for and treat it, and understand the best language to use in the office regarding drug use.  

On March 13, the SNJMATCOE is hosting a full-day Office-Based Addiction Care symposium at Cooper University Hospital. There will be many lectures throughout the day touching on different facets of addiction and how everyone from the head of a family medical practice to front desk staff can be part of the solution.  

Jeff Jaeger, MD, an addiction medicine physician in the Cooper Center for Healing, helped to program the day’s curriculum and answered the following questions about the ways different medical offices can help people who struggle with addiction.  

On March 13, the SNJMATCOE is hosting a day-long training event to educate people about Office-Based Addiction Care. Why this topic? 

Addiction remains very common and is quite frequently undertreated. We have medications and strategies that can be very effective in treating addiction, but many outpatient medical providers feel under-prepared to use these medications and tools.  

Because of their frequent contact with patients, as well as the trust they establish with patients over often years, outpatient providers are well-positioned to provide this care. In this training, we aim to provide these providers (and the teams they work with) with the tools to provide this care in their practices. 

What does office-based addiction care look like?  

The most important role outpatient practices can play is in identifying substance use and substance use disorders, since you cannot treat what you do not diagnose. A big part of the training will be helping providers recognize SUD when they see it.  

From there, I would say the next important thing is assuring your practice has adopted strategies to minimize the stigma associated with SUD, as we know that stigma plays a big role in why patients choose not to disclose their substance use or seek care. 

After that, it is a matter of increasing comfort with the many FDA-approved medications we have to treat SUD. Notably, buprenorphine is a life-saving medication that can be (and should be) prescribed by anyone with a DEA license. There is a lot of anxiety about this medication, but with some training, it can be a part of anyone's toolbox for treating opioid addiction.  

One important goal of the training is to get attendees to the point where they feel comfortable assuming the prescriber role for patients already on buprenorphine, and, ideally starting the med for patients who need it. 

You talk about buprenorphine for OUD. What about other use disorders such as AUD or stimulant use disorder? Are there effective treatments that can be managed in someone’s primary care office? 

Certainly! The pharmacologic treatments for alcohol use disorder are effective, and relatively easy to prescribe. I’m referring to acamprosate, naltrexone, and disulfiram specifically. These work better with some counseling about pros and cons, side effects, etc., and our training will review some strategies to improve the likelihood of success. 

Stimulant use disorder is a challenge to treat, as there are no FDA-approved medications for this. But there are strategies as well as some meds that have shown some success, and we will be discussing those as well. 

Sedative use is very common in primary care as well as outpatient care in general. This includes benzodiazepines such as alprazolam (Xanax), clonazepam (Klonopin), or others. As these are habit-forming, overuse is unfortunately very common, which can have very serious consequences, especially in combination with other sedating medications, and in certain conditions like COPD and sleep apnea. Identifying and addressing overuse is an important role for outpatient providers, and we will be discussing strategies for when this arises. 

Benzodiazepines can have particularly dangerous withdrawal periods which can be fatal if mismanaged. Instead of abruptly stopping, it’s typically recommended to slowly taper doses down, which is very challenging, and warrants close attention (as well as patient agreement and participation). We will be addressing this as well, and providing tips for providers and practices who find themselves looking to undertake this. 

How does addiction screening work in outpatient settings?  

Identification is really as simple as having a system in place to ask patients about their substance use at regular intervals, say annually, or more often depending on other risk factors.  

Finding the language to ask in a way that is likely to garner honest answers is not so simple, but we will discuss strategies that work. For example, patients need to feel comfortable that answering honestly about substance use will be treated with the same confidentiality as other topics discussed in the clinical encounter and need to be reassured that they will be treated the same by providers and staff regardless of their answers. 

Reducing stigma is of course linked to this. This involves assuring that every single staff member in a practice comes to appreciate the importance of choosing words about substance use in a way that does not make patients feel worse about their situation.  

For example, we use the term "person with a substance use disorder" rather than "addict.” Seemingly simple changes like this can convey the message that we see the person first—not their disease. 

This training will be in person, with a virtual option. Besides lectures, what other activities are planned? 

We’ll be running group sessions that promise to be very interesting. We will be covering topics as diverse as how to incorporate peer navigators into practice, how to care for adolescents with SUD, and the nuts and bolts of telehealth in addiction medicine.  

It really does promise to provide practitioners with many tools to make it easier for them to provide excellent and rewarding care to these vulnerable patients.