Patricia Á. Fortunato

Harris, R. A., Khatana, S. A. M., Glei, D. A., & Long, J. A. (2025). Stimulant–Involved Cardiovascular Disease Mortality and Life Years Lost, 2014 to 2023. Substance Use: Research and Treatment, 19, 29768357251342744.

This past spring, a trend analysis found that over the past decade in the United States, stimulant-involved CVD mortality surged with average annual percent change (AAPC) at 10.1%. Methamphetamine-involved deaths exceeded cocaine—methamphetamines were correlated with 580,570 years of life lost (YLL); cocaine was a contributing cause with 423,528 YLL; and approximately 1.95% of stimulant-involved CVD deaths included both methamphetamines and cocaine listed on death certificates.

In addiction medicine, we've built up resources on pain, opioid use and other substance use, and inclusive of CVD. BUT, we need more resources focused on stimulant use and CVD, and I'm grateful for the critical work being done in Philly by the Substance Use Prevention and Harm Reduction (SUPHR) team.

As of December 2025, Philly is recording its lowest number of fatal overdose deaths since 2016. This progress reflects the hard work being done by SUPHR and community-based partners including Savage Sisters Recovery, and the evidence base of ongoing SBIRT, MAT, harm reduction, and trauma-informed SDoH support.

Learn more about the SUPHR Heart-to-Heart campaign here.

So many of us with experience in addiction medicine—whether from clinical or peer perspectives—know these issues and that stimulants run the spectrum from dextroamphetamine–amphetamine to caffeine and nicotine to methamphetamine, cocaine, and phencyclidine.

My hope is that we get to the point where patients seeking support for unhealthy stimulant or polysubstance use, dependence, or stimulant use disorder (StSUD) or PSUD are screened for CVD in all care settings; where high-risk CVD patients are screened for substance use inclusive of stimulant use; and where destigmatizing clinical practices and multidisciplinary teams are predominant.

Last spring, an infectious disease modeling study revealed that since that time, vaccination to protect against 14 pathogens in the EPI saved 154 million lives. Of this number, 146 million were children younger than five years, among whom 101 million were infants younger than one year. Further, of all lives saved by vaccination, the MMR saved the most and spanned all global income strata.

As a result of the EPI's foundational work, vaccination is now attributed to 40% of decreased global infant mortality.

Shattock, A. J., Johnson, H. C., Sim, S. Y., Carter, A., Lambach, P., Hutubessy, R. C., ... & Bar–Zeev, N. (2024). Contribution of Vaccination to Improved Survival and Health: Modelling 50 Years of the Expanded Programme on Immunization. The Lancet, 403(10441), 2307–2316.

Still, the study's findings underestimate the full impact of vaccination, as influenza, HPV, COVID–19, and others weren't included. A separate study found that COVID–19 vaccination worldwide prevented more than 19 million excess deaths during the first year of global programs. In the United States, during that first year, our programs prevented more than one million deaths and more than 10 million hospitalizations.

Despite this progress, over the past two years, COVID–19 booster shot uptick among Americans was poor. While 50% of older adults received boosters, less than 25% of Americans overall received them. Health care professionals are not excluded from this decline, with less than one-third having participated in the 2023–2024 program.

Patient trust in physicians declined during the pandemic and has continued. However, findings from the 2025 KFF Tracking Poll on Health Information and Trust revealed that presently, Americans largely trust (85% across political parties) their personal physicians. This trust supports the critical role of providers in humanizing, listening to, and counseling patients.

KFF data further showed a trend in shifting attitudes towards childhood vaccines among parents. As of 2025, 82% report staying up-to-date with recommended vaccines, including the MMR, for their children; and 17% report delaying or skipping vaccines. It has been scientifically proven that vaccines, including MMR vaccines, are not linked to autism. Yet, among adults, 3% report belief in this myth; 20% report being open to believing it; and 41% report being uncertain.

