ACP: Substance Use Disorder Prevention, Treatment Recommendations

The American College of Physicians (ACP) published a set of public policy recommendations for the prevention and treatment of substance use disorders involving illicit and prescription drugs. 

Nitin S. Damle, MD, MS, MACP, president, ACP stated, “Substance use disorders are treatable chronic medical conditions, like diabetes and hypertension, that should be addressed through expansion of evidence-based public and individual health initiatives to prevent, treat, and promote recovery.”

The paper, published in the Annals of Internal Medicine, states that only 18% of the 22.5 million people in the United States who need treatment for an illicit drug or alcohol use problem receive it. The recommendations focus on substance use disorder related to illicit drugs and misuse of prescription drugs, particularly opioids. 

Marijuana was included as an illicit drug because its use and possession remains illegal in many states. And though alcohol and tobacco use disorders are recognized as public health issues, they were deemed “outside the scope of this paper.”

The major recommendations include the following:

1. Substance use disorder is a chronic medical condition and should be managed as such.
2. ACP supports the implementation of treatment-focused programs as an alternative to incarceration or other criminal penalties for persons with substance use disorders found guilty of the sale or possession of illicit substances.
3. Stakeholders should assess the risks and benefits of removing or reducing criminal penalties for nonviolent offenses involving illicit drugs.
4. Multiple stakeholders should cooperate to address the epidemic of prescription drug misuse, including the following strategies: implementation of evidence-based guidelines for pain management; expansion of access to naloxone to opioid users, law enforcement, and emergency medical personnel; expansion of access to medication-assisted treatment of opioid use disorders; improved training in the treatment of substance use disorders, including buprenorphine-based treatment; establishment of a national prescription drug monitoring program (PDMP); and improvement of existing monitoring programs.
5. Health insurance should be required to cover mental health conditions, including the evidence-based treatment of substance use disorders, and abide parity rules.
6. The workforce of professionals qualified to treat substance use disorders should be expanded.
7. Training in the treatment of substance use disorders should be embedded throughout the continuum of medical education.
8. The effectiveness of public health interventions to combat substance use disorders and associated health problems should be studied.

“Physicians can help guide their patients towards recovery by becoming educated about substance use disorders and proper prescribing practices, consulting prescription drug monitoring systems to reduce opioid misuse, and assisting patients in their treatment,” said Dr. Damle.

For more information visit annals.org.