September 30, 2019

Screening+Support: An Addiction Specialist’s Perspective on Drug Screening Guidelines

Partners Population Health Perspectives blog aims to share the opinions and ideas of our leadership team on health care topics related to population health management. Sarah Wakeman, MD, is an addiction medicine specialist at Mass General and a national thought leader in treatment for substance use disorders. In this post, she shares her thoughts on newly proposed screening guidelines for illicit drug use.

The U.S. Preventive Services Task Force (USPSTF) recently published draft recommendations that all adults should be screened for drug use, stating that, “Screening should be implemented when services for accurate diagnosis, effective treatment, and appropriate care can be offered or referred.”

As a physician who specializes in Addiction Medicine, I am always on the lookout for progress in implementing best practices in the care of patients with substance use disorder—particularly during Recovery Month. The ongoing addiction and drug overdose crisis is a stark reminder of the morbidity and mortality associated with untreated drug use disorder. Just like many other health conditions, drug use disorder can be effectively screened for in general medical settings. This is crucial, because effective treatments exist—which can also be delivered right in the medical setting.

For far too long, because of historic stigma and misunderstanding, substance use disorders have been seen as something outside of the purview of health care providers and the medical system. The reality is, these are highly treatable conditions. Normalizing effective screening and management as a part of general medical care is absolutely crucial if we are going to get our arms around the ongoing public health crisis related to substance use.

The caveat is that screening must occur as a part of a broader implementation of services for effective treatment and ongoing management. This approach of building up an infrastructure of treatment and recovery supports and then working to expand screening is exactly what we have been doing in population health.

Over the past few years, we have been supporting the implementation and integration of key components of effective substance use disorder treatment into primary care across Partners. This has included training and mentorship in the prescribing of medications to treat opioid and alcohol use disorder, the use of recovery coaches, developing specialized substance use disorder treatment teams, developing tools in our electronic health record (EHR) to support buprenorphine prescribing, and providing case-based and didactic education.

These proposed recommendations are a huge step forward in integrating care for people who use drugs and people with drug use disorders into the health care system. By bringing conversation about drug use into mainstream clinical discussions and screening protocols—the same way a clinician would screen for heart disease or discuss symptoms of diabetes—the more we as providers can reduce the stigma associated with drug use.

Sarah Wakeman, MD is the Medical Director for the Mass General Hospital Substance Use Disorder Initiative, program director of the Mass General Addiction Medicine fellowship, and an Assistant Professor of Medicine at Harvard Medical School. She is also the Medical Director of the Mass General Hospital Addiction Consult Team, co-chair of the Mass General Opioid Task Force, and clinical lead of the Partners Healthcare Substance Use Disorder Initiative. She is the Medical Director of RIZE Massachusetts, a state-wide, private sector initiative created to build a $50 million fund to implement and evaluate innovative interventions to address the opioid overdose crisis.

She received her A.B. from Brown University and her M.D. from Brown Medical School. She completed residency training in internal medicine and served as Chief Medical Resident at Mass General Hospital. Clinically, she provides specialty addiction and general medical care in the inpatient and outpatient setting at Mass General Hospital and the Mass General Charlestown Health Center. 

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