A Call to Arms: The Role of the Psychiatry Resident in the Current Opioid Epidemic

On February 2, 2016, the White House released an update to the President’s annual budget, proposing $1.1 billion in additional funding to address the growing epidemic of prescription opiate and heroin abuse in the United States. This revision of the 2010 National Drug Control Strategy and 2011 Prescription Drug Abuse Prevention Plan pledged improved access to medication-assisted treatment, addiction research, prescriber training and expanded prevention efforts for an illness to which the Centers for Disease Control and Prevention attributes greater annual mortality than motor vehicle accidents (1). Even as top government agencies fight to stem the tide of opiate abuse, overdoses, and deaths, the stigma of addiction persists—among the general population, those who represent us in government, and even our colleagues in medicine—resulting in inadequate access to what is now the standard of care for opiate use disorders: detoxification then multimodal treatment programs that include long-term opiate replacement medication (2). Reluctance to accept opiate replacement and harm-reduction practices as the new standard perpetuates inadequate care practices, despite compelling data that detoxification-only and abstinence-only approaches result in high rates of relapse and overdose (2–4).

The numbers of opioid users, overdoses, and deaths continue to escalate, with an alarming transition rate to heroin (now often laced with fentanyl at unpredictable potencies), despite legislative measures increasing prescriber oversight and limiting opioid availability (4). As psychiatrists, we have a unique role to play in this public health crisis.

Advocate Within Your Training Program

Request training in naloxone kit prescribing and counseling, and prescribe them to appropriate patients and their families (5). Obtain a Drug Enforcement Agency “X” license to prescribe buprenorphine/naloxone and be familiar with the practice. Seek to care for patients with comorbid substance and psychiatric disorders to better appreciate their accompanying diagnostic challenges and complex care needs. Request education on the ever-evolving legislative changes regarding opiates and other substances of abuse. Stay up to date with the literature linking substance use and chronic psychiatric illness (6).

Advocate Within Your Community

Encourage local governments to approve over-the-counter access to naloxone emergency kits (5). Be a proponent of the harm-reduction model: abstinence-only programs are often inadequate and can perpetuate stigma (2, 3). Emphasize the need to treat rather than incarcerate. Support the enforcement of prescription monitoring programs and mandated reviews by prescribers (5, 6). Volunteer to speak publicly to provide evidence-based information and combat stereotypes.

Advocate Within Your Medical System

Assess whether your hospital is equipped to host a needle exchange program or will accept unused medications (6). Seek out opportunities to collaborate with medical and surgical training programs to provide education about the treatment of patients with comorbid substance use disorders. Emphasize the importance of frequent reviews of prescription monitoring programs and the dangers of haphazard prescribing practices (5, 6).

During the last opiate epidemic of the 1880s, largely considered iatrogenic, physicians played a considerable role in limiting access to opiates, advocating for more appropriate prescribing practices, increased police involvement, and eventually the passage of the Harrison Act of 1915, which mandated monitoring and documentation of prescriptions from medical sources (2). We must prepare ourselves for the influx of patients who will need our care. We must provide care that is supported by the literature rather than public or political opinion. We can help curb this epidemic, like our predecessors before us.

In this issue of the Residents’ Journal, our authors have addressed topics highly relevant to the care of this complex and stigmatized population. We hope you find the articles a valuable read.