Compassionate Care in Addiction Medicine: A Conversation with Karen Haessler PA-C

Insights from Karen Haessler, PA-C, on reducing stigma, navigating substance use disorders, and building meaningful connections with patients.

Addiction medicine isn't just for addiction specialists. Whether working in emergency medicine, primary care, psychiatry, surgery, or obstetrics, PAs regularly encounter patients affected by substance use disorders. Yet stigma, limited training, and uncertainty about treatment can create barriers to effective care.

In a recent episode of PA Mindset Matters, hosts Jessica Spissinger and Mercedes Dodge spoke with Karen Haessler, PA-C, an addiction medicine PA whose career spans 25 years in paramedicine, emergency medicine, and hospital-based addiction treatment.

From building an addiction consult service to navigating complex withdrawal presentations, Karen shares practical lessons that every PA can incorporate into clinical practice.

Building Addiction Care Into Everyday Medicine

Karen's journey into addiction medicine began long before she became a PA. After 25 years as a paramedic and subsequent experience in emergency medicine, she helped develop a grant-funded, hospital-wide addiction consult program.

The service supports patients across emergency departments, inpatient units, orthopedic surgery, and obstetrics and gynecology.

This integrated approach recognizes a fundamental reality: substance use disorders don't exist in isolation from other medical conditions.

A patient hospitalized for an infection, fracture, or pregnancy-related complication may also need treatment for opioid use disorder or alcohol withdrawal. Addressing these needs during hospitalization creates opportunities to initiate treatment, prevent complications, and connect patients with ongoing care.

Language Is Harm Reduction

One of the most important themes of the conversation is that how we speak to patients matters.

Stigmatizing language can reinforce shame, discourage disclosure, and undermine trust. Simple changes in terminology can help create a more supportive clinical environment.

Consider these substitutions:

• Instead of "addict," use "person with a substance use disorder."

• Instead of "clean" or "dirty" urine, use "negative" or "positive" toxicology results.

• Instead of "drug abuse," use "substance use" or "unhealthy substance use."

• Instead of "noncompliant," describe the specific barriers affecting treatment participation.

Language alone won't eliminate stigma, but it can change the tone of a clinical encounter.

For patients who have experienced judgment or discrimination in healthcare settings, respectful communication may be the first step toward rebuilding trust.

Opioid Use Disorder: Treatment Shouldn't Have to Wait

Hospitalization provides an important opportunity to initiate medications for opioid use disorder (MOUD), including buprenorphine and methadone.

These evidence-based treatments reduce opioid-related mortality and support long-term recovery.

Karen discusses several clinical situations that require thoughtful management.

Buprenorphine Around Surgery

Patients receiving buprenorphine may require surgery or treatment for acute pain. Historically, clinicians often discontinued buprenorphine before procedures because of concerns about pain control.

Current guidance generally supports continuing buprenorphine through the perioperative period, with individualized adjustments when necessary.

Multimodal analgesia, coordination with anesthesia and addiction specialists, and appropriate use of additional analgesics can help manage pain while minimizing the risks associated with treatment interruption.

Low-Dose Buprenorphine Initiation

For patients exposed to fentanyl or other highly potent synthetic opioids, traditional buprenorphine initiation can be challenging because of concerns about precipitated withdrawal.

Low-dose initiation strategies, sometimes called microinduction, allow buprenorphine to be introduced gradually while a full opioid agonist is still present.

These approaches require appropriate clinical protocols and monitoring but can offer another pathway into treatment.

Addiction Treatment During Pregnancy

Karen also describes the importance of integrated addiction treatment during pregnancy, including methadone initiation and programs such as Moms Do Care.

Pregnant patients with opioid use disorder may face significant stigma and fear of judgment or legal consequences.

Evidence-based treatment, coordinated prenatal care, and compassionate communication are essential to supporting both maternal and infant health.

Alcohol Withdrawal: Recognize Risk Early

Alcohol withdrawal is another common and potentially life-threatening condition encountered across healthcare settings.

Karen highlights the importance of early screening, identifying patients at risk for complicated withdrawal, and following established treatment protocols.

