Honora Englander
@honoraenglander.bsky.social
Addiction Medicine Physician and health services researcher, Director/ PI of OHSU's Improving Addiction Care Team (IMPACT); recent US France Fulbright scholar. Committed to improving health systems. views=mine
I'm still getting my legs about me on #BlueSky so not sure who's here, but for starters, tagging a few including: @maiasz.bsky.social @levfacher.bsky.social @suenlw.bsky.social@stephenhrnrp.bsky.social @drscotthadland.bsky.social @drsarahwakeman.bsky.social @yaleadm.bsky.social @suenlw.bsky.social
April 1, 2025 at 7:49 PM
I'm still getting my legs about me on #BlueSky so not sure who's here, but for starters, tagging a few including: @maiasz.bsky.social @levfacher.bsky.social @suenlw.bsky.social@stephenhrnrp.bsky.social @drscotthadland.bsky.social @drsarahwakeman.bsky.social @yaleadm.bsky.social @suenlw.bsky.social
Huge thanks to #USFulbright #FondationNeurodis #LeCentreHospitalierVinatier, my ✨hosts @benjaminrolland.bsky.social @marieroustide.bsky.social, our participants, and a long list of ppl who helped mentor, teach, and support this work
April 1, 2025 at 7:47 PM
Huge thanks to #USFulbright #FondationNeurodis #LeCentreHospitalierVinatier, my ✨hosts @benjaminrolland.bsky.social @marieroustide.bsky.social, our participants, and a long list of ppl who helped mentor, teach, and support this work
Seeing this in practice offered such a sharp contrast to the the US. And, it offers not only a critique but an alternative to policies and practices rooted in punishment and control.
My hope is that clinicians, policy makers can use this to better recognize our assumptions & move forward in the US
My hope is that clinicians, policy makers can use this to better recognize our assumptions & move forward in the US
April 1, 2025 at 7:43 PM
Seeing this in practice offered such a sharp contrast to the the US. And, it offers not only a critique but an alternative to policies and practices rooted in punishment and control.
My hope is that clinicians, policy makers can use this to better recognize our assumptions & move forward in the US
My hope is that clinicians, policy makers can use this to better recognize our assumptions & move forward in the US
We also found that to accomplish this, clinicians balanced flexibility and structure, weighing clinical decisions and risks in context /7
April 1, 2025 at 7:35 PM
We also found that to accomplish this, clinicians balanced flexibility and structure, weighing clinical decisions and risks in context /7
The biggest Qs that I have heard from US clinicians about this is: "are you saying abstinence is bad?"
My reply: No! The point is not that abstinence is bad, or that we shouldn't support people when that is their goal. But if the system imposes it, there are unintended harms. / 6
My reply: No! The point is not that abstinence is bad, or that we shouldn't support people when that is their goal. But if the system imposes it, there are unintended harms. / 6
April 1, 2025 at 7:34 PM
The biggest Qs that I have heard from US clinicians about this is: "are you saying abstinence is bad?"
My reply: No! The point is not that abstinence is bad, or that we shouldn't support people when that is their goal. But if the system imposes it, there are unintended harms. / 6
My reply: No! The point is not that abstinence is bad, or that we shouldn't support people when that is their goal. But if the system imposes it, there are unintended harms. / 6
This is so different than the US, where in subtle and very overt ways, the whole system prioritizes abstinence.
Even among healthcare clinicians who embrace harm reduction, harm reduction is often positioned as an intermediate or lesser goal. Not THE goal of MOUD /5
Even among healthcare clinicians who embrace harm reduction, harm reduction is often positioned as an intermediate or lesser goal. Not THE goal of MOUD /5
April 1, 2025 at 7:28 PM
This is so different than the US, where in subtle and very overt ways, the whole system prioritizes abstinence.
Even among healthcare clinicians who embrace harm reduction, harm reduction is often positioned as an intermediate or lesser goal. Not THE goal of MOUD /5
Even among healthcare clinicians who embrace harm reduction, harm reduction is often positioned as an intermediate or lesser goal. Not THE goal of MOUD /5
What did we find?
Participants described pt engagement as the #1 goal of OAT. They felt imposing or expecting abstinence was harmful and might obligate patients to lie or “lead a double life,” lead to mistrust, missed care opportunities, and “losing patients” who disengaged from care /4
Participants described pt engagement as the #1 goal of OAT. They felt imposing or expecting abstinence was harmful and might obligate patients to lie or “lead a double life,” lead to mistrust, missed care opportunities, and “losing patients” who disengaged from care /4
April 1, 2025 at 7:25 PM
What did we find?
Participants described pt engagement as the #1 goal of OAT. They felt imposing or expecting abstinence was harmful and might obligate patients to lie or “lead a double life,” lead to mistrust, missed care opportunities, and “losing patients” who disengaged from care /4
Participants described pt engagement as the #1 goal of OAT. They felt imposing or expecting abstinence was harmful and might obligate patients to lie or “lead a double life,” lead to mistrust, missed care opportunities, and “losing patients” who disengaged from care /4
We compared methadone policies in US and FR (below).
Here, we interviewed healthcare stakeholders (MDs, nurses, pharmacists, drug user union activists, policymakers) to explore how they approached methadone and bup, drawing lessons for the US and elsewhere.
pubmed.ncbi.nlm.nih.gov/38878588/
Here, we interviewed healthcare stakeholders (MDs, nurses, pharmacists, drug user union activists, policymakers) to explore how they approached methadone and bup, drawing lessons for the US and elsewhere.
pubmed.ncbi.nlm.nih.gov/38878588/
Comparing methadone policy and practice in France and the US: Implications for US policy reform - PubMed
Despite being among the most effective treatments for opioid use disorder, methadone is largely unavailable in the United States, due primarily to federal and other policies that limit its availabilit...
pubmed.ncbi.nlm.nih.gov
April 1, 2025 at 7:22 PM
We compared methadone policies in US and FR (below).
Here, we interviewed healthcare stakeholders (MDs, nurses, pharmacists, drug user union activists, policymakers) to explore how they approached methadone and bup, drawing lessons for the US and elsewhere.
pubmed.ncbi.nlm.nih.gov/38878588/
Here, we interviewed healthcare stakeholders (MDs, nurses, pharmacists, drug user union activists, policymakers) to explore how they approached methadone and bup, drawing lessons for the US and elsewhere.
pubmed.ncbi.nlm.nih.gov/38878588/
I spent a year studying methadone and bup care (OAT) in France where 87% of ppl with opioid use disorder receive OAT vs <20% in the US
w the brilliant @benjaminrolland.bsky.social & Marie Jauffret-Roustide, I wanted to understand *HOW*. Turns out: clinicians and systems prioritize engagement/ 2
w the brilliant @benjaminrolland.bsky.social & Marie Jauffret-Roustide, I wanted to understand *HOW*. Turns out: clinicians and systems prioritize engagement/ 2
April 1, 2025 at 5:27 PM
I spent a year studying methadone and bup care (OAT) in France where 87% of ppl with opioid use disorder receive OAT vs <20% in the US
w the brilliant @benjaminrolland.bsky.social & Marie Jauffret-Roustide, I wanted to understand *HOW*. Turns out: clinicians and systems prioritize engagement/ 2
w the brilliant @benjaminrolland.bsky.social & Marie Jauffret-Roustide, I wanted to understand *HOW*. Turns out: clinicians and systems prioritize engagement/ 2