Addiction medicine PA Arianna Campbell discusses opioid use disorder treatment, buprenorphine, stigma, healthcare access, California Bridge, and why every PA has a role in addiction care.
A healthcare system can have evidence-based treatment, trained clinicians, and excellent programs—and still fail the patient who cannot figure out how to get through the front door.
That tension is at the center of our conversation with Arianna Campbell, DMSc, MPH, PA-C, CAQ-EM, DFAAPA, on the PA Mindset Matters podcast.
Arianna has spent more than 25 years in emergency medicine and nearly a decade working in addiction care. Her career has increasingly focused on a deceptively simple question:
When we identify someone who needs help, what are we actually going to do for them?
That question helped move Arianna from individual clinical encounters into healthcare systems change, including work with California Bridge and efforts to make evidence-based addiction treatment easier to access across emergency departments, hospitals, and communities.
Her message is relevant far beyond addiction specialists.
Addiction Medicine Is Part of Everyday Medicine
Patients with substance use disorders do not present only to addiction clinics.
They arrive in emergency departments with withdrawal or overdose. They appear in psychiatry with mood symptoms, psychosis, trauma, or anxiety. They receive care in primary care, pain management, obstetrics, infectious disease, hepatology, cardiology, pulmonology, and countless other settings.
For Arianna, that creates both responsibility and opportunity.
Early in her emergency medicine career, she recognized a gap: clinicians were becoming better at identifying opioid use disorder, but identification alone did not answer the most important clinical question.
What happens next?
Screening without an accessible treatment pathway can leave both the clinician and patient knowing there is a problem but without a meaningful next step.
That realization led Arianna and colleagues to begin offering buprenorphine in the emergency department to patients with opioid use disorder and withdrawal.
What began locally ultimately contributed to the development of California Bridge, an effort that expanded addiction treatment programs across hundreds of California hospitals and later supported implementation efforts beyond the state.
Evidence-Based Treatment Is Only Useful if Patients Can Access It
One of the most important themes from the episode is the difference between building a healthcare service and building a healthcare service that patients can actually find.
After years of expanding hospital-based addiction treatment, Arianna and her colleagues asked another basic question:
What does this system look like from the patient's perspective?
They tried searching for treatment the way someone in crisis might.
They encountered confusing websites, disconnected phone numbers, insurance barriers, delays, unanswered calls, and treatment options that were difficult to identify even when effective programs already existed.
That experience helped inform CA Bridge Connect, a statewide effort designed to help people navigate toward addiction treatment when they are ready to seek care.
The lesson applies throughout healthcare: clinicians may know where the resources are, but our patients often do not.
For someone experiencing withdrawal, fear, instability, or ambivalence about treatment, asking them to navigate five phone calls and multiple disconnected systems may be enough to lose the opportunity entirely.
Opioid Use Disorder Is a Time-Sensitive Condition
Arianna repeatedly returns to the importance of treating opioid use disorder as a medical condition that deserves the same urgency and consistency we apply elsewhere in medicine.
Her approach begins with protection.
Before expecting complete abstinence, restored employment, repaired relationships, or long-term recovery, clinicians have to help keep the person alive and engaged.
That can include:
offering evidence-based medication for opioid use disorder
providing access to naloxone
treating withdrawal
reducing immediate medical risk
understanding the patient's goals
creating a realistic next step into care
This reframes success.
A patient does not need to achieve every long-term recovery goal during the first encounter for that encounter to matter.
Sometimes success today is preventing an overdose.
Sometimes it is treating withdrawal.
Sometimes it is starting buprenorphine.
Sometimes it is creating enough trust that the patient comes back tomorrow.
Moving Beyond “Are We Just Substituting One Drug for Another?”
Clinicians who treat opioid use disorder routinely encounter concerns about medications such as buprenorphine.
Patients and families may ask whether medication treatment is simply replacing one opioid with another.
Arianna's response is grounded in the same approach clinicians use when discussing other chronic illnesses: explain the evidence, answer questions without judgment, and make a medical recommendation based on risk and benefit.
The larger issue is normalization.
We routinely recommend medications for diabetes, hypertension, asthma, and other chronic conditions. Patients with substance use disorders deserve the same straightforward conversation about evidence-based treatment.
Instead of reacting negatively to questions or ambivalence, Arianna encourages clinicians to welcome them.
Curiosity matters.
A patient asking, “Am I just trading one drug for another?” is not necessarily refusing treatment. They may be trying to understand it.
That question creates an opportunity for education and shared decision-making.
Stigma Is Not Just an Attitude Problem
Another powerful part of the conversation is Arianna's discussion of stigma.
It is easy to approach stigma as though the solution is simply telling clinicians to become more compassionate.
But Arianna's work suggests something more complicated.
Healthcare behavior is influenced not only by attitudes, but also by training, workflow, expectations, resources, and incentives.
When her own hospital began distributing naloxone, some staff worried that providing it might encourage substance use. Instead of labeling colleagues as stigmatizing, Arianna examined how to create meaningful practice change.
Education included lived experience, the neurobiology of addiction, clear clinical expectations, and measurable changes in care.
The question became not simply: Do clinicians say they have less stigma?
But: Did the patient's experience actually change?
That distinction matters.
Trauma-informed care requires more than compassionate language. It means asking what barriers, experiences, systems, and assumptions may be shaping the patient's interaction with healthcare.
PAs Can Help Change the System
Arianna's career also offers an important lesson for PAs.
She did not begin her career intending to redesign addiction care.
She began in primary care and spent much of her career in emergency medicine. The systems work emerged because she noticed something in clinical practice that did not make sense—and kept asking questions.
That same mindset has carried into her advocacy for PA education and recognition in addiction medicine.
Arianna has been involved in efforts supporting the development of an Addiction Medicine CAQ pathway for PAs, while simultaneously emphasizing that addiction care should not become something clinicians believe they cannot provide without specialty certification.
Specialized expertise matters.
But so does ensuring that every PA has enough addiction medicine knowledge to recognize substance use disorders, discuss evidence-based treatment, respond without stigma, and connect patients with care.
Staying Curious—and Staying Grounded
Systems change requires persistence, but Arianna repeatedly comes back to humility.
Ask whether what we are doing is working.
Follow the patient's journey.
Be willing to discover that the system we built does not work as well as we thought.
Then change it.
That same self-awareness extends to clinician wellness. Arianna describes intentionally reconnecting with family, rafting, trail running, sunshine, and getting her “feet in the dirt” as ways of restoring herself when professional responsibilities become heavy.
For clinicians working in addiction, psychiatry, emergency medicine, or other high-intensity settings, that reflection matters too.
We cannot control every outcome. But we can remain clinically grounded, continue questioning ineffective systems, and make it easier—not harder—for patients to receive the care they need.
Listen to the Full Conversation
Hear our complete conversation with Arianna Campbell on the PA Mindset Matters podcast as we discuss addiction medicine, buprenorphine, stigma, harm reduction, healthcare systems change, CA Bridge Connect, the evolving role of PAs in addiction care, and what it takes to turn evidence into access.
Listen on Spotify, Apple Podcasts, Podbean, or YouTube, and follow PA Mindset Matters for more clinician-to-clinician conversations about psychiatry, behavioral health, addiction medicine, professional growth, and whole-person care.
