Making sense of opioid prescribing in the midst of the overdose crisis

By Sarah Wakeman, MD
September 18, 2018

In the face of a growing crisis of overdose deaths, predominantly driven by opioid-related fatalities, there has been a tremendous focus on decreasing the prescribing of opioid pain relievers. The reason for the drive to reduce prescribing is pretty simple; when we looked at the onset of the current crisis of opioid-related deaths, it was strongly correlated with rising rates of prescription opioids and treatment admissions for prescription opioid use disorder. As policy makers and clinicians looked at this correlation, a simplistic narrative emerged. If increased prescribing rates “caused” the overdose crisis, then reducing prescribing should curtail deaths. Unfortunately, as the saying goes, “For every complex problem there is an answer that is clear, simple and wrong.” As prescribing rates have decreased over the past five years, we have seen opioid-related deaths increase significantly. Continue reading “Making sense of opioid prescribing in the midst of the overdose crisis”

Who is Failing Whom? Moving Towards Person-Centered Addiction Treatment

By Sarah E. Wakeman, MD, FASAM
August 11, 2017

It is not enough to simply say addiction is an illness. If we truly believe this, then we must ensure our language and approach mirror how we care for patients with other illnesses.

The need for treatment modification is a hallmark of disease management, particularly for complex, chronic illnesses like diabetes or HIV. We expect that for many patients a typical treatment course will include periods of remission and recurrence with associated adjustments in medication or other interventions. We even have a term for treatment for the most severe cases of refractory disease; we call it “salvage therapy.” For cancer, salvage therapy refers to “Treatment that is given after the cancer has not responded to other treatments.”1 Note that the lack of response is focused on the disease, appropriately, and not the patient. Continue reading “Who is Failing Whom? Moving Towards Person-Centered Addiction Treatment”

Supervised Injection Sites: A Boston Doctor Speaks Out

(photo: Massachusetts General Hospital, Boston. Ma.)

June 29, 2017

Dr. Sarah Wakeman speaks about the process that informed her opinion on supervised injection facilities:

Opening supervised injection sites to address the opioid crisis in America is a controversial subject. Dr. Sarah Wakeman, the medical director of Massachusetts General Hospital’s Substance Use Disorder Initiative and Addiction Consult Team, has something to say about it.

As a staunch supporter of evidence-based treatment for patients with substance use disorders, you may hear her expert opinion by clicking on the brief video below…

Do you have an opinion to share as well, or questions for Dr. Wakeman? Use the comment section to start a conversation about supervised injection sites.

Read more posts by Dr. Sarah Wakeman:

Waiting for Addiction Treatment: A Deadly Proposition
Summary: Dr. Wakeman discusses the results of a randomized pilot study of interim buprenorphine dosing for individuals with opioid use disorder.

Harvard Medical School is offering free online accredited CE/CME courses in identifying and treating opioid use disorder for physicians, physician assistants, nurse practitioners, nurses, and social workers. Each course contains additional resources to assist health care providers in treating patients with opioid use disorder. Select a course below to learn more and enroll:

Understanding Addiction

Identification, Counseling, and Treatment of OUD

Collaborative Care Approaches for Management of OUD

Dr. Sarah Wakeman is medical director of the Substance Use Disorder Initiative and the Addiction Consult Team at Massachusetts General Hospital (MGH), co-chair of the Mass General Opioid Task Force, and clinical lead for the Partners Healthcare Substance Use Disorder Initiative. Dr. Wakeman is also an assistant professor in medicine at Harvard Medical School and course director for Understanding Addiction. Twitter

(photo credit:


Waiting for Addiction Treatment: A Deadly Proposition

By Sarah E. Wakeman, MD, FASAM
May 3, 2017

In a 2016 research letter to the New England Journal of Medicine, Dr. Sigmon and colleagues describe the results of a randomized pilot study of interim buprenorphine dosing for individuals with opioid use disorder.1 Interim buprenorphine dosing means offering medication alone to people on a waiting list to get into a buprenorphine treatment program, which generally involves medication plus counseling. This study randomized patients to either staying on the waiting list or getting just the buprenorphine administered at home by an automated and locked pill dispenser. The results were compelling. All of the participants who remained on the waiting list continued to use illicit opioids. In contrast, the majority of those treated with buprenorphine stopped using opioids completely, with abstinence rates of 88%, 84%, and 68% at 4, 8, and 12 weeks (P<0.001 for all comparisons). Continue reading “Waiting for Addiction Treatment: A Deadly Proposition”