PCMS_Philadelphia_Medicine_Spring2018 - 45

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As physicians, we too have been guilty of perpetuating the
stigma. A study in the International Journal of Drug Policy showed
that physicians were more likely to recommend punishment if a
patient were described as being a "substance abuser," yet more
likely to recommend treatment if they were described as having
a "substance use disorder."10 The language we use matters, as does
our belief in the patient before us. The acceptance of CUES, and
ultimately their success, is dependent on our collective ability to
recognize and reduce the stigma surrounding drug use. As experts
in diagnosing and treating diseases, physicians are poised to lead
the push for CUES and other harm reduction interventions.

Part of a larger strategy
Despite the substantial evidence in support of CUES, however,
they should not be viewed as a silver bullet in addressing the opioid
crisis in Philadelphia. A study commissioned by the city on the
health benefits of a supervised consumption facility suggests that
single CUES could save up to 76 lives per year, a fraction of the
number of people dying annually from drug overdoses.11

That should not diminish their potential role in reducing the
morbidity and mortality from opioids, but indicates that CUES
are just one part of a larger strategy in combatting this crisis. Just as
syringe exchange programs complement prevention and treatment
activities in reducing HIV transmission, so too would a CUES
exist alongside other ongoing and future efforts in reducing the
deleterious effects of substance use.
After a decade of prescribing opioid painkillers to too many
patients, albeit under the influence of deceptive pharmaceutical
advertising that touted the safety and effectiveness of these drugs,
we physicians have had a role in creating the crisis we are now
trying to combat. It behooves us to do all we can to address it,
including prescribing fewer opioids, offering patients medication-assisted treatment, reducing the stigma surrounding substance use
disorders, and, I believe, supporting CUES, an evidence-based,
harm-reduction intervention that will save lives. *

Medical Examiner's Office, Philadelphia Department of Public Health.
Mayor's Task Force to Combat the Opioid Epidemic. Available at: https://dbhids.org/wp-content/uploads/2017/05/OTF_Report.pdf
3
Yes to SCS, Seattle. Available at: https://www.yestoscs.org/whatisanscs
4
Milloy MJ, Wood E. Emerging role of supervised injecting facilities in human immunodeficiency virus prevention. Addiction 2009;104(4):620-1.
5
Bayoumi AM, Zaric GS. The cost-effectiveness of Vancouver's supervised injection facility. CMAJ 2008;179(11):1143-51.
6
Wood E et al. Changes in public order after the opening of a medically supervised safer injecting facility for illicit injection drug users. CMAJ
2004;171(7):731-4.
7
Wood E et al. Impact of a medically supervised safer injecting facility on drug dealing and other drug-related crime. Subst. Abuse Treat. Prev. Policy
2006;1:13.
8
Freeman K et al. The impact of the Sydney Medically Supervised Injecting Centre (MSIC) on crime. Drug and Alcohol Review 2005;24:173-84.
9
Wood E et al. Rate of detoxification service use and its impact among a cohort of supervised injecting facility users. Addiction 2007;102(6):916-19.
10
Kelly JF, Westerhoff CM. Does it matter how we refer to individuals with substance-related conditions? A randomized study of two commonly used terms.
Int J Drug Policy 2010 May;21(3):202-7.
11
Larson S, Padron N, Mason J, Bogaczyk T. 2017. Available at: https://dbhids.org/wp-content/uploads/2018/01/OTF_LarsonS_PHLReportOnSCF_
Dec2017.pdf
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