Anna Maria South, MD, is an addiction medicine physician who treats patients with substance use disorders. She is also an assistant professor at the University of Kentucky College of Medicine training the next generation of health care leaders to improve access and advance treatment. 

The need for compassionate care is vital in addiction medicine. Every four hours, someone in Kentucky dies from an overdose. The Commonwealth is above the national average for hospitalizations for injection-related endocarditis.* 

Patients with an untreated opioid use disorder have a mortality rate that is six times higher than the general population.** At the same time, mortality-reducing, Food and Drug Administration (FDA)-approved medications (methadone, buprenorphine, and naltrexone) are available. 

Dr. South said these medicines are “severely underprescribed and underutilized,” noting that less than 10 percent of people in the U.S. who would benefit from being on medication for opioid use disorder are actually treated this way.*** 

Opioid use disorder is a chronic medical disease. Dr. South educates her patients about treatment options to empower them to make informed decisions about their care. Often, the treatment plan includes prescribing medications such as methadone and buprenorphine that are mortality reducing and can help alleviate the painful symptoms of opiate withdrawal while lessening the craving for opiates. In addition, naltrexone is approved for treatment of opioids and alcohol use disorder.

A common misconception about medication for opioid use disorder is that it is simply “replacing one drug for another.” OUD is a disease of the brain, not a lack of willpower, and withdrawal from opioids can cause debilitating side effects. Medications for opioid use disorder act on opioid receptors in the brain to both reduce cravings and the effects of illicitly used opioids. 

In other words, if a person uses opioids while on medication, the euphoria (or “high”) that usually comes with using the drug will be blocked. Studies show that the vast majority of people who attempt to stop using opioids “cold turkey” or stop medication treatment after a few weeks or months are very likely to relapse.

When Dr. South was training in residency at the University of Kentucky, she met a patient who helped her understand the power of access to treatment. 

“I had one patient who started on medication, and she was crying. I remember she was a little older than me and she told me her life story. We really bonded,” Dr. South said. “She told me how addiction has affected her life for the last two decades. For her to then say, ‘This medication is going to change my life,’ and to see how well she did with this medication was amazing to me.”

Recently, Dr. South has used her expertise to help populations who are incarcerated and suffering from substance use disorders. Joining faculty Laura Fanucchi, MD, MPH, and Michelle Lofwall, MD, Dr. South first-authored a viewpoint paper in the Journal of the American Medical Association (JAMA), advocating for access to treatment. The article points out that denying patients standard-of-care treatments because they are incarcerated violates ethics, constitutional amendments, and the Americans with Disabilities Act (ADA). 

In 2022, Dr. South was named the Bell Addiction Medicine Scholar, which allowed her to enhance addiction medicine training by developing an interactive lecture series for medical students, residents, and attending physicians. Her project focused on the importance of treating opioid use disorder among hospitalized incarcerated persons and ways to implement addiction treatment in the hospital setting. Dr. South is also part of the newest DREAM Scholar cohort.

In addition, Dr. South is the assistant director of the Health Equity and Advocacy Thread (HEAT), for the College of Medicine, an initiative under the Office of Medical Education to ensure that the curriculum focuses on addressing social determinants of health so that medical students learn how to address health inequities and can provide comprehensive, patient-centered care for patients from diverse backgrounds. 

Dr. South said the stigma around addiction can create innate, harmful biases preventing others from recognizing that some patients have a genetic predisposition for addiction and environmental triggers like substance use in their family, their peer group, or trauma that leads to addiction. 

As an educator interacting with learners, Dr. South said the next generation of addiction medicine specialists “are enthusiastic” about ways they can help.

“They see that addiction is a chronic medical disease that affects people from all socioeconomic, cultural, racial backgrounds, and they want to provide the best medical care they can for patients from diverse backgrounds,” Dr. South said, adding that her learners give her “a lot of hope for the future of addiction medicine.”

*Source: Siddiqi et al Rural-urban differences in hospitalizations for opioid use-associated infective endocarditis in Kentucky, 2016-2019. J Rural Health. 2022. 38(3). 604-611.

**Source: Dupouy J. et al Mortality Associated With Time In and Out of Buprenorphine Treatment in French Office-Based General Practice: A 7-year Cohort Study. Ann. Fam. Med. 2017. 15(4): 355-358. 

Evans E. et al Mortality Among Individuals Accessing Pharmacological Treatment for Opioid Use Disorder in California, 2006-2010. Addiction. 2015. 110 (6): 996-1005. 

Sordo L. et al Mortality Risk During and After Opioid Substitution Treatment: Systemic Review and Meta-Analysis of Cohort Studies. BMJ. 2017. 357:j1550. 

***Source: Gupta R, Levine RL, Cepeda JA, Holtgrave DR. Transforming Management of Opioid Use Disorder with Universal Treatment. N Engl J Med. 2022 Sep 21.