As we bear witness to the decline of public trust in vaccination due to misinformation, we must speak up across public platforms if we are able to do so and refute unscientific statements. Further, as reduced MMR vaccination rates drive increases in outbreaks and cases across the U.S., we must seek to further educate ourselves and our communities where necessary.

Coming from disparate cultures, I'm intimately familiar with hesitancy and am incredibly grateful to work with physicians in research and development of effective tools and resources. Providers should seek to understand disparities in social determinants of health, demonstrate compassion, address hesitancy directly, facilitate a safe space for patients to convey concerns, and provide evidence-based information, without shaming patients or directly discrediting them.

Rotter, L. K. (2024). Do You Feel Safe at Home?. New England Journal of Medicine, 391(9), 785–787.

Intimate partner violence (IPV) remains a persistent public health crisis. Findings from the 2024 National Intimate Partner and Sexual Violence Survey (NISVS) revealed that 41% of women and 26% of men experience IPV in their lifetime. Further, this past November, the United Nations Office on Drugs and Crime (UNODC) and UN Women published research on the state of femicide in 2023, acknowledging that worldwide, 85,000 women and girls were intentionally killed that year and that 60% of these homicides were committed by an intimate partner or loved one/family member.

A review of the literature acknowledges the prevalence of IPV victims/survivors suffering from acute injuries and chronic conditions, with high rates of chronic pain, mental illness, substance dependence, and cardiovascular disease. Research further acknowledges that patients can benefit from connecting with providers and discussing unhealthy relationship experiences, regardless of whether the patient is interested in referral to IPV services; and that victims/survivors value being provided information on services and assistance with connection.

Drs. Christopher Miller and Omonyêlé Adjognon et al. noted:

"Emphasis should be put on better assessing adoption, fidelity, and person-centeredness in IPV screening, as almost all clinicians across healthcare settings will encounter patients who have experienced IPV. Deliberately seizing every opportunity to properly screen for IPV, counsel, refer, and follow up on patients who endorse IPV in healthcare settings is a cornerstone to address this public health issue effectively."

The American Medical Association (AMA) recommends a systems approach with all physicians across clinical practice settings to perform screening. Many health systems have integrated screening in clinical workflows. However, a gap persists in initiation and intervention, with physicians struggling with lack of education on the topic and discomfort in engaging patients.

As we work towards screening and healing for victims/survivors, my clinical colleagues and I completed a mixed-methods project on lack of evidence-based, culturally responsive educational tools and practice for intersectionality. Further, as we develop physician education resources to initiate and foster destigmatizing experiences for at-risk patients, I remain dedicated to my continued work towards improved and trauma-informed preventive care.

I often reflect on my initial, foundational work helping to educate physicians and implement system-wide SBIRT. The gap therein also focused on physicians largely struggling with lack of education on the topic and provider stigma.

Over the past decade, Cleveland Clinic HVTI had a 23% increase in patients admitted for injection drug use–associated infective endocarditis (IDU–IE) requiring surgery. Similar to outcomes across the Unites States, patients s/p at HVTI have done well for the first three months and the highest risk post-op period prevalently occurs between 90–180 days. At that point and across the U.S., PWID have approximately 10-fold increased risk of overdose or redo surgery compared to those who do not inject drugs. The five-year rate of death for those who undergo initial surgery remains higher for PWID related to IDU relapse, IE recurrence, CHF, and age.

I wrote about some personally meaningful topics here and here.

I'm so grateful to have helped lead this project. As part of an evidence-based addiction medicine integration with primary care networks, we launched and disseminated a health communication series on specific substances (opioids, alcohol, benzodiazepines, stimulants as excerpted above, psychedelics, cannabis and marijuana) and prescriber education materials on SBIRT. SmartPhrase templates are also created for EMR.

The methadone prescribing algorithm is published as part of the Southern New Jersey Medication for Addiction Treatment Center of Excellence (MATCOE) Emergency Department Addiction Pathways (EDAP) and in the Journal of Emergency Medicine (JEM), March 2023. Learn more here.

