Drug Overdose, Addiction and Binge Drinking: Medical Problems with Public Health Consequences

The inexorable link between the practice of medicine and the fostering of public health is especially clear when dealing with severe drug and alcohol problems. Therefore, this focus section of the Rhode Island Medical Journal (RIMJ) addresses both clinical concerns like pain management and addiction treatment and also the ways in which the medical profession is joining with public health specialists and the community. This is not the first issue of the RIMJ to deal with opioids. RI Health Director, Dr. Michael Fine, the leader in combating the current overdose epidemic, coordinated a special section of the RIMJ issue of November 2013 (Vol. 96, No. 11) which examined opioid prescribing. It is an excellent complement to this issue. (See http://rimed.org/rimedicaljournal/2013/11/2013-11-17-integrity+opioids.pdf) The ways in which Rhode Island has approached the overdose epidemic exemplifies the benefits of the medicine-public health connection. Public health authorities, community groups and the medical profession have reached out proactively to those in need of treatment and support. Projects were launched to make naloxone widely available. For example, the Rhode Island Medical Society successfully advocated for the passage of the Good Samaritan Law in Rhode Island to protect anyone who calls 911 or who administers naloxone in good faith from criminal or civil liability. Implementation of the Good Samaritan law has successfully gained the necessary cooperation of EMTs and the police. Pharmacists have implemented a collaborative practice agreement with the medical profession allowing pharmacists to furnish naloxone without requiring an individual prescription. In addition, the RI Health Department has launched a new FDA-supported opioid prescriber education project. (See http://medicineabuseproject.org/searchandrescue/ri-start) Incorporating the diagnosis and treatment of addictive diseases into mainstream medicine has been a painfully slow process. Fortunately, that is changing. Now there is both public and medical recognition that addiction is a disease and that treatment is both necessary and effective. Both the federal parity legislation and the Affordable Care Act mandate that substance use disorders (and mental illness) are entitled to the same essential benefits as other medical and surgical conditions. This can only enhance the cooperation between medicine and public health advocates. DRUG AND ALCOHOL DISORDERS AND TREATMENT