Improving global prehospital and emergency medicine, public health, and disaster health care and preparedness

Addiction Medicine

Posted by: Joseph Cuthbertson; 4 January 2017; 6:50 pm

Post written by: Dr. William Bograkos, MA, DO, FACOEP, FACOFP
Chair, WADEM Osteopathic Physicians Section; President, AOAAM


The November 2016 edition of “EM News” published an article titled “Carfentanil, the New Beast on the Block.”1 Emergency Medicine News targets our colleagues in emergency medicine, emergency medical services, acute care, Tactical Emergency Medical Support, and emergency medicine academia. Our journal, Journal of Addictive Diseases serves the sub-specialty of Addiction Medicine. The “beast” doesn’t care if we are united or divided.

Deaths from opiates in the United States continue to surpass deaths from motor vehicle trauma. Overdose deaths from licit and illicit opioids have quadrupled since 1999. Ninety one Americans die every day from an opioids overdose.2 The intersection of substance use, misuse, substance use disorders, and emergency medical systems is a very dangerous intersection. Every medical specialty is aware of this intersection. Every medical specialty passes through this intersection. Our sub-specialty of Addiction Medicine should be offering its direction and guidance to colleagues as they approach this threatening intersection. Acute intoxication and chronic toxic brain injury requires attention from all public health stakeholders.

The danger and disaster associated with drugs of abuse is capable of touching all specialties. Public Health Disasters and the disaster within individuals require a response from all specialties. The opiate disaster extends beyond emergency and recovery phases. Development of positive coping skills, prevention, mitigation, and preparedness to face the triggers associated with relapse are individual and inter-disciplinary strategies. Strategic planning and execution of planning does not take place in silos.

When President Nixon declared “the war on drugs” in 1971- 1972, cash crops in the Golden Triangle served as a “point source” for the “opiate epidemic.” The “EM News” article on carfentanil importation was interesting as this cargo too crossed the Pacific. However, synthetic opiates require more narcan to reverse their effect and produce greater profits by reducing logistic supply chains. Diversion of synthetic opiates by transnational and local criminals has proved to be a clear and present danger to public health and public safety. Profits fund criminal networks, its undercurrent of associated violence, and the tsunami of public health threats that threaten our communities.

Clinicians focus on the prevention and treatment of this deliberate epidemic. We have been taught to treat one patient at a time. We seek the differential diagnosis and the etiology of the illness. Let us pause and read VADM Murthy’s discussion on the dynamics of the public health catastrophic event before us.3 Exposure to public health threats often lead to disease and outbreak scenarios. Exposure followed by the use of drugs of abuse often leads to addiction as a brain disease. Metric tons of heroin and illicit synthetic drugs enter the United States every year. Pain specialists and dedicated physicians are not the single “point source” in the opiate epidemic. Flawed drug strategies and concepts without medical consultation today, may lead to the medical professional being blamed for the outbreak of cannabis dependence tomorrow, even though the medical profession objected to the term “medical cannabis.” Flawed guidance today may prevent patients from receiving appropriate integrative pain management in the future.

All public health outbreaks need to be contained and controlled by strong coalitions of dedicated stakeholders. Drugs and bugs know no ethnic or geographic boundaries. Coalitions build bridges across silos of academies, cultures, and disciplines. As a sub-specialty, we are in a unique position to serve our patients, our communities, and our nation. The AOAAM membership demographics are unique. Our members hold a multitude of primary specialties and hold membership across academies within the American Osteopathic Association.

It is my hope that an united academy will invest in the future of the profession by encouraging the growth of Addiction Medicine student clubs across our universities and facilitating their discussions in an interdisciplinary format. The opportunity for dynamic dialogue across disciplines should be fostered at our universities. Substance use disorder is a thinking problem. Addiction is a brain disease and the circuitry is complex. Our students will require mentoring from their elders. Seasoned physicians often see more than neuroimaging. The next beast on the street will be more dangerous. As a medical sub-specialty, I hope we will encourage bridge building with stakeholders across public health and public safety.

Bridges are the first targets in war. Allow me to quote Dr. Martin Luther King and, “Let us build bridges and not walls.” Let us build bridges for the access to healthcare. As a sub-specialty, let us strengthen the bridges that connect us with all medical specialties.


  1. Gussow, Leon. “Toxicology Rounds: Who Said the Opioid Crisis Couldn’t Get Any Worse?” Emergency Medicine News 38, no. 11 (November 2016): 1, 29-30.
  2. CDC, “Understanding the Epidemic/ Drug Overdose/ CDC Injury Center.” (accessed January 1, 2017).
  3. Surgeon General. “The Surgeon Generals Report on Alcohol, Drugs, and Health.” (accessed January 1, 2017).