Founding Principles and Background:
All patients with substance use disorders deserve harm reduction-focused care, regardless of whether their goal is full abstinence, reduced use, or continued use.
Primary care integrated with mental health care demonstrates the most efficacious outcomes for patients with substance use disorders; however, patients who decline or are not yet ready for mental health care are still deserving of care for their substance use disorder in the primary care setting.
Harm reduction is central to EHHOP's care for this population; patients set goals, and we strive to help them get there.
Resources on this page are tailored to management in the outpatient primary care and mental health setting, to maximize applicability to EHHOP; this is not intended to be comprehensive, and inpatient treatment options are intentionally excluded.
If a patient with SUD is identified and is interested in psychotherapy and/or pharmacotherapy, you can (1) refer to Mental Health Clinic through the ancillary clinic referral spreadsheet, or (2) utilize the in-person Mental Health Clinic consult-liaison (C/L) service (ask Head/MHC TS's for help with this, if you need).
If a patient with SUD is not interested in Mental Health Clinic referral, you at Main Clinic can still treat the patient with a focus on their SUD, including motivational interviewing, harm reduction, and pharmacotherapy. Be sure to elicit the patient’s goals (family, health, eating better, financial, work) and utilize them in motivational interviewing.
The EHHOP SUD Director (see EHHOP Roster) will follow patients with SUD (so make sure to notify them!), assist with clinical management and coordination.
Relevant medications on formulary: PO naltrexone, acamprosate, disulfiram.
Relevant medications to coordinate with EHHOP SUD Director (see EHHOP Roster): vivitrol (IM naltrexone).
Fentanyl test kits & Narcan: see Harm Reduction section (below).
Nicotine patches and lozenges: Patients can call 1-866-NYC-QUITS, complete a 15 minute interview to receive a 2 week supply of patches and lozenges. They can follow up every 2 weeks to get up to 6 weeks yearly.
Relevant medications without current access: buprenorphine (all formulations, including Suboxone, Sublocade, Subutex), methadone (due to policy restrictions, must connect with methadone maintenance program).
Annual Pre-Screener for alcohol, drug use with SBIRT
Tobacco-related lung cancer and AAA screenings (see Tobacco Use Disorder section below)
Alcohol Use Disorder (AUD):
Combined pharmacotherapy with integrated mental health care (CBT or psychotherapy) is the most efficacious outpatient treatment option for patients with AUD
Alcohol withdrawal can be fatal; proactive patient education about withdrawal symptoms with provision of specific emergency department return precautions are a critical components of harm reduction-focused care for all patients still using alcohol
Tobacco Use Disorder & Smoking:
Annual low dose CT for lung cancer screening - recommended for all adults age 50 to 80 years with a 20+ pack-year smoking history and either currently smoke, or have quit within the past 15 years
1-time screening for abdominal aortic aneurysm (AAA) with ultrasonography in men aged 65 to 75 years who have ever smoked (USPSTF)
Opioid Use Disorder (OUD)?
