Progress and Future: Meeting the Needs of the Nation's Substance Use Crisis.

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Back to table of contents Next article From the Guest EditorFull AccessProgress and Future: Meeting the Needs of the Nation’s Substance Use CrisisJustine W. Welsh, M.D., Joji Suzuki, M.D.Justine W. WelshSearch for more papers by this author, M.D., Joji SuzukiSearch for more papers by this author, M.D.Published Online:11 Apr 2019https://doi.org/10.1176/appi.focus.20190002AboutSectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail Drug overdoses are now one of the leading causes of injury and mortality in the United States. Similar to the U.S. strategy for the AIDS epidemic, the country needs a highly coordinated response to combat increasing rates of substance use. Unfortunately, many underserved areas still lack access to evidence-based treatments. Important questions about substance-related treatment strategies also remain unanswered, such as how long to leave individuals on medication-assisted treatment and whether certain formulations of buprenorphine work better for specific patient populations. This issue of Focus explores a range of substance-related topics that are clinically relevant to the practicing psychiatrist. The articles are written by some of the leading experts in the areas of clinical treatment, research, and drug related-policy. We thank Focus’s editor, Mark Rapaport, M.D., for encouraging us to highlight such an important topic.On the opioid front, Bertha Madras, Ph.D., a member of the President’s Commission on Combating Drug Addiction and the Opioid Crisis, and her colleague, Hilary Connery, M.D., Ph.D., provide an insightful analysis of the scope of the opioid crisis and governmental efforts to combat the growing epidemic (1). They also propose roles that psychiatrists could take in advocating for change and providing high-quality treatment of patients with substance use disorders. Richard Rosenthal, M.D., carries the theme of opioid-related disorders and offers a review of various delivery systems for intermediate- to long-acting buprenorphine maintenance treatment options, some of which are novel solutions to reduce issues related to diversion and nonadherence (2). Finally, Joji Suzuki, M.D., as a co-guest editor of this issue, discusses the approach to general hospital treatment of endocarditis that is associated with injection drug use (3).However, we also need to be careful not to have the opioid epidemic overshadow the demand for more effective treatment strategies for all substance use disorders. Co-guest editor Justine Welsh, M.D., examines the use of substances on college campuses, as well as some of the specific challenges and approaches to treatment in this population (4). Despite significant gains across the field, training in addictions remains limited not only in the medical community, but also in general psychiatry. In this issue, John Renner, M.D., provides a review of the inadequacy of addiction training among psychiatric residents and the stigma associated with substance use treatment (5). To overcome such challenges, he proposes ways to incorporate additional training into the psychiatric curriculum based on his experience working with the Boston University/Veterans Affairs training model. Amid the changing political landscape, Arthur Williams, M.D., and Kevin Hill, M.D., M.H.S., offer insight into cannabis policy and provide a comprehensive review on the epidemiology and treatment of cannabis use disorder (6). Muhammad Iqbal, M.D., and colleagues explore treatment recommendations for co-occurring substance use disorders and other psychiatric conditions (7). We hope that these articles provide much-needed insights into the significant progress our field has made and where we hope to go in our ability to provide tailored treatment options to individuals with substance use disorders.Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta (Welsh); Department of Psychiatry, Brigham and Women’s Hospital, and Harvard Medical School, Boston (Suzuki).References1 Madras BK, Connery H: Psychiatry and the opioid overdose crisis. Focus 2019; 17:128–133Google Scholar2 Rosenthal R: Novel formulations of buprenorphine for treatment of opioid use disorder. Focus 2019; 17:104–109Google Scholar3 Suzuki J: Assessment and management of endocarditis among people who inject drugs in the general hospital setting. Focus 2019; 17:110–116Google Scholar4 Welsh JW, Shentu Y, Sarvey DB: Substance use among college students. Focus 2019; 17:117–127Google Scholar5 Renner JA: Counteracting the effect of stigma on education for substance use disorders. Focus 2019; 17:134–140Google Scholar6 Williams AR, Hill KP: Cannabis and the current state of treatment for cannabis use disorder. Focus 2019; 17:98–103Google Scholar7 Iqbal MN, Levin CJ, Levin FR: Treatment for substance use disorder with co-occurring mental illness. Focus 2019; 17:88–97Google Scholar FiguresReferencesCited byDetailsCited byNone Volume 17Issue 2 Spring 2019Pages 87-87The Changing Landscape of Substance Use Disorders KeywordsAdministrationDrug/Substance AbusePDF download