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Psychiatrists can, should help address the opioid epidemic
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Psychiatrists and mental health professionals have a vital role to play in addressing the national opioid epidemic, according to a viewpoint published in JAMA Psychiatry.
“We believe psychiatrists are uniquely skilled and ideally suited to be leaders in treating this epidemic,” Srinivas B. Muvvala, MD, from Yale School of Medicine, and colleagues wrote.
“Psychiatrists are unique among physicians in having specialty training in treating trauma, depression, and other co-occurring psychiatric disorders and assessing suicidal behavior; increasingly, there is a growing awareness of the association between suicide and opioid use,” they continued. “Psychiatrists can provide integrated mental health care and relapse prevention counseling and therefore are uniquely qualified to provide office-based addiction treatments efficiently.”
In this viewpoint, Muvvala and colleagues argued that all psychiatrists should have training in assessing and treating patients with opioid use disorder. To respond to the epidemic, they recommended more psychiatrists complete the 8-hour training needed to prescribe buprenorphine, psychiatrists include buprenorphine treatment in routine psychiatric practice, and all residency programs require buprenorphine education for physicians in training.
Psychiatrists can incorporate buprenorphine treatment into outpatient practices easily and safely and recent evidence supports the safety and feasibility of physicians initiating buprenorphine treatment at home, according to the viewpoint. Mentoring programs are available to help physicians overcome any concerns when prescribing buprenorphine.
“Psychiatrists are in an excellent position to meet the requirement that buprenorphine be given in conjunction with psychosocial services,” Muvvala and colleagues wrote. “Psychiatrists can provide in-house counseling and also work collaboratively with other disciplines (eg, psychologists, social workers, nurses and counselors).”
In addition, Muvvala and colleagues wrote that U.S. general psychiatry residency programs are lacking in basic areas of training and only require 1 month of addiction treatment experience.
“Training programs need to broaden the exposure of residents to effective treatments in addiction, particularly in outpatient settings that include competency in prescribing medications for [opioid use disorder],” they wrote. “Buprenorphine training should be a required competency of psychiatry training.”
Ensuring that mental health clinicians know resources for training and mentoring psychiatrists to prescribe buprenorphine exist is critical, the authors wrote.
“Addressing the national opioid epidemic is the responsibility of every psychiatrist,” Muvvala and colleagues wrote. “With commitment and a modest investment in further training, the expertise of psychiatrists in treating other psychiatric disorders can be extended to the effective treatment of [opioid use disorder].” – by Savannah Demko
Disclosure: One author reports consulting for Alkermes; no other relevant financial disclosures were reported.
Perspective
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Adam Bisaga, MD
While primary care providers can treat an uncomplicated opioid use disorder (OUD) as effectively as specialists, a significant number of patients have a more complex disorder. OUD can be complicated by other substance use disorders (SUDs) or co-occurring other psychiatric disorders, and psychiatrists are better positioned to treat those patients. However, many psychiatrists are reluctant to provide treatment to those patients, even though they treat other complex, chronic psychiatric disorders, and routinely prescribe controlled substances. One of the reasons is that like other physicians, psychiatrists share outdated, stigmatized views on the nature of addiction, which leads to unfounded fears of working with this patient population.
Psychiatrists often do not feel that they have sufficient training to provide such care and have limited access to the supervision and support networks necessary to become proficient in treating SUDs. Psychiatry residency programs often do not have an addiction psychiatrist on the faculty, which should become a requirement together with the modernized and expanded addiction training curriculum.
As Muvvala et al suggest, training on the use of buprenorphine and other medication in treatment of OUD should be a required competency of psychiatry training. In addition to becoming competent clinicians, psychiatrists are ideally suited to become consultants, supervisors, mentors and educators to help realign medical education and to support health care system as it evolves to provide effective care for individuals with OUD.
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