Top Docs Q&A: Jeffrey Samet
This post is part of our Top Docs Q&A series where we ask a physician who was selected as one of our Top Docs questions about their field, life as a doctor, and practicing in the Greater Boston area.
Name: Jeffrey Samet
Hospital Affiliation: Boston Medical Center
Title: Chief of internal medicine at Boston Medical Center; Professor of medicine and public health at Boston University Medical School
Field: Internal Medicine
Specialty: Alcohol and Drug abuse, HIV/AIDS
This February, the state police department reported that in the last four months 184 people died of heroin overdoses in Massachusetts. Dr. Jeffrey Samet, formerly a medical director of addictions prevention, treatment, and recovery support services at the Boston Public Health Commission, is working in finding ways to better address substance abuse issues in a primary care setting.
Why did you choose internal medicine?
I quickly learned that the surgical hands-on stuff didn’t appeal to me so much. So I went into internal medicine and from there I realized that I liked the whole person and the way their different systems work together, so that’s how I ended up in primary care. In that realm, I was then fascinated by individuals whose life and body were getting torn apart by substances and how I could help them.
How has the primary care field changed over the last 20 years?
I love that addressing alcohol and drug issues is becoming part of mainstream medical care. When I began internal medical training 30 years ago, it was not. Also, the tools that are in place now, in terms of medication and counseling, as opposed to 20 years ago, are really effective. I have patients that tell me a medication saved their life, and patients who are on antivirals for HIV so they are able to live their life. Also, medications are almost ready to come out out that can actually cure Hepatitis C.
How did addiction first become an issue addressed in a primary care setting?
It’s been in the last 10 to 15 years or so, and it’s taken some time for those involved in primary care teams to realize how addiction impacts the course of standard diseases like diabetes and congestive heart failure. Once that evidence got out though, I think it shifted the perspective and now it’s agreed that we should be addressing this issue in primary care.
What are the latest advancements in addiction treatment?
In March, Governor Deval Patrick declared a public health emergency around heroin overdoses in Massachusetts, and he said that the state needs to get intranasal naloxone (a drug that stops overdoses) in the hands of all first responders. I’ve also been involved in creating models of how we can set up effective ways to deliver buprenorphine, which is a highly effective medication that reverses opioid dependence, in the primary care setting.
What else has Massachusetts been doing for this issue?
I think our state is very on the ball. It has one of the most enlightened policies of harm reduction, especially with the distribution of inhaled naloxone for opioid overdose prevention. There’s also a movement of support groups. For example, there’s a group that the state has been very supportive of, called “Learn to Cope,” which helps families dealing with the loss of loved ones from to overdose.
How can those involved in primary care work to reduce the amount of overdoses?
Probably one of the best approaches is the use of buprenorphine in primary care, because it’s a fairly low stigmatized medication. Methadone has also been a very useful drug for treating opioid dependence, but for some people it’s considered too highly stigmatized because it’s not integrated into a general medical care setting. Also a team-based care approach has really worked for patients with addiction, so nurses, social workers, and psychiatrists are all really important in fixing this problem together.
Why do you think there has been a recent increase in heroin overdoses in Massachusetts?
Heroin use has been going up, but there has also been this tainted heroin going around that is combined with fentanyl, which is a highly potent opioid (used for pain relief). That combo drug is multiple times more potent than regular heroin. Overdoses have unfortunately been going on at very high rates for a long time though, this spike has just brought it into the public eye.
Some of your other work has been on the impact of alcohol on patients with HIV, could you explain this?
We noticed that one of the top reason HIV patients were missing their medication was alcohol, and that for these patients alcohol was also associated with unsafe behavior like unprotected sex or using dirty needles. Then we started looking at if there’s a biologic mechanism in which alcohol has a negative impact or speeds up the HIV disease progression. Now we are doing a study in Uganda to see if that is indeed the case. We’ve also done work in Russia for about 15 years around that topic.
What do you love most about internal medicine?
I love having the privilege of caring for individuals over a long period time. I’ve seen some patients with pretty complex diseases who are now doing wonderful. I’ve also seen patients with addiction that have been in recovery for a long time now, and that’s been incredibly gratifying.
What’s your favorite part about practicing in Boston?
Boston attracts great colleagues, doctors, nurses, social workers, and really creative people. You also get really high quality and bright trainees coming in from the top medical universities, and what a pleasure they are to work with.