Philadelphia Medicine Winter-Spring 2021 - 23

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So what is best for
the patient?

" It's hard to understate how dire the
situation is right now, " Bass said.
People are more alone and stressed out,
Bass said.

" This question seems to weigh abstinence
as the preferred outcome for someone who is
in recovery, and we know that recovery does
not happen only through abstinence, " Bass
said. " What would happen if we measured
treatment success by a person's overall health
and not on completing an indefinite period
of abstinence? This could give people a
larger sense of autonomy and acknowledge
that addiction is a chronic relapsing disease. "
Bass noted that it may be better to " reframe " substance use disorder in the chronic
disease model, which " would encourage
patients to seek medical attention when they
need it, rather than avoid medical visits when
they are using drugs because they are afraid
of being treated poorly, " she said.

What's the best option?

The recent Morbidity and Mortality
Weekly Report, or MMWR, by the Centers
for Disease Control and Prevention, or
CDC, indicates an increase in substance use,
according to Bass.

Bass also empowers patients to make the
right choice for themselves, as far as which
type of medication and what other adjunctive
treatments (such as counseling and support
groups) to use by giving them all of their
options and outlining each option's risks
and benefits.

Have to be options

" Ask patients what they think will work
There have to be options for treatment,
best for them, " she said. " If they prefer
and
that's why it is important to know and
abstinence, whether it is because of their
understand
where a patient is coming from.
religious affiliation or their family's influence
on their health decisions, my job is to make
" I prefer to use any treatment options that
sure that this patient understands that they my patient chooses for themselves, " Bass said.
will be at a much higher risk of death from " I am focused on keeping my patients alive,
a fentanyl overdose if they choose to use any so I want to make sure they have access to
street drug, because fentanyl has contaminated all options (recognizing that an outpatient
the drug supply. "
treatment program is the only place to access
methadone).
I also make sure that all of my
Bass works to ensure the patient has
patients
have
Narcan
readily available. "
Narcan to stop a fatal opiate overdose, and

" that their family and friends know where
they keep it and how to use it when it is
needed, " she said.

According to Drugs.com, Narcan, a
brand name for naloxone, blocks or reverses
the effects of opioid medication, including
extreme drowsiness, slowed breathing or loss
of consciousness.
Bass noted Narcan can be mailed to your
home as a Philadelphia resident. To learn how,
visit www.bit.ly/MailNarcan.
" I like to give patients all the possible
options, including medication for opioid
use disorder, " Bass said.
That includes Naltrexone, Buprenorphine
(with and without naloxone) and Methadone,
" which has the most evidence for reducing
morbidity and mortality, " she said.

But there are other factors in a patient's life.
Are they getting proper nutrition? What is
their housing situation? Are they emotionally
sound? Can they receive comfort and self-care?
" Another important aspect to consider
is connecting people with housing, as this
has been shown to help with sustained
recovery, " Bass said. " People who use drugs
are often undertreated for their other chronic
conditions. "
One size does not fit all, Bass cautioned.
And a combination of the pandemic and
ongoing substance abuse in the general
population is exacerbated by the strains of
COVID-19 mitigation efforts and regulations
that hamper us all.

" Admissions to the emergency department
for liver ailments attributed to alcohol are
increasing, overdose rates are higher than ever
recorded and our drug supply is contaminated
with fentanyl, " she said. " Inpatient addiction
treatment beds have been restricted for much
of the past year because of COVID-19, so we
need to make sure that access to treatment
is easily obtained in ways that patients can
actually receive it. "
Bass said that primary care, outpatient
treatment programs or locations that can
treat multiple co-morbidities are good fits
for many of these patients.
" This is highlighted by the need for
treatment of common comorbidities with
substance use, such as hepatitis C virus, HIV,
soft-tissue infections and endocarditis, among
others, " she said.
Connecting with patients who use drugs
allows us to offer preventative medicine such
as cancer screenings and PrEP (pre-exposure
prophylaxis, the medicine people at risk for
HIV take to prevent getting HIV from sex
or injection drug use), she said.
" Allowing for treatment of all the comorbidities in one location increases success, "
Bass noted.
Also important: " One thing that is extremely harmful is discontinuing pregnant
patients from buprenorphine or methadone, "
Bass said. " It is also recommended not to have
any pregnant patients go through withdrawal. "
In the end, a whole-patient approach
works best.
" We need to start teaching all health care
professionals how to successfully screen
for substance use and to treat withdrawal
symptoms, so we can better engage this
patient population, " Bass said. *

Winter-Spring 2021 : Philadelphia Medicine 23

https://philamedsoc.org/ http://www.Drugs.com http://www.bit.ly/MailNarcan

Philadelphia Medicine Winter-Spring 2021

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