Addiction psychiatrist expanding treatment for opioid use disorder
Published on Thursday, October 11, 2018
By: Ruth Cummins
The University of Mississippi Medical Center’s first-ever addiction program has a new resource that gives patients what’s considered the national gold standard of care in treating opioid use disorders.
Dr. Saurabh Bhardwaj, an addiction psychiatrist hired in August, is seeing patients on Wednesday and Thursday afternoons in the Behavioral Health Specialty Clinic at the Jackson Medical Mall. An assistant professor in the Department of Psychiatry and Human Behavior, he is the Medical Center’s first provider to offer medication-assisted treatment, or MAT, for opioid use disorder.
Those medications include drugs that reduce cravings for opioid drugs and prevent addicts from getting high if they relapse.
“We are the first to roll out a formal addiction program for UMMC, starting with our clinic for alcohol use disorders for mild to moderate cases that began in 2017,” said Dr. Scott Rodgers, professor and chair of Psychiatry and Human Behavior.
The arrival of Bhardwaj, who trained in psychiatry at the University of Pittsburgh Medical Center and recently completed a fellowship in addiction psychiatry at the Northwestern University School of Medicine in Chicago, “is a milestone for our addiction treatment,” said Dr. Jeff Parker, professor of psychiatry.
Parker and Dr. James Rowlett, a veteran researcher and professor of psychiatry, direct the addiction program. The team also includes additional psychiatrists, psychologists, nurse practitioners, social workers and other providers.
“He is the first and only faculty member in our department and the Medical Center with specialty training in the treatment of addictions, and whose primary responsibility is to provide clinical care,” Parker said of Bhardwaj. “With him in place, we can provide pharmacotherapy for addictions that we weren’t able to do before.”
“With the opioid crisis all over, it’s a terrible time,” Bhardwaj said. “A lot of people are on opioids for chronic pain, and a lot of doctors have started to curb the overprescribing. People are going to family and friends, or even the streets, to get them. They don’t know what dose they are taking, or what’s mixed in it.
“A lot of them end up using heroin, and many are overdosing and dying.”
Bhardwaj’s patients are all adults, but they don’t fit a stereotype. Some have a long history of opioid use and multiple relapses. Some live in neighborhoods that don’t encourage sobriety. Some have a family history of addictive drug use.
“Anyone with an opioid disorder, no matter how they acquired it, could be a patient in this clinic,” Parker said.
But they all need to understand that “they have a disease, and that they need to act on it,” Bhardwaj said. “It’s a disease that bypasses your critical thinking and decision making. You are not thinking. You initially use drugs impulsively, and when it’s compulsive, that is when it becomes a huge problem.
“It’s tricky,” he said. “For a long time, there’s been an emphasis of addiction being a disease of willpower, and that some people don’t have the willpower to overcome it. However, we forget that addiction is a disease like any other chronic disease. If someone has diabetes and isn’t taking their medication, you don’t throw them out of your clinic because they didn’t take their insulin correctly.”
The core of the Medical Center’s addiction psychiatry services, Parker and Bhardwaj say, is evidence-based, individually tailored treatment for each patient.
“A lot of the studies show that if you give medications for opioid use disorder, the success rates are good. There’s no reason not to do it,” Bhardwaj said. “Some people say that if you use the MAT model, you’re replacing one addiction with another. That’s not true. We’re trying to change minds and show people that this works.”
Two of the medications Bhardwaj prescribes are naltrexone and buprenorphine/naloxone. Naltrexone works in the brain to prevent feelings of well-being, or a high, for opioid users, and it decreases the desire to take opiates. Buprenorphine, packaged with or without combination with naloxone, works to prevent cravings and withdrawal symptoms in someone who stops taking opioid drugs.
Addiction psychiatrists not only must possess a special license and waiver to prescribe the medications, but they also must have specific training. “Addiction psychiatry is such a big field now,” Bhardwaj said. “If I feel a patient needs a medication, I am providing that treatment in concert with other treatments that are personalized. It’s not cookie cutter.”
The program aims to give more access to care, including telepsychiatry for patients in the state’s rural corners who have had an initial visit at the addiction clinic. Already, the clinic is getting lots of referrals from other providers, although one isn’t required.
“It’s a very exciting time. I’m glad to be here to help fill the gaps,” Bhardwaj said. “If you’re getting comprehensive addiction treatment, there’s a much better chance that you won’t use addictive drugs and have the repercussions.”
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