During a recent series of panel discussions on how best to address the opioid crisis, one factor repeatedly came up — stigma. One panelist, Dr. Michelle Tuten, associate professor at the University of Maryland School of Social Work, devoted her remarks to the topic of stigma during the most recent presentation held by the Office of Philanthropy at the University of Maryland, Baltimore.
She called stigma “a factor that arguably has had the most profound impact on the creation of the opioid epidemic, and one that will continue to impact what solutions are available for addressing the opioid crisis.”
Finding solutions was uppermost on the minds of those who organized and attended the gatherings throughout the region in 2018. UMB President Jay A. Perman launched the series at an event held in April in Anne Arundel County. Panel discussions were also held in Howard and Montgomery counties throughout the year.
The series, “UMB: Targeting Solutions to the Opioid Crisis,” concluded Nov. 8 at the Grand Lodge of Maryland in Cockeysville with a presentation by Tuten and three other UMB faculty members who have expertise in substance abuse treatment and research.
Representing the University of Maryland School of Pharmacy was Bethany DiPaula, a professor in the Department of Pharmacy Practice and Science. Representing the University of Maryland School of Medicine were Dr. Christopher Welsh and Dr. Eric Weintraub, associate professors in the Department of Psychiatry.
Weintraub, who served as moderator, reminded the invited audience of the epidemic’s toll. In Maryland last year, he said, more than five people a day lost their lives to opioid-related overdoses.
Contributing to the stigma are significant misconceptions about opioid use disorders, said Tuten, who is co-director of the Center for Addiction Research, Education, and Service, or CARES. The center is UMB’s interdisciplinary effort to address the adverse impact of addiction.
Misconceptions that fuel the stigma about addiction “run counter both to science and what we know about the nature of substance use disorders,” Tuten said. “Truth is a powerful weapon.”
These misconceptions include a perception that individuals are lacking in moral character and willpower; that usage is a choice that can be stopped at any time; that continuation is a refusal to change; and that the only real measure of success is complete abstinence during and following treatment. Indeed, voluntary control is affected by genetic vulnerability, environmental factors and, most significantly, the effects of addictive substances in the brain, she said.
Beyond the general public, inaccuracies persist even among providers, Tuten said. These include mistaken perceptions that individuals with substance use disorders are harder to treat; are less compliant; and relapse at exceptionally high rates.
Panelists called for greater understanding among health care professionals of the effectiveness of medication-assisted therapies, such as buprenorphine and methadone, and the methods involved in administering them. DiPaula and Welsh spoke of ways that they are broadening clinicians’ knowledge in their respective disciplines.
DiPaula is a board-certified psychiatric pharmacist who directs the Psychiatric Pharmacy Residency Program at UMSOP and pharmacy services at the Springfield Hospital Center in Sykesville. Working under the state’s collaborative drug therapy management protocols, she has worked at several clinical sites as part of the health care team treating patients with psychiatric and substance use disorders.
“I serve as a physician extender,” DiPaula said. “This type of practice will work in multiple outpatient settings. We’ve also been able to demonstrate that it can optimize care and save costs,” she said, referring to data collected at three different health care settings. And each site has a training rotation “so we can train future pharmacists to continue to work in this practice area.”
Welsh is medical director of outpatient addiction treatment services at the University of Maryland Medical Center. As medical director of the Substance Abuse Consultation Service at the hospital, he oversees substance abuse assessment and intervention with patients throughout the medical center.
“We try to treat people when they’re willing and ready,” he said, referring to a multi-disciplinary team that provides consultations and sees dozens of people per day who are admitted to UMMC for a variety of reasons. Welsh said he is working with Baltimore City to help other hospitals replicate the model.
Beyond that, he said, “We’re trying to help throughout the rest of the state.” For example, he and other experts are now on call when primary care physicians need to consult with them about addiction treatment. Calls that were initially focused on methadone and buprenorphine now extend to complicated pain management, he said.
Patricia Fanning is a senior media relations specialist at the University of Maryland, Baltimore, which approved the re-publication of this story.