Clinical pearls for PAs:

1. Assess withdrawal risk before symptoms become severe. A history of withdrawal seizures or delirium tremens is particularly important.

2. Recognize that withdrawal can progress rapidly. Seizures and delirium tremens may occur even when initial symptoms appear relatively mild.

3. Use structured assessment appropriately. Tools such as CIWA-Ar can support symptom monitoring in suitable patients, but they have limitations in patients who cannot reliably communicate.

4. Don't overlook thiamine. Patients with chronic heavy alcohol use or malnutrition may be at risk for Wernicke encephalopathy, a potentially serious neurologic emergency.

5. Know when to escalate care. Severe autonomic instability, seizures, delirium, and significant medical comorbidities warrant higher levels of monitoring and treatment.

Standardized protocols help clinicians recognize deterioration and deliver timely, evidence-based care.

Emerging Substances: Kratom, Fentanyl, and Beyond

The substance use landscape continues to evolve, requiring clinicians to remain curious and informed.

Karen discusses emerging concerns involving fentanyl adulterants, including xylazine and medetomidine, as well as kratom.

Kratom Is Not Necessarily Benign

Kratom is often marketed as a natural product for pain, mood, or opioid withdrawal. However, its active alkaloids interact with opioid receptors, and regular use can lead to physical dependence and withdrawal.

Symptoms may resemble opioid withdrawal, including anxiety, gastrointestinal distress, restlessness, and insomnia.

Karen discusses the use of buprenorphine for kratom withdrawal, an emerging off-label treatment approach supported primarily by limited clinical evidence.

A key takeaway is to ask specifically about kratom and other nonprescription substances rather than assuming patients will include them when discussing drug use.

Recognizing New Adulterants

Xylazine and medetomidine are non-opioid sedating agents that may appear in the illicit opioid supply.

Their presence can complicate intoxication and withdrawal presentations. Naloxone remains essential when opioid exposure is suspected, although it does not reverse the direct effects of these non-opioid substances.

Supportive care, monitoring, and awareness of local drug supply trends are increasingly important.

The Therapeutic Alliance Is a Clinical Intervention

Beyond medications and protocols, one of the most meaningful themes of the conversation is the importance of human connection.

Patients with substance use disorders may have experienced repeated rejection, judgment, or fragmented healthcare. Clinicians have an opportunity to offer something different.

That begins with listening without assumptions, recognizing ambivalence, respecting patient autonomy, and understanding that recovery rarely follows a linear path.

It also requires self-reflection.

What assumptions do we bring into the room? How might frustration, burnout, or unconscious bias influence our interactions?

Compassionate care does not mean abandoning clinical boundaries or ignoring risk. It means approaching patients with dignity while providing evidence-based treatment.

Building Your Addiction Medicine Skills

PAs do not need to specialize in addiction medicine to make a meaningful difference.

Karen highlights several resources for clinicians interested in expanding their knowledge:

• Providers Clinical Support System (PCSS): Education, mentorship, and clinical resources related to substance use disorders.

• American Society of Addiction Medicine (ASAM): Clinical guidelines, education, and professional development.

• Boston Medical Center Grayken Center for Addiction: Addiction medicine training and educational resources.

Even small improvements in screening, communication, withdrawal recognition, and treatment initiation can improve patient care.

The Bottom Line: Every PA Has a Role in Addiction Care

Addiction medicine is not defined solely by prescribing buprenorphine, managing withdrawal, or working on a specialty consult service.

It is also about recognizing opportunities to intervene, reducing barriers to treatment, and creating clinical environments where patients feel safe seeking help.

Karen Haessler's experiences remind us that meaningful addiction care requires both clinical knowledge and human connection.

We may not be able to change a patient's entire journey in one encounter, but we can change how they experience healthcare in that moment.

And sometimes, that is where recovery begins.

Listen to the Episode

PA Mindset Matters: Compassionate Care in Addiction Medicine — A Conversation with Karen Haessler

Join Jessica Spissinger and Mercedes Dodge for a conversation about addiction medicine, harm reduction, emerging substance use trends, and practical strategies for providing compassionate, evidence-based care.

Addressing stigma, unlocking skills.