Provider Perspective: Malik Burnett, MD, MBA, MPH

The harm reduction approach to healthcare is a very important, yet often misunderstood, aspect of engaging people with substance use disorders.

Rooted in the idea that there should be neither stigma nor shame associated with human behavior, harm reduction services are key to building a physically and mentally healthy state of Maryland. Providing healthcare services that are free from stigma and shame helps patients develop trust with their providers, which in turn leads to increased engagement in care.

Malik Burnett, MD, MBA, MPH, is medical director of the Center for Harm Reduction Services at the Maryland Department of Health. He works from the principles of harm reduction by supporting patients as they strive towards recovery and reducing the stigma associated with substance use.

Read the Q&A below to see how Burnett helps to bring the state of Maryland alive!

Can you tell us about your work?

“I work with patients who have substance use disorders and try to help them achieve sustainable recovery. 

My goal beyond working with patients at an individual level is to build a system that is able to effectively support patients who have substance use disorder, eliminate the stigma associated with substance use disorders, and change the framework and approach to drug use from one that is centered around criminal justice to one that’s centered around public health.”

What inspired you to enter this field?

“I originally got interested in drug policy back in 2012 after doing a general surgery residency. It started with the efforts toward changing cannabis laws. I looked at the data and saw that the enforcement of cannabis laws was disproportionately biased against communities of color, which really inspired me to get involved in running a campaign to end cannabis prohibition in the nation’s capital while working for the Drug Policy Alliance.

Since that time, I have looked for opportunities to combine my medical, public policy, and business backgrounds to build a better system for how we approach various drugs in the United States.”

What are some common misconceptions surrounding your work?

“I think that by and large, people don’t really have a good understanding of the fact that people who have substance use disorders are very much disconnected from society at large; they don’t necessarily have a robust support system, both within the healthcare system and outside of the healthcare system. Their social determinants are largely very poor and the support systems and the social safety net that we’ve built to help people improve their position in society do not [always] work for people who have substance use disorders. 

If we’re going to be serious about tackling the overdose crisis that we’re dealing with, we have to work better to stitch together the various social safety net systems to better capture this population.”

What are some of the challenges that you faced over the past two years? How did you overcome them?

“Some of the biggest challenges that I’ve faced over the past couple of years are largely dealing with the stigma, both within the population of patients that I take care of and amongst policymakers, and helping them understand the realities of the situation that we’re in– at least with the policymakers so far. The status quo, in terms of our strategies to approach various issues around drugs, has been woefully inadequate and to a great extent failed. We should be very intentional about looking critically at our current strategies and being very progressive in our application of new strategies. 

And then within the population of patients that I take care of, it has been a challenge just dispelling some of the misconceptions and stigmas around the medications that we use to take care of them. Largely due to the policy, orientation structures around methadone, maintenance, and even buprenorphine, patients have a lot of misconceptions about those medications. Getting patients to understand that those medications are their best strategy for long-term recovery is kind of the everyday struggle.” 

What do you hope to see in the future?

“My hope is that we can move addiction medicine from being what I would describe as the third rail of healthcare into the mainstream. I call it the third rail because healthcare is divided into physical care, and then mental healthcare, and then addiction care. And so it’s the third-order removed from the mainstream healthcare system. The future of my field would be best achieved if we can, along with mental healthcare, get it all and treat people in a comprehensive sort of way where we address all of the various issues that they’re dealing with– their physical, mental, and behavioral health.”

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