Addiction Treatment in the COVID Era

Special Section: From the SFMMS Addiction Conference

ADDICTION TREATMENT IN THE COVID ERA

David E. Smith, MD

On June 18, 2021, the annual David E. Smith Symposium convened online, sponsored by the San Francisco Marin Medical

Society. Held annually since 1968, the conference serves as a platform to raise awareness about developments in the treatment of addiction and substance use disorders. Throughout its history, the conference has brought knowledge about addiction medicine to West Coast practitioners. This year’s theme was “Addiction Treatment in the Covid Era.”

My collaboration with the San Francisco Medical Society goes back more than 50 years, beginning soon after I founded the Haight Ashbury Free Clinic during the Summer of Love in 1967. My malpractice carrier refused to cover the clinic’s operations, serving youth who migrated to San Francisco. The San Francisco Medical Society stepped in to insure us so we could continue. The Haight Ashbury Free Clinic’s successor, HealthRight360, still provides medical, dental, and behavioral health services to 40,000 people annually in 11 California counties.

Today, San Francisco is the epicenter for a nationwide drug crisis: in 2020, 80 lives were lost to fentanyl overdose for every 100,000 people in the city. The National Institute for Drug Abuse (NIDA) has labeled this phenomenon “deaths of despair.” Contributing to this, street drugs, including methamphetamine and Xanax, are often laced with fentanyl to boost their effect. Substance use disorder strains the medical resources of every specialty, as it leads to a variety of problems, such as methamphetamine psychosis, overdoses requiring emergency care, and endocarditis resulting from injecting drugs.

This year, Symposium presenters covered changes to the rules governing buprenorphine, a mixed agonist-antagonist that represents a major advance in the options for the medical treatment of addictive disorders. Buprenorphine, a Schedule 3 drug, offers more access than methadone, a Schedule 2 drug which is only available in a limited number of federal- and state- approved opiate treatment programs. Still, a recent study in ASAMs Journal of Addiction Medicine found that only 13 percent of residents felt qualified to treat opiate addiction when the patients entered the medical system.

Furthermore, 89 percent of those residents said they believe that Drug Enforcement Agency (DEA) restrictions and training requirements compromised their ability to use these medicines. To administer buprenorphine for this purpose, physicians must apply to the DEA for a waiver (the “X waiver”) and take a training course. To improve the medical response, HHS is relaxing the X waiver requirements, in the hopes that doing so will reduce some of the impediments to physician responses to the opiate crisis. Regina LaBelle, acting director of the Office of National Drug Control Policy, said, “Addiction treatment should be a routine part of healthcare, and this new guideline will make access to quality treatment for opioid use disorders more accessible. The guideline is an important step forward in our efforts to bend the curve of the overdose and addiction epidemic.”

Some of our other faculty have summary essays in this issue of the SFMMS journal, wherein you can read of some of the latest concepts in addiction etiology, treatment, and recovery. The half-day online conference was very well-received and is posted in full on the SFMMS website, www.sfmms.org .

My co-chair Steve Heilig of the SFMMS and I thank the San Francisco Marin Medical Society for hosting this year’s conference. Presenting the latest guidelines and scientific advances—free of charge—to the San Francisco medical community and frontline health care workers is consistent with the original motto of the Haight Ashbury Free Clinic, “Health care is a right, not a privilege.”

David E. Smith, MD is a 54-year SFMMS member; Founder, Haight Ashbury Free Clinics; Past-president of the California Society of Addiction Medicine and the American Society of Addiction Medicine; and one of the most highly-awarded UCSF faculty members for his leadership, teaching, research and more.

References

Shuey B. et al, “Evaluation of Resident Physicians' Knowledge of and Attitudes Towards Prescribing Buprenorphine for Patients With Opioid Use Disorder.” J Addiction Med Volume 15, Number 3, May/June 2021.