Cardiology Magazine

Editors' Corner | Steps in the Treatment of Pulmonary Embolism (Watch Out! The Staircase is Tricky!)

Cover Story | Pulmonary Embolism: A Clinical Approach

Feature | Ten Americas: Growing Disparities Creating Demographic Chasms

Feature | Bridging the Gender Gap in Heart Health: Women's Specialized Clinics

Feature | Championing Change: Herman Taylor on Improving Heart Health For All

New in Clinical Guidance | Newest AUC Provide Clinical Guidance on Cardiac Implantable Electronic Devices

New in Clinical Guidance | ACC Issues Guidance on Arrhythmia Monitoring After Stroke

From the Member Sections | Tackling the Polypharmacy Pandemic in CV Care

Focus on Heart Failure | Thinking Outside the Ice Box: Preservation Techniques, New Technologies in Transplantation

For the FITs | The Emergence of Substance Use Disorders and Their Implications in Cardiovascular Disease

Courageous Conversations | The Invisible Armor: A Personal Reflection on The Power of Resilience as a Black Woman in Cardiology

Quality Improvement For Institutions | NCDR Research: Data Driving Better Practice, Patient Outcomes

Prioritizing Health | Journey of the Health and Well-Being Coaching Profession

Heart of Health Policy | ACC Advocacy Welcomes New Members of Congress

Heart of Health Policy | Action Steps Following CCTA Coding Change From 2025 OPPS Final Rule; Coding Corner: How to Use New ASCVD Risk Assessment and Management Codes

JACC in a Flash | Aircraft Noise Poses Threats to Heart Health; More

The Pulse of ACC | Welcome to Camp Cardiac; ACC.25 Pre-Conference Opportunity: Renal Denervation

Number Check | Powering Quality Improvement

ACC Mission in Action | Making a Global Difference

For the FITs | The Emergence of Substance Use Disorders and Their Implications in Cardiovascular Disease

For the FITs

The number of people in the U.S. who suffered from substance use disorder (SUD) in 2022 hit 48.7 million, of whom 17.3% were >12 years old. The economic burden of opioid use disorder alone was estimated at $1.02 trillion in 2017. Most of these costs were due to overdose, as well as reductions in quality of life and cardiovascular system complications. While the adverse cardiovascular system effects of alcohol and tobacco are well-established, the effects of other illicit substances on the cardiovascular system are not as clear. As fellows in training (FITs) in cardiovascular disease, it is imperative to understand this growing phenomenon to best treat our patients.

Resources to Monitor Prescription Drug Use

The prescription drug monitoring program (PDMP) is an electronic database providing a detailed log of controlled substances prescribed within a state. PDMPs allow providers to analyze patient and provider prescribing practices in real time. PDMPs improve opioid prescribing practices at the state level to protect at-risk patients while minimizing liability on prescribers. With the rise in contamination of heroin with illicit synthetic opioids like fentanyl, preventive measures have become increasingly important.

Present and Future Implications

How can we treat patients if we are unfamiliar with their disease pathologies and social determinants of health (SDOH)? As FITs, it is critical to advocate for the disenfranchised. We must push for better care and reform for our patients suffering from SUD. Merely uptitrating guideline-directed medical therapy for a patient without secure housing misses the mark. There should be no hesitation in aggressive medical management and holistic care as appropriate. However, if we ignore SDOH and substance use-related issues, we may do our patients a disservice. So how do we mitigate this?

Steps For FITs

The Substance Abuse and Mental Health Services Administration (SAMHSA) and the Providers Clinical Support System (PCSS) are two invaluable resources for those interested in learning more about SUD mitigation and management. Resources to learn more about treating opiate use, for FITs, early career professionals and established cardiologists, are available:

  • SAMHSA: Substance Use Disorder Treatment Options. Available here.
  • PCSS: 8-Hour DEA Training, and More. Available here.

For FITs with a special interest in SUD, there are excellent opportunities for further training. Under the Medication Access and Training Expansion (MATE) Act, physicians and trainees can take a free, eight-hour training session to fulfil their Drug Enforcement Agency (DEA) requirement to prescribe suboxone.

For those interested in pursuing certification to prescribe suboxone, please visit:

  • PCSS: 8 Hour MOUD Training. Available here.

Steps For Programs

No fellowship training programs currently offer a dedicated track for SUD and cardiovascular disease. At Rutgers New Jersey Medical School (NJMS), my institution, for internal medicine residents we have an Urban Health track, which encompasses access to and comprehensive care for disenfranchised populations. These clinical experiences are complemented by a structured didactic curriculum covering topics like SDOH, women's health, SUD and incarcerated care. In a parallel manner, fellowship programs could consider establishing pathways of distinction for SUD during training.

Fellows interested in gaining hands-on experience with SUD can participate in dedicated addiction medicine rotations, didactic opportunities and rehabilitation site visits. Gaining experience in both the inpatient and outpatient settings would provide comprehensive training in acute intoxication, withdrawal and maintenance therapy.

There are several grant opportunities from the ACC and American Heart Association to address public health issues and preventive medicine. This funding could be used for community health initiatives like SUD prevention. For example, at Rutgers NJMS, we are using the ACC Chapter/Section Grant to help mitigate cardiovascular disease in patients suffering from SUD, utilizing strategies like co-location and contingency management. Information about the ACC Chapter Section Grant and how to apply is available here.

Steps For the Community

Empowering communities is a critical strategy in the reduction of SUD. With the support of grassroots movements involving key community stakeholders, political figures, local leaders and religious figures, SUD can be addressed through a combination of fundraising, awareness campaigns and political activism.

On the ground, mobile substance use care vans can provide preventive services for those suffering from SUD. Harm reduction programs such as needle exchange programs can facilitate safe disposal of needles and reduce cardiovascular disease such as infective endocarditis.

After engaging the community, encouraging our patients to follow healthier lifestyles is imperative. One way to do this is for patients to share clinical vignettes in an open, nonjudgmental forum. The simple act of sharing these experiences is therapeutic and builds camaraderie, community and confidence. Likewise, patient education sessions can help those with SUD better understand their condition.

At the population level, we must advocate for updated guidelines that reflect caring for this often-neglected patient population. As future cardiologists, FITs must accept the responsibility of caring for those who often are unable to care for themselves.

For more information regarding marijuana, cocaine and/or opiate use disorder and their pathophysiology and cardiovascular effects, a reading list is provided below.

Afif Hossain, MD

This article was authored by Afif Hossain, MD, fellow in training in noninvasive cardiology at Rutgers Medical School in Newark, NJ.

Reading List

Krantz MJ, Palmer RB, Haigney MCP. Cardiovascular Complications of Opioid Use: JACC State-of-the-Art Review. J Am Coll Cardiol. 2021;77(2):205-223. Available here.

Havakuk O, Rezkalla SH, Kloner RA. The Cardiovascular Effects of Cocaine. J Am Coll Cardiol. 2017;70(1):101-113. Available here.

DeFilippis EM, Bajaj NS, Singh A, et al. Marijuana Use in Patients With Cardiovascular Disease: JACC Review Topic of the Week. J Am Coll Cardiol. 2020;75(3):320-332. Available here.

Centers for Disease Control and Prevention. Opioid Use Disorder: Treating. Available here.

Centers for Disease Control and Prevention. Safety and Effectiveness of Syringe Services Programs. Available here.

Resources

Clinical Topics: Cardiovascular Care Team

Keywords: Cardiology Magazine, ACC Publications, Prescription Drugs, Social Determinants of Health, Opioid-Related Disorders, United States Substance Abuse and Mental Health Services Administration, Controlled Substances