New recommendations from the American College of Physicians (ACP) on the treatment of addiction will help physicians shift perspectives on how they treat the disease, a San Diego addiction specialist said.
On Monday, the ACP issued comprehensive recommendations for doctors prescribing and treating addiction disorders.
Some of the guidelines included asking physicians to become more familiar with appropriate guidelines related to pain management and controlled substances like prescription opioids and non-opioid drugs, becoming familiar with Prescription Drug Monitoring programs, learning more about naloxone, a drug used to reverse overdoses and learning more about medication-assisted treatment of opioid use disorders.
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The recommendations speak to something addiction specialists have known for years, said Clark Smith, M.D., an addiction specialist and director of Recovery Works in San Diego, a clinic offering help to those addicted to alcohol and drugs.
“The big thing today is, you know, they're saying what people in the addiction field have been saying for 20, 30 years: addiction should be considered an illness, just like any other illness," Smith said. "It’s treatable, it responds to treatment and may need lifelong treatment."
To effectively treat those addicted to alcohol and drugs, Smith said, doctors need to shift their perspectives on the disease. Oftentimes, he said, when addicts go through a hospital detox, they do not get any kind of treatment when they finish - and they end up relapsing.
One way to help patients looking for long term success is through proper prescribed addiction medication, Smith said. The first six to 12 months after detox and making the change to get sober are crucial, he added.
That's why the ACP's recommendation asking physicians to improve their training in the treatment of substance use disorders, including with buprenorphine-based treatment, is so important, Smith said.
Buprenorphine is the first medication to treat opioid addiction that can be prescribed in physician offices. The medication reduces cravings and withdrawal symptoms.
The move to ask physicians to consider medication to treat addiction is important, Smith said, because patients "really benefit from getting medication treatment, not just rehab or 12 steps - that actual medicational treatment makes a difference and gives them better success."
“With these medication treatments – and there are a couple others, Vivitrol is the most effective – the rate of relapse will go way down," Smith said.
Research from the San Diego and North County drug courts, Smith said, showed that patients who took all six doses of Vivitrol in their allotted times stayed drug free over the next two years.
But the reason many doctors have not been prescribing medication to treat addiction lies in the past, Smith said. In the past, medications with methadone, and others, have not been effective, Smith said.
“You know, a lot of addiction specialists don’t prescribe these medications either," Smith explained.
Some doctors still stick with old school treatments: 12 step programs, Alcoholics Anonymous, and power of will. While those can be effective for some, Smith said, using proper and effective medication can help longevity.
“Frankly they haven’t been very effective, especially for opiate addiction. So now we have new treatments and they’re much more effective and American College of Physicians is recognizing that and basically getting the word out that addiction should be treated like diabetes is treated," Smith said, referencing the fact that diabetes patients need constant treatment.
"They’re saying they’ll need lifelong treatment," Smith added. "Addiction is a chronic illness, although once people get clean and sober and are back to their own rehabilitation, they don’t necessarily need a lot of medical appointments."
Smith hopes that with these new guidelines comes a shift, and with that, more help for addiction patients.
"Addiction specialists have been advocating for this for a while," Smith said.