Posted on Jan 28, 2021
When Dr Jeff Harries first read in a 2003 Lancet article about a pharmacotherapy that helped some patients with alcohol use disorder (AUD), it began a change in how he understood AUD.
“AUD is a chronic brain disorder that is caused by excess alcohol use,” Dr Harries explains. “People drink to treat the symptoms of the disorder, which includes agitation, anger and anxiety, but using alcohol perpetuates the disorder.”
He had learned in medical school and his Internship that AUD was caused by poor choices, weak character, and poor upbringing. Because of the Lancet paper, Dr Harries prescribed topiramate to a 45-year-old man with a 30-year history of severe AUD, and within a month, the man quit drinking permanently. The Penticton family doctor began trialling all of his patients with AUD on this medication with many successes. Not everyone responded to that medication, unfortunately.
In 2016 when Dr Harries learned that there were additional medications, such as naltrexone and acamprosate, that had been shown to help some people with AUD, he discovered that they could also help his patients, including those for whom topiramate hadn’t helped. Some of these medications even had an impact on certain patients with cocaine, methamphetamine, and cannabis use disorders.
Thrilled by the success of pharmacotherapy as an effective adjunct to counselling, compared to the standard detox and rehab route, Dr Harries recommended it to other doctors and addictions specialists. Many remained unconvinced, citing the potential side effects of medications, the failure of aversive medication-based therapies like Antabuse, and the myriad of stigmas that surround AUD. This frustrated him, and by 2017, Dr Harries decided he had to “change the paradigm” of this disorder. Since then, he’s shared his story of understanding and treating AUD differently at Continuing Medical Education (CME) and other events, speaking to more than 150 groups in BC and Alberta, comprising more than 4,500 people.
To gauge the uptake of his message, Dr Harries and his team – a knowledge transfer PhD, a former Interior Health executive and a health quality expert – launched a Physician Quality Improvement (PQI) project that measured the rate of medication being prescribed to treat AUD in communities where he had spoken, versus the rate prescribed in communities where he had not. The results showed prescriptions quadrupled for AUD in places where he’d spoken. In the South Okanagan alone, over the first 18 months of his talks, 1,000 people with AUD began to be treated with proven pharmacotherapies.
Dr Harries likens prescribing medication for AUD to prescribing an antibiotic for pneumonia – it is absolutely essential. He sat on the AUD Guideline Development Committee for the BC Centre on Substance Abuse, whose guidelines were released in December 2019, and he’s actively supporting the promotion of those guidelines. In addition, he recently wrote a “This Changed My Practice” article, published by UBC. In 2020, Dr Harries and his team established the Canadian AUD Society to promote national awareness.
Dr Harries earned his medical degree – and met his wife, Dr Leona Harries – at the University of Calgary. The couple has nine children. Dr Harries and his wife closed their joint practice after Dr Harries was diagnosed with Amyotrophic Lateral Sclerosis (ALS) in 2018. He equates ALS with AUD, saying that what’s necessary for both is simply evidence-based, hopeful and compassionate patient-centered care.
“AUD is the same as any illness,” Dr Harries explains. “If everybody around you is saying ‘Oh, the condition you have is hopeless, give it up, you’ll never get better, you’re failing, and you are going to die, no matter what you do,’ anyone would just wither up and die. But we don’t do that for most illnesses – we love people, we encourage them all we can, and they survive, or they do much better than they would have done with care that was without hope and compassion. In that way, ALS is similar to AUD -- neither is without hope, which is how we used to think.”
PQI is a flagship initiative of the Specialist Services Committee, a partnership of Doctors of BC and the Ministry of Health. In collaboration with BC health authorities, PQI works to enhance physician capacity by providing training and hands-on experience on quality improvement projects, ultimately promoting a culture of learning, openness and dedication to quality improvement in the health care system.
