Intermediate
Workshop Session
Laura Kehoe, MD, MPH, FASAM
Medical Director, MGH Substance Use Disorder Bridge Clinic
Massachusetts General Hospital, Harvard Medical School
Sharon Stancliff, MD
Associate Medical Director of Harm Reduction in Health Care
New York State Department of Health
Elizabeth Salisbury-Afshar, MD, MPH, FAAFP, DFASAM, FACPM
Director of the Center for Multi-System Solutions to the Opioid Epidemic
American Institutes for Research (AIR)
The hallmark of addiction is loss of control and ongoing compulsive substance use despite negative consequences and is underscored by significant difficulty in executive functioning and organization. As such, especially early on in care or at a time of relapse, highly structured treatment modalities and scheduling are unrealistic for many at best, and potentially lethal for others at worst. If late or missed appointments result in longer waits or missed opportunities for care, or substance use results in discharge from care or referral to a higher level of care when the patient is either not able or ready to make such a change, the result can be no level of care.
Despite prescription drug monitoring programs, misuse deterrent opioid formulations, expanded education efforts for safe pain prescribing and SUD screening and management, increased buprenorphine trainings and expanded waivers, the substance use disorder treatment gap remains and the opioid overdose epidemic continues to soar. The landscape of the opioid epidemic has changed even more dramatically with fentanyl and carfentanyl, requiring more readily available care and flexible care models to help keep people engaged in care, while we work with them through the natural history of substance use disorder. By partnering with patients in this manner, we help keep them alive, lower their risk of ongoing serious health complications or overdose, and increase their chances of continuing to engage in meaningful treatment; we collaborate with them in the practice of harm reduction.
The session organizers will review harm reduction as patient centered care congruent with the practice of all medical specialties. They will describe specific case examples of how harm reduction can be used in clinical practice, review flexible care models to engage patients with ambivalence or other competing life priorities, and explore ways to gain buy-in from colleagues in order to shift culture and increase comfort in providing harm reduction care within their continuum.
The second half of the session will be spent in small groups where participants will review potential barriers to incorporating harm reduction into practice and explore how they would envision operationalizing and providing such care within their current practice.