When caring for patients with opioid and other substance use disorders, focus on using tools such as evidence-based medications, naloxone, and fentanyl test strips.
Lifelong Learning in Clinical Excellence | August 31, 2022 | 2 min read
By Brendan Saloner, PhD, Johns Hopkins Medicine, Omeid Heidari, PhD, NP, MPH, Johns Hopkins Medicine
A mobile treatment van parked outside the Baltimore City Detention Center serves a transient patient population, including many who are leaving jail custody. At a recent visit, Heidari met with a Black patient about his substance use. The patient shared how buprenorphine allowed him to reduce his heroin use over time and eventually stop. During his appointments how he uses buprenorphine to address his withdrawals and cravings was discussed, as well as his ongoing cocaine use and safer ways to use it. They had a conversation about long-term goals, connecting with a therapist, and preventing or reversing an overdose for his friends. A “one-size-fits-all” algorithm doesn’t work in treating most chronic diseases. The same applies to treating patients with opioid use disorder.
These small lessons reveal a larger insight into how clinicians can help reduce overdose risk for minority patients. The moment is critical–the exponential surge in American drug overdose deaths have affected all communities, but the recent impact has been especially severe on minority communities. In 2020, overdose deaths for Black and Native Americans exceeded the rate for White counterparts. Fentanyl is the most commonly involved drug in overdose, increasingly in combination with stimulants such as cocaine and methamphetamines.
Here are few things we can do:
1. Engage patients on their individual risk factors.
Don’t know if your patients use drugs? Just ask. A non-judgmental conversation about drug use can reveal how often patients use drugs, which drugs they use, and in what manner. This prepares you to have a more targeted conversation with patients about what resources they’d like to use.
2. Practice harm reduction.
Ensure that patients who use drugs leave a visit with a prescription for naloxone, or even better, a kit in hand. Even patients who don’t regularly use opioids can benefit from naloxone and overdose education because of the growing presence of fentanyl in the street drug supply. Fentanyl test strips are a helpful tool for patients who aren’t sure if their drugs contain fentanyl.
3. Embrace low threshold treatment.
If you diagnose an opioid use disorder, connect your patient with treatment or start them on buprenorphine in your office. The growing evidence suggests that rapid induction with medication helps patients reduce or eliminate illicit drug use, manage their symptoms of withdrawal, and ultimately save their lives. Not currently licensed to prescribe buprenorphine? The federal training requirement for controlled substance prescribers was eliminated in 2021 meaning that you can complete a quick “Notice of Intent” application here to get started.
This piece expresses the views solely of the author. It does not necessarily represent the views of any organization, including Johns Hopkins Medicine.