At the beginning of my residency, phrases like “history of IV drug use” and “opioid use dependence” often condemned patients to hospital stays without adequate pain management. Patients screamed during dressing changes for upper extremity wounds, and wept themselves to sleep after debridement surgeries. Young people with a history of opioid use in their 20s and 30s were admitted with infective endocarditis, but seldom completed the full six-week course of IV antibiotics. Discharges against medical advice became inevitable, often occurring late at night after just a week or two of treatment.
Withholding pain medication resulted in worse outcomes. Patients avoided dressing changes, which hindered proper wound healing. PTs left the rooms frustrated when patients couldn’t, or wouldn’t, participate due to pain. Those with infective endocarditis returned repeatedly after incomplete treatment, suffering from worsening embolic events in the lungs, brain, and extremities. Our team’s hardened attitudes toward these patients only exacerbated their health outcomes.
A shift occurred with the elimination of the X-waiver for Suboxone. The Mainstreaming Addiction Treatment (MAT) Act, part of the Consolidated Appropriations Act of 2023, removed the federal requirement for an X-waiver. Now, any clinician with a DEA registration that includes Schedule III authority can prescribe buprenorphine for opioid use disorder without needing additional certification. Based on my experience, I believe integrating Suboxone into hospital treatment plans drastically improved patient outcomes.
Suboxone is a crucial tool for harm reduction and patient care. Suboxone is one of three medications approved by the FDA for opioid use disorder. A meta-analysis showed that the risk of death due to overdose in patients receiving no medication-assisted treatment is eight times higher than in those receiving medication-assisted treatment, such as Suboxone. Medications such as Suboxone in opioid use disorder also lead to a reduction in the rates of HIV and hepatitis C transmission, relapse, and criminal activity. Taking Suboxone protects patients from death, with a recent systematic review published in JAMA Psychiatry finding all-cause mortality during either methadone or buprenorphine maintenance was less than half the rate compared to those not in treatment.
On the cardiology team, we cared for a young patient with IV drug use and opioid dependence who was hospitalized with infective endocarditis. On her first night, she wandered into other patients’ rooms, seeking drugs. Instead of dismissing her, we collaborated with the nursing staff to treat her with compassion and consulted our pain management team to guide Suboxone therapy. Each day, I saw her making laps around the floor with her IV pole, smiling and greeting us — a stark contrast to the distress we had once anticipated from such cases.
The opioid epidemic created deep distrust in the medical system’s approach to pain and addiction. As a result, we have historically either under-treated or over-treated pain, failing to recognize that each patient experiences it differently. During my residency, I witnessed the introduction of Suboxone into our treatment protocols. Clinical trials showed that using Suboxone for 12 weeks in young adults rather than just short-term detoxification and counseling improved outcomes. Patients were less likely to use opioids, cocaine, marijuana, injectable drugs, or drop out of treatment. Using therapies such as Suboxone allowed us to move beyond the traditional reliance on abstaining from any treatment for our patients and enabled patients to heal.
My experience with inpatient pain management showed me that the medical community still doesn’t fully understand pain and addiction. Despite this lack of knowledge, the biotechnology industry does not actively invest in new therapeutics. Active clinical drug programs have decreased from 220 to 124 from 2017 to 2025. Only 0.7% of pain therapeutics pass Phase I clinical trials to FDA approval, compared to a 6.5% success rate for novel drugs across all other disease processes. Addiction therapeutics also only increased from 29 to 39. Venture capital is not investing in these endeavors despite 100 million Americans living with pain or addiction.
Treatment approaches vary widely because of this knowledge gap and lack of innovation in the biotechnology and pharmaceutical industries. I observed our team implementing novel therapies for those with a history of opioid dependence, like ketamine infusions for postoperative pain, and emphasizing multimodal pain management strategies, ensuring that medications were scheduled to prevent breakthrough pain. Orders were adjusted to incorporate pain control before dressing changes, which improved patient cooperation and healing.
Many patients and doctors remain wary of Suboxone and methadone, viewing them as just another addiction. In reality, these are safe and effective alternatives to narcotics and IV drug use. Modern medicine is far from finished innovating in the fields of pain management and addiction treatment. I look forward to deepening my understanding of pain pathways and exploring emerging therapies. As treatment evolves, I am committed to providing compassionate, dignified, and evidence-based care to this vulnerable patient population. Addiction is a chronic disease state like essential hypertension and diabetes. Medications such as Suboxone allow patients to return to society without criminal activity or illicit drugs, and reduces the overall effect of substance use disorders.
What novel treatment approaches have you seen make a difference for patients who are struggling? Share in the comments!
Dr. Kathleen Grant is a primary care physician in Athens, Georgia. She enjoys hiking, yoga, and playing ukulele with her husband. Interests in general internal medicine include rural populations, medical education, and cancer prevention. Dr. Grant is a 2024–2025 Doximity Op-Med Fellow.
Illustration by Jennifer Bogartz
