A Call for a ‘Peace Plan’ to Properly Treat Opioid Use Disorder

At the 2021 Rx Drug Abuse and Heroin Virtual Summit, IBH President Robert L. DuPont, MD presented a session entitled. “Combining Medications With 12-Step Model Treatment” that he co-presented with Marvin D. Seppala, MD, of the Hazelden Betty Ford Foundation, Center City, Minnesota. In a follow-up interview for the Rx Summit Newsroom, Dr. DuPont focuses on the need for a “peace plan” between substance use disorder treatment models that use and do not use medications.

Video Interview Part 1

Dr. DuPont discusses the 12‑step‑oriented model of addiction treatment and the need for it to “add medication as a fully respected, long-term option for patients with opioid use disorder”. He also discusses his goal to help the 2 treatment camps “stop fighting with each other” and his hopes that both can” work together in mutual respect”.

Video Interview Part 2

Should physicians with opioid use disorders be offered an option of opioid agonist treatment?

A new article published in the Journal of the Neurological Sciences reviews neuropsychological impairment associated with substance use by physicians; describes common neurocognitive deficits following use of various drug classes; and reviews the neurocognitive impact of pharmaceutical treatments for opioid use disorder (OUD). Authors emphasize the importance of continued testing/monitoring for physicians with substance use disorders (SUDs) following acute treatment.

In response to this review article, Robert L. DuPont, MD and Mark S. Gold, MD authored a commentary published in Clinical Psychiatry News, noting that to understand the controversy over the use of medication-assisted treatment (MAT) in the care management of physicians with OUDs requires: 

• An understanding of state PHPs and how those programs oversee the care of physicians diagnosed with SUDs, including OUDs; 

• Recognition that medical practice in relationship to SUDs is treated by state licensing boards as a safety-sensitive job; and

• An understanding of the historical context of the unique system of care management for physicians which began in the early 1970s.

"Dr. Polles and colleagues call attention to the unique care management of the PHP for all SUDs, not just for OUDs, because the PHPs set the standard for returning physicians to work who have the fitness and cognitive skills to first do no harm. They emphasize the importance of making sustained recovery the expected outcome of SUD treatment. There is a robust literature on the ways in which this distinctive system of care management shows the path forward for addiction treatment generally to regularly achieve 5-year recovery. The current controversy over the potential use of buprenorphine and buprenorphine plus naloxone in PHPs is a useful entry into this far larger issue of the potential for PHPs to show the path forward for the addiction treatment field." Read more.