Addiction’s Seat at the Table: An Interview With Outgoing APA President

CONFERENCE REPORTER

Petros Levounis, MD, MA, is the outgoing President of the American Psychiatric Association (APA); a professor and chair of the Department of Psychiatry and associate dean for professional development at Rutgers New Jersey Medical School; and the chief of service at University Hospital in Newark, New Jersey. Levounis stopped in the press room at the 2024 APA Annual Meeting to discuss his year as president, his presidential theme, and his thoughts on addiction psychiatry.

PT: Addiction is the theme of this year’s APA Annual Meeting. What does it mean to you, as the outgoing president of the APA, to have this topic highlighted?

Petros Levounis, MD, MA: Addiction has not been showcased in presidential themes or in annual meetings in the past. This shows a great need to bring addiction into the fold, to have a seat on the table. I decided not only to have it as a presidential theme, but also chose to have many campaigns, with 1 every 3 months. The first was tobacco and vaping. The second was on opioids, meant to coincide with recovery marketing. The third one was an eligible different side of the dais and people having more drinking. The fourth one was in the emerging field of technology, technological addictions that we are now studying. Each one of them is very rich. I had very specific messages on each one of them, both for physicians and for the general public.

The message was extremely simple. One: dispel myths and misconceptions about both substance use disorders and behavioral addictions. Two: state as loudly as possible that treatment is available, safe, and effective. These are the 2 things that guide us for this year.

PT: You are speaking in a session and teaching a course on buprenorphine at this year’s Annual Meeting. What is the top recommendation you would give to a clinician seeking to set up office-based treatment with buprenorphine for patients with opioid use disorder?

Levounis: Number one, the buprenorphine waiver does not exist. In December 2022, Joe Biden signed the Mainstreaming Addiction Treatment Act into law, but it has not trickled down. People may think that we need even more regulations behind buprenorphine. We dispel that myth. That is a very specific niche. We need to dispel it so anybody can prescribe in office—you do not have to have any special training or a special license or anything like that.

Sublocade, which is the more dangerous form of buprenorphine, does need a little more work. You need refrigeration. You need to have a relationship with a pharmacy. Buprenorphine is a wonderful, wonderful medication and we use it, but with sublocade, you need to have good instruction. It is a little more involved, while just prescribing good old sublingual buprenorphine is very, very straightforward.

PT: What upcoming pipeline treatments are you excited about? How might they help patients with addiction in the future?

Levounis: I will mention naloxone for acute opioid intoxication because I think they go hand in hand. My major interest, effort, scholarships, publications and so on have been the diffusion of opioid use disorder, which maybe includes buprenorphine, but let's not forget the hyper acute situation of saving somebody's life with naloxone. The controversy which you may be coming across is with nalmefene (Opvee). Essentially, it is a long-acting opioid antagonist. The people who make Opvee advertise it as better than naloxone; they say that it protects you for a longer period of time. I guess I can hear that argument of course, especially in the days of fentanyl, that you may want to have more coverage anyway, that way you do not have resurgence of hyper short acting opioids in the system. But the problem with the long-acting blockade over the opioid system is that it delays the life-saving initiation of stuff like buprenorphine. Let’s say you have somebody in the emergency room, you want to start giving buprehnorphine as quickly as possible and boom, somebody in the field gave a person Opvee or nalmefene and now you are blocked and you cannot start your work.

PT: What advice would you give to the incoming APA President after your year?

Levounis: I would tell them that the support of the staff is absolutely incredible. It really is. I have been in organizations for about 7 years and we all have support. Our staff, our administration—make as much use of it as you can. There is so much enthusiasm and so much hard work going on. All you have to do is perhaps coordinate a little bit or find the right people to ask, and work will be done.

PT: What are you most proud of from the past year?

Levounis: I set out to bring addiction to the table. And I think that both the membership and the general public are more aware of addiction and addiction treatment, so the needle has moved.

Also, we put some structures together like the convening of several different organizations to keep the needle moving, not just within substance use. When we convened the American College of obstetricians and gynecologists, and family medicine, and internal medicine, and osteopathic medicine, and pediatrics, and so on, brought them all into the same room, it was not just the presidents. Presidents come and go. We were also accompanied by the communications people, because there are different numbers of people that will continue this work in the future. A lot of these kinds of collaborations have been done on the presidential level and fine, that is good. But it is the staff that will continue the work.

PT: Is there anything you wish you could have achieved but did not? The answer can be no. If you achieved everything you set out to do, that would be amazing…

Levounis: I have 2 major personal academic kind of interests: (1) addiction, which is purely professional, and (2) LGBTQ+ mental health, which is personal and professional. I was very torn between addiction and LGBTQ+ mental health for my presidential initiative. Some people suggested that I do a combination of the 2—a terrible idea, terrible idea because it feeds into that stereotype that all there is to being gay is the doing drugs and having a good time. We are not there yet. Maybe one day we will actually highlight the dangers of drugs in LGBTQ+ communities without the fear that we are going to be further stigmatized and further discriminated against.

So our theme on addiction was wonderful. But it did leave a little something to be desired on the LGBTQ+ mental health front, which I wish we had an opportunity to flesh out more. I was delighted last night in the fireside chat with Anderson Cooper that LGBTQ+ issues were highlighted. I saw the clock countdown to 8 or so minutes left in our discussion. I said, I have to go there—I have to talk about gay stuff. He took the ball and ran with it, and we talked about coming out and the decision of having kids as a gay man. It went very well. I felt that, of course, this topic was not as big as the addiction initiative, but at least there was some kind of nod to LGBTQ+ mental health. Still, that was something I wish that we had been able to pursue further.

PT: Thank you!