Harm reduction resources specific to opioid use are described in detail below
Stimulant (cocaine, methamphetamine) Use Disorder:
Harm reduction resources specific to stimulant use are described in detail below
Sedative/Hypnotic (benzodiazepine, barbiturates) Use Disorder:
Sedative/hypnotic withdrawal can be fatal; proactive patient education about withdrawal symptoms with provision of specific emergency department return precautions are a critical components of harm reduction-focused care for all patients still using sedatives/hypnotics
Other Care Modalities and Considerations:
De-stigmatizing Language: Examples
Person/patient who uses drugs (PWUD)
Person/patient with substance use disorder INSTEAD OF "addict, alcoholic, drug user"
Medication assisted treatment OR pharmacotherapy INSTEAD OF "replacement therapy
Person in recovery
Abstinent OR sober/currently OR actively using INSTEAD OF "clean/dirty"
Recurrence of use OR return to use INSTEAD OF "relapse"
- If you want to practice a harm reduction-focused approach before you see a PWUD in clinic, contact the Director of Substance Use Disorder Services (email at the bottom of this page) to practice
Where to access harm reduction supplies and resources:
Naloxone - available at EHHOP in supply locker (ask the Teaching Senior to locate); senior clinicians must train patients to use; Naloxone/Narcan training guide located here
Fentanyl test kits - available at EHHOP in supply locker (ask the Teaching Senior to locate); senior clinicians must train patients to use; Fentanyl test kit considerations
Syringe exchanges - syringes cannot be distributed at EHHOP because we are not a state recognized syringe exchange; help you patient find a local syringe exchange using this New York State directory of syringe exchanges
Never use alone information - patients can call 1-800-484-3731, or use an online chat; services are anonymous, and will call an ambulance if the patient overdoses and stops responding
Safe consumption sites OR overdose prevention centers - two available in NYC, located at 104 -106 E 126th Street OR 500 W 180th Street
Which patients should access the above harm reduction supplies and education:
Patients with known opioid use disorder or recreational opioid use
Patients prescribed opioids for acute or chronic pain management (naloxone only)
Patients with known stimulant use disorder or recreational stimulant use
Patients who use any substance, by any route of administration (oral, injection, intranasal) obtained from a non-medical provider
Patients who inject any type of substance (syringe exchange information, safe consumption sites specifically)
Harm reduction is individual - how does substance use harm this individual patient?
Sobriety is only our definition of success if this is your patient's stated goal
Tailor harm reduction to the specific substance the patient uses
Provide patient education on possible harms they may experience, and what to do if these arise (e.g., what to do if they develop symptoms of withdrawal)
If you want to practice motivational interviewing before you see a PWUD in clinic, contact the Director of Substance Use Disorder Services (email at the bottom of this page) to practice
Patient identifies their goals - ask at each visit, goals change
How can I as your provider help you achieve this goal?
Ask motivation and confidence on a scale of 1-10; why not higher, and why not lower?
Identify barriers to reaching goals, and troube-shoot collaboratively with the patient
Praise when goals are met
Available within the Mount Sinai Health System at Mount Sinai Beth Israel or Mount Sinai West (through the Mount Sinai Addiction Institute)
Available free of charge, with outpatient "chemical dependency clinic" follow up, regardless of ability to pay or documentation status, through Health and Hospitals (e.g., Metropolitan Hospital, Harlem Hospital)
Student-Facing Educational Resources:
If you are interested in self-directed ways to learn more about caring for patients with use disorders, please consider explore the following:
Alcohol Use Disorder:
Vivitrol Injection Instructions (to be done by trained providers, only)
National Harm Reduction Coalition - a national-scale organization providing publicly harm reduction education resources
When a use disorder intersects with domestic or intimate partner violence, please refer the patient or family member(s) to Mount Sinai's Sexual Assault and Violence Intervention Program (SAVI) - can be reached by phone at 212-423-2140
National, state and local policies impact the health of our patients with use disorders. Learn more about important advocacy movements working to improve care provision to this patient population below:
If you are interested in (1) connecting EHHOP patients with use disorders with relevant community resources, or (2) learning more about care for this patient population ongoing in the greater East Harlem/NYC community, please explore the following:
Harm reduction and addiction medicine: community resource guidebook - contains information about referrals to SUD-focused primary care, inpatient/outpatient rehab, detox facilities, support groups, methadone clinics, buprenorphine provision, and community harm reduction organizations
East Harlem Community Health Committee - meets monthly on Thursdays, and has a Behavioral Health sub-committee which covers provision of harm reduction and addiction medicine care in East Harlem
VOCAL-NY - "a statewide grassroots membership organization that builds power among low-income people directly impacted by the drug war"
Speak with social work and/or ACT during/after clinic
All EHHOP student volunteers with questions or comments can reach out to our Director of Substance Use Disorder Services (see EHHOP Roster) by email.