Abstract
Building on decades of Academy activities related to substance use, this report emphasizes three guiding principles: 1. Drug treatment should be accessible to all drug users seeking care, including those who are incarcerated. Because turning users away when programs are operating at or above capacity represents lost opportunities for care, programs should be prepared to commence treatment at the time users request it. 2. Addiction is a complex, chronic, relapsing illness for which various inpatient, residential, and outpatient treatments are used, depending on the substances involved, the intensity and duration of the addiction, the characteristics and tolerances of the patient, and the circumstances involved. Optimal addiction treatment requires generalists in medical care who are knowledgeable and capable in the areas of diagnosis and management; specialist consultation and care; specific programs dedicated to the acute and chronic care of drug users; and the multidisciplinary participation of appropriately qualified counselors, social workers, and other professionals. 3. Steps need to be taken to reduce the health-related harms associated with injection drug use, including the transmission of human immunodeficiency virus (HIV), hepatitis B and C, and other blood-borne pathogens. Harm reduction incorporates many modalities, such as HIV prevention education, including condom use and safer sex counseling and education; referrals for drug treatment and other health care and social services; interim methadone maintenance; and syringe and needle availability and exchange programs. Each of these interventions represents important medical and public health strategies that may decrease some of the secondary medical consequences of injection drug use.