Recommended citation:

In January of 2022, an emergency medicine resident collaborated with an addiction medicine medical director to consider the possibility of micro-induction when presented with a unique opportunity to establish a patient on buprenorphine from an urgent care center. The multidisciplinary team previously established a buprenorphine/naloxone sublingual (BUP/NX SL) micro-induction for outpatient protocol* for clinical implementation and successful utilization across campuses and with Southern New Jersey Medication for Addiction Treatment Center of Excellence (MATCOE) networks.

*To support buprenorphine prescribers who may often find themselves sketching the micro-induction process for patients, the addiction medicine content manager designed health communication material outlining the aforementioned protocol for micro-induction in the outpatient setting, in addition to adjunctive medications. The protocol is featured in a manuscript, authored by the content manager and clinical team, and submitted for peer review and publication. Learn more here.

Recommended citation:

Yesterday, I received the COVID–19 booster shot. My minor side effects are fatigue, sore arm, headache, and body chills. Overall, it was a very positive experience. Thank you to the dedicated teams at Rowan University and the New Jersey Department of Health (DOH). ♥

The Act aims to increase access to and modernize the process of obtaining MAT. This proposed change in federal legislation would decrease barriers to treatment by sustaining relaxed methadone dispensing regulations enacted during the COVID–19 pandemic and making methadone available at pharmacies, enabling ease of patient access to evidence-based treatment and empowering them to spend less time waiting in line for their medication.

During the pandemic, federal restrictions have been temporarily lifted and allow patients to take home larger quantities of methadone at a time; preliminary studies have shown that this has increased engagement with treatment. The federal exemption has been extended—however, patients are still required to obtain their medication albeit larger doses from opioid treatment programs (OTP). The bill also calls for research to evaluate the effects that legislative changes have on treatment access and outcomes.

The paper was presented to Senator Joseph F. Vitale and the New Jersey State Legislature, and an iteration abridged summary was published in the New Jersey Medication for Addiction Treatment Centers of Excellence (MATCOE) newsletter. Learn more here.

Recommended citation:

Excerpted from "The Treatment of Patients," an essay on Dr. Marie Nyswander, in the New Yorker, July 3, 1965.

Recovery Month poster displayed in clinic at our Medication for Addiction Treatment Centers of Excellence (MATCOE).

The term “recovery” can be overwhelming for many people who love someone struggling with substance dependence or substance use disorder (SUD)/addictions, or who have personal experiences with these issues and who know the term’s history rooted in stigmatizing foundations.

Recently, as I thought through health communication concepts for Recovery Month, I reflected on what I’ve learned to date in the field of addiction medicine. I’m grateful for the thousands of physicians and all health care professionals who dedicate their focus to learning ways to support their patients through our work, and for the hundreds who have kept in touch and gone on to become champions in safer prescribing practices, MAT, and harm reduction strategies.

Most importantly, I admire our thousands of patients in all stages of recovery. They are immensely brave and should be celebrated year-round.

I’m ever-grateful to work as part of a multidisciplinary team of providers, interdisciplinary professionals, and peer specialists. Together, we know that the process of healing is nonlinear, that a small step forward is still progress, and that a step backward is not failure. Our mission, vision, and ongoing work continues to inspire my growth in the field.

My sister, pictured with me above, accompanied me this past weekend and helped support my new work's open house celebrating our outpatient addiction medicine site and artwork exhibition. I really do have the best sisters.

I'm so grateful to my family, friends, and colleagues as I embark on new experiences.

I'm ever-grateful to have learned so much and still. Through this work, I've cultivated deeper empathy for all patients living in chronic pain and/or with substance use disorder (SUD)/addictions, and have zeroed in on the urgent need to eliminate disparities in social determinants of health (SDoH) and advance health equity for and with historically excluded populations and medically complex patients across the United States.

All excerpts from courses/content approved by our stakeholders.

The American Society of Addiction Medicine (ASAM) Placement Criteria outlines the treatment continuum as four broad levels of service, within five broad levels of care: early intervention, 0.5; outpatient services, 1; intensive outpatient/partial hospitalization services, 2; residential/inpatient services, 3; and medically managed intensive inpatient services, 4.

Within the five levels of care, there are decimals, 2.1, 3.1, 3.3, 3.5, and 3.7, to represent benchmarks along the continuum, meaning patients can move up and down in terms of intensity of their treatment, without necessarily being placed on a different level of care.

From our Comprehensive Overview of MAT CME course for licensees, part of the Opioid Medical Education Program.

Also through this work, my abilities are respected and stretched further by my physician leadership, and I'm proud to share that I've led a full portfolio of innovative, incredibly successful programming, primarily focused on the confluence of acute or chronic pain and preventing, treating, and/or reducing harm in substance dependence or SUD among special populations.

It cannot be understated how these multitude of distinctive and humanistic experiences have helped shape who I am today. I came into this work driven by healing and I continue with a clear understanding of my why—and for that, I'm forever grateful. Most importantly, I'm a kinder and more patient person, and I attribute that to all that I've learned in the field.

Across late 2020, as part of my existing role, I had the opportunity to collaborate with partnering physicians, part of my alma mater's allopathic medical school, to lead oversight of the MATCOE Training and Education Program. This experience resulted in a milestone outcome of medical licensees who completed our CME didactics, and the opportunity to become skilled in facilitating large-scale educational sessions with physicians and all prescribers.

With the confluence of the overdose crisis and pandemic increasingly impacting the state and on a global scale, I recognized that continuing on my path was where I could be helpful.

Left to right, clockwise: Medical students engaged in community outreach to increase access to and uptake of vaccinations (photos featured in our MATCOE reports); a licensee who participated in our MAT CME course in September 2020 and who began providing buprenorphine for OUD eight months later; and our COVID–19 Response Guide for New Jersey Licensees and Naloxone Distribution and Training Programs Guide, both part of OMEP.

This collaboration led to connecting on shared values and new colleagues creating and proposing a uniquely-designed role for me. I'm very happy to share that I've since continued in my initial position, albeit in a less consuming capacity, and have joined my new colleagues as content manager as of early 2021. In this role, I'm working closely with physician leadership and defining direction, establishing tone, and stewarding content strategy across departmental and institutional addiction medicine efforts. It's been a rush of new work and similarly, having the opportunity to continually collaborate and innovate.

Photo of MATCOE Emergency Department Addiction Pathways (EDAP) prototype.

My new work supports a full portfolio of pre-award to post-award clinical innovations, with initial focus on clinical design programming. Most recently, I had the opportunity to work with the addiction medicine medical director on the Emergency Department Addiction Pathways (EDAP) "bridge" innovation in a rural area.

This program has since launched (photograph above of addiction medicine prescriber education resources hub in the ED) and ensures patients can receive buprenorphine and naloxone sublingual film (BUP/NX SL) induction based on the Clinical Opiate Withdrawal Scale (COWS). All patients are discharged with a prescription; follow-up appointment for continued care in an outpatient addiction medicine setting; and health communication, focused on home induction guidance, education on all forms of opioids and harm reduction strategies, and SDoH resources. Bridge to methadone treatment is also available.

Together, we strategized and envisioned the compendium of clinical and educational resources. These resources consist of prescriber education and destigmatizing health communication written by the addiction medicine physician leadership team and I, from clinical and peer perspectives, and that I developed and designed. SmartPhrase templates are also created for various EMR.

After preparing and implementing the EDAP hub and promoting its launch, our prototype continues to be iterated and disseminated across statewide and national clinical networks. The project team is also pursuing funding to support alternatives to opioids for acute pain management in the ED.

Several factors underlie the development of OUD and the difficulty that patients can experience in meeting and maintaining abstinence: short-term direct and indirect mu–opioid receptor (MOR) agonist effects; neuroplasticity; and genetic, developmental, and environmental factors including the effect of stress on the hypothalamic–pituitary–adrenal axis (HPA).

MAT medications bind to MOR in the central nervous system (CNS) and peripheral nervous system (PNS), gastrointestinