2023/04/25
LIFE-HEALTH-ADDICTION-TREATMENT-DMT.
- Dreamstime/Dreamstime/TNS
PHILADELPHIA — As a primary care physician at Jefferson Health, Greg Jaffe helps his patients navigate diabetes and high blood pressure, flu shots and annual checkups — standard fare for a family medicine practitioner. But for many of his patients, he also oversees a type of care that most of his colleagues in primary care won't take on: addiction treatment.
Jaffe had no intention of treating patients for addiction when he became a doctor. But in 2021, he began running a small, once-a-week clinic at Jefferson that prescribed patients buprenorphine, an opioid-based addiction medication. After patients are stabilized at the clinic, they are transferred to primary care physicians — including Jaffe — making their long-term addiction treatment more convenient.
Jaffe's new slate of patients has opened his eyes to the benefits of providing addiction medicine along with primary care, as a kind of one-stop shop for patients who often face significant barriers to getting any kind of health care.
New research backs up this idea. Primary care physicians who care for people with addiction can prevent more people from dying of an overdose, according to a new study from the University of Pittsburgh.
People with opioid addiction are often referred to specialty treatment clinics — even if they seek help from their primary care doctor. But offering overdose-reversing drugs and addictiontreatment medication through routine primary care visits could help people with addiction lower their overdose risk and live longer than if they got treatment elsewhere, according to a new study published in JAMA Open Network.
The approach has challenges: Patients may not have an established primary care provider. And doctors may not be trained in addiction treatment. But in Philadelphia, doctors who have already integrated addiction treatment into their practice say it's a strategy with big potential.
Some doctors, Jaffe said, don't know much about addiction medications and may judge people who use drugs.
"Doctors don't want 'those people' in their waiting room," he said, but addiction is widespread enough that it's likely primary care doctors are already treating patients with addiction without realizing it.
Jaffe has grown close with several patients in his addiction clinic who transferred to his primary care practice. He relishes the opportunity to address other health concerns they have outside of their addiction.
"Addiction medicine is primary care," he said. "We can treat their opioid-use disorder, but we can also treat them as whole patients."
The new study out of University of Pittsburgh reinforces what Jaffe has learned from his own practice.
The study used data on drug users, their risk of overdoses and infections, and their likelihood to enter treatment to create hypothetical models that simulated an addiction patient's journey through the treatment system, said Raagini Jawa, an assistant professor of medicine at Pitt and the lead author of the study.
The study tested three scenarios:
1. Patients received buprenorphine, an opioid-based addiction medication from a primary care doctor.
2. Patients received both buprenorphine and kits with tools to reduce the harmful effects of drug use, including sterile syringes and the overdose-reversing drug naloxone.
3. Patients were referred to an outside clinic for addiction treatment. This approach most closely resembled how primary care doctors typically handle patients needing addiction treatment.
Researchers estimated that patients who received addiction medication alone and those who received medication plus harm-reduction tools extended their life expectancy by more than two and a half years. And patients who got both buprenorphine and harm-reduction tools were 33% less likely to die due to an infection from drug use or an overdose.
Jawa said researchers used a hypothetical model because real-world research on primary care and addiction treatment tends to be affected by the same barriers that keep many family doctors from treating opioid-use disorder at their own practices.
"We have plenty of studies where we have tried to implement addiction treatment into primary care. They run into barriers like a lack of time, a lack of program leadership support, stigma, and low interest in treating opioid-use disorder," she said. "A model can tell us what the magnitude of a potential strategy is — what can happen in an ideal world."
Jawa treats addiction at her own primary care clinic and says her patients benefit from being able to address all their health needs at a single office, instead of going elsewhere for addiction treatment.
"For a lot of our patients with substance-use disorder, there's so much stigma when it comes to accessing any sort of health care," she said. "If there's one face that can be their go-to provider, that helps with building trust. It becomes a medical home."
PHILADELPHIA — As a primary care physician at Jefferson Health, Greg Jaffe helps his patients navigate diabetes and high blood pressure, flu shots and annual checkups — standard fare for a family medicine practitioner. But for many of his patients, he also oversees a type of care that most of his colleagues in primary care won't take on: addiction treatment.
Jaffe had no intention of treating patients for addiction when he became a doctor. But in 2021, he began running a small, once-a-week clinic at Jefferson that prescribed patients buprenorphine, an opioid-based addiction medication. After patients are stabilized at the clinic, they are transferred to primary care physicians — including Jaffe — making their long-term addiction treatment more convenient.
Jaffe's new slate of patients has opened his eyes to the benefits of providing addiction medicine along with primary care, as a kind of one-stop shop for patients who often face significant barriers to getting any kind of health care.
New research backs up this idea. Primary care physicians who care for people with addiction can prevent more people from dying of an overdose, according to a new study from the University of Pittsburgh.
People with opioid addiction are often referred to specialty treatment clinics — even if they seek help from their primary care doctor. But offering overdose-reversing drugs and addictiontreatment medication through routine primary care visits could help people with addiction lower their overdose risk and live longer than if they got treatment elsewhere, according to a new study published in JAMA Open Network.
The approach has challenges: Patients may not have an established primary care provider. And doctors may not be trained in addiction treatment. But in Philadelphia, doctors who have already integrated addiction treatment into their practice say it's a strategy with big potential.
Some doctors, Jaffe said, don't know much about addiction medications and may judge people who use drugs.
"Doctors don't want 'those people' in their waiting room," he said, but addiction is widespread enough that it's likely primary care doctors are already treating patients with addiction without realizing it.
Jaffe has grown close with several patients in his addiction clinic who transferred to his primary care practice. He relishes the opportunity to address other health concerns they have outside of their addiction.
"Addiction medicine is primary care," he said. "We can treat their opioid-use disorder, but we can also treat them as whole patients."
The new study out of University of Pittsburgh reinforces what Jaffe has learned from his own practice.
The study used data on drug users, their risk of overdoses and infections, and their likelihood to enter treatment to create hypothetical models that simulated an addiction patient's journey through the treatment system, said Raagini Jawa, an assistant professor of medicine at Pitt and the lead author of the study.
The study tested three scenarios:
1. Patients received buprenorphine, an opioid-based addiction medication from a primary care doctor.
2. Patients received both buprenorphine and kits with tools to reduce the harmful effects of drug use, including sterile syringes and the overdose-reversing drug naloxone.
3. Patients were referred to an outside clinic for addiction treatment. This approach most closely resembled how primary care doctors typically handle patients needing addiction treatment.
Researchers estimated that patients who received addiction medication alone and those who received medication plus harm-reduction tools extended their life expectancy by more than two and a half years. And patients who got both buprenorphine and harm-reduction tools were 33% less likely to die due to an infection from drug use or an overdose.
Jawa said researchers used a hypothetical model because real-world research on primary care and addiction treatment tends to be affected by the same barriers that keep many family doctors from treating opioid-use disorder at their own practices.
"We have plenty of studies where we have tried to implement addiction treatment into primary care. They run into barriers like a lack of time, a lack of program leadership support, stigma, and low interest in treating opioid-use disorder," she said. "A model can tell us what the magnitude of a potential strategy is — what can happen in an ideal world."
Jawa treats addiction at her own primary care clinic and says her patients benefit from being able to address all their health needs at a single office, instead of going elsewhere for addiction treatment.
"For a lot of our patients with substance-use disorder, there's so much stigma when it comes to accessing any sort of health care," she said. "If there's one face that can be their go-to provider, that helps with building trust. It becomes a medical home."
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