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ACP issues guidance to prevent, treat substance use disorders

Substance use disorders related to illicit and prescription drugs, including opioids, can be effectively prevented and treated through public and individual health interventions, according to a position paper drafted by ACP’s Health and Public Policy Committee and published in Annals of Internal Medicine.

“Drug overdose deaths, particularly from opioids such as prescription pain relievers and heroin, is a rising epidemic,” Nitin S. Damle, MD, MS, MACP, president of ACP, said in a press release. “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.”

More than 22.5 million Americans required treatment for illicit drug or alcohol use in 2014, according to the press release; however, only 18% received any treatment, which is extremely low compared with rates of patients receiving treatment for hypertension (77%), diabetes (73%) and major depression (71%), indicating limited access to care for substance use disorders, the ACP noted.

The ACP offered several essential recommendations to combat the epidemic of substance misuse based on its review of multiple databases of studies, reports and surveys — mostly conducted within the past 10 years — that evaluated the prevention and treatment of substance use disorders. It recommends that physicians familiarize themselves with and follow appropriate clinical guidelines related to pain management and controlled substances, including prescription opioids, nonopioids and nondrug interventions. Access to naloxone to opioid users, law enforcement and emergency personnel, as well as access to medication-assisted treatment of opioid use disorders should be expanded, according to the ACP. Training in substance use disorders treatment should be improved and implemented throughout medical education, the ACP recommended. The organization also supports establishing a national Prescription Drug Monitoring Program while improving upon existing monitoring programs.

“ACP strongly urges prescribers to check Prescription Drug Monitoring Programs in their own and neighboring states as permitted prior to writing prescriptions for medications containing controlled substances,” Damle said.

In addition, the ACP recommends that treatment-focused programs should be implemented as an alternative to incarceration or other criminal penalties for individuals with substance use disorder guilty of selling or possessing illicit substances. ACP supports mental health coverage requirements for insurers, including evidence-based substance use disorders treatment. There should be an expansion of professionals qualified to treat substance use disorders, the ACP suggests. Public health interventions aiming to reduce substance use disorders and associated health problems should be evaluated for effectiveness, according to the ACP.

“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,” Damle said.

The ACP noted that it included marijuana as an illicit drug within the paper. The paper does not address alcohol or tobacco use disorders. - by Alaina Tedesco

Disclosure: The authors report financial support from the ACP operating budget.