‘Eventually we settled on a topic and our speakers, though we had many interested individuals and an abundance of potential material’
It all started with a listserv message.
A member of both the Addiction & Toxicology and Bioethics SIGs took soundings from SIG leaders then suggested a co-sponsored workshop at CLP 2023 addressing practical ethical issues that arise in caring for inpatients with substance use disorders.
But would the topic be… assessing capacity and how to ethically move forward after the determination, often dealing with impaired/judgmental/estranged surrogates; conceptualizing harm reduction as morally imperative and promulgating this view as a C-L psychiatrist; managing in-hospital use in context of conflicting values around privacy and safety, and when intercepting use results in the patient leaving the hospital (net result being that the patient is going to use either way, but then doesn’t get any medical care)…?
There were a lot of debated subjects to choose from.
They settled on a single topic to create an in-depth workshop—with the thought they could get together again to revisit other topics at future ACLP annual meetings.
The listerv message—from Sam Zwiebel, MD, MA, assistant professor of Clinical Psychiatry at the University of Pennsylvania Perelman School of Medicine—concluded: “I’m looking to assemble a few of us comfortable with and interested in speaking about the SUD/bioethics overlap. Hope to hear from you soon!”
And so Bioethical Considerations of Harm Reduction: A Workshop Co-Sponsored by the Addiction & Toxicology and Bioethics SIGs at CLP 2023 in Austin, Texas (November 8-11), was born.
Just after the workshop was accepted by the Annual Meeting Committee—one of several co-sponsored by two of the Academy’s SIGs—we caught up with Sam:
How did the idea for the subject matter come about?
Bioethics underlies so much of the work we do as C-L psychiatrists and is particularly critical in the treatment of patients with substance use disorders (SUDs). Caring for patients with SUDs can be very challenging, often due to moral distress, though we don’t always recognize our uneasy feelings as such. We had many ideas about different topics to cover and ultimately decided on harm reduction as a topic of manageable size for a workshop.
Are there particular bioethics issues which your members have raised/discussed?
There is an endless supply of bioethical issues that arise in caring for patients with SUDs. Many of our members are interested in the role of involuntary treatment, the nuances of capacity assessments, and anti-stigma work to achieve equitable care for these patients. Additionally, many of our members work in the area of transplant psychiatry, so candidacy evaluations and resource allocation for patients struggling with addiction are frequent topics of discussion.
How have the two SIGs liaised?
I am a member of both SIGs and have been the early career chair of the Bioethics SIG. ACLP is such a close-knit community and it was a pleasure to coordinate with leadership and membership from both SIGs to bring everyone together. After corresponding with SIG leadership from both Bioethics and Addiction & Toxicology and garnering endorsement, we moved forward with putting out a call to members at large to express interest. Eventually we settled on a topic and our group of speakers, though we had many interested individuals and an abundance of potential material. We all met through video conferencing to hash out the details, delegate roles, and finalize the submission.
How have you found working cooperatively?
This workshop came together so easily! SIG leadership was highly responsive and our crew was outstanding in developing the submission. Attending virtual SIG meetings throughout the year is the best way to connect with the chairs, and while we were open to anyone joining as a speaker, I happen to already know the chairs and speakers through fellowship interviews, job interviews, and connections made over shared interests at our annual meeting.
What are you aiming to achieve with the workshop / what do you expect attendees to take away from it?
We hope that attendees will feel more confident practicing and advocating for thoughtfully measured harm reduction in a way that strikes the right balance of patient autonomy and non-maleficence. Attendees should be able to systematically recognize and analyze key issues in their own cases and appreciate that there are highly implementable strategies for breaking down complex cases into manageable chunks.
Do you have a synopsis of the content yet and line-up of speakers (showing who is from which SIG)?
Brent Schnipke, MD, (fellow, Northwestern University, Addiction & Toxicology) will discuss how harm reduction is an ethical, patient-centered practice.
Miyuki Fukui, MD, (fellow, University of Southern California, Addiction & Toxicology) will present practical guidance on implementing harm reduction measures for the management of in-hospital substance use.
Nicholas Kontos, MD, FACLP, (Massachusetts General Hospital, Bioethics) will critique the prevalent dichotomization of providers as stigmatizers versus supporters and offer a more nuanced interpretation of the ethics of harm reduction.
Myself, (early career psychiatrist, University of Pennsylvania, Bioethics and Addiction & Toxicology) I’ll examine how the management of SUDs compares to other psychiatric presentations of self-harm, and analyze how ethical principles are inconsistently applied across different disorders.
James Levenson, MD, FACLP, (Virginia Commonwealth University, Bioethics) will moderate the workshop.
What format are you adopting to include attendee participation?
Our workshop will guide audience members through case-based discussions highlighting some of the most common ethical issues in harm reduction to provide practical guidance on navigating these challenges. There will be a lot of time devoted to questions and audience discussion.
Have your two SIGs worked together before, or is this the first time?
I believe that prior to my involvement in ACLP, there was a workshop dedicated to the bioethics of managing patients with injection drug use-related infective endocarditis, which is my primary clinical passion. This year, there was so much enthusiasm for the joint effort and we plan on joint submissions in the future.
Have you been given a slot in the program yet?
Not yet. We will be assigned a slot in the coming weeks and invite everyone to join us!