What is Next in the Fight Against Substance Use Disorders Globally?

Picture Source: (Coleman, 2020)

Over the past weeks, we have explored the global approaches to Substance Use Disorder policies and treatments. Some countries, such as Portugal and France, are ahead of the curve in their approaches to this global problem. And, unfortunately, some countries are miles behind, such as Russia. The U.S. is somewhere in the middle.

Portugal especially changed the story for 10% of its population when it started looking at addiction as a medical problem and made an organized effort to de-stigmatize SUD in the community and the healthcare system. Portugal’s policies are liberal and progressive. Drug offences are de-criminalized as long as they are not related to dealing drugs to others. Although France is not quite there yet, French doctors can prescribe Buprenorphine. This has removed barriers to access for SUD patients and is helping to decrease stigma in their healthcare system. France continues to expand its programs with mobile services and rural addiction centers. Russia is sadly lagging behind. The medical treatments provided are punitive at best. In addition, there are barriers to coming forward if you have a substance-use problem in Russia. Drug users are outcast and often lose their jobs and drivers licenses (Thom, Duke, Frank, Bjerge, 2013).

Where does that leave us in the U.S.? If we look at all we have learned, we can see what approaches seem to have the greatest impact. The U.S., however, struggles from its siloed approach to care. In addition, the stigma patients encounter in the healthcare system and the community compounds the problem. Colorado is approaching SUD in a holistic manner and addressing both access and stigma. Their program provides support for the social determinants of health as well as medical-assisted programs that are designed to remove barriers (AMA, Colorado Medical Society, Manatt, 2019).

The U.S. is going to need to remove silos and reach across disciplines and industries in order to solve the substance use disorder crisis. One great area of impact would be to remove stigma at the healthcare and the community level. This would take a dynamic campaign with professionals, employers, schools, and community centers. In addition, all medical providers should undergo education to increase self-aware of biases, learn how to manage SUD patients, and to eliminate stigma.

One area that lacks efforts in the U.S. is mental health services. Patients with SUD often need mental health support as well. This means that we need to remove barriers to treatment and make both SUD and mental health services accessible. Mobile services would help the rural communities, especially if multidisciplinary teams are funnelled to areas where these services are lacking. Medicine-Assisted Treatment clinics with multidisciplinary providers would also go a long way to making the care more holistic and accessible.

Finally, SUD treatment success depends on an infrastructure that addresses the social determinants of health. Services should include work retraining and support, family training and support, access to healthy foods and shelter, wellness education, and of course a safe environment.

Sources

AMA, Colorado Medical Society, & Manatt. (2019). Spotlight on Colorado – end-opioid-epidemic.org. Retrieved from https://www.end-opioid-epidemic.org/wp-content/uploads/2019/01/AMA-Paper-Spotlight-on-Colorado-January-2019_FOR-WEB.pdf

Thom, B., Duke, K., Frank, V. A., & Bjerge, B. (2013, August 1). Stakeholders in opioid substitution treatment policy: similarities and differences in six European countries. Retrieved from http://eprints.mdx.ac.uk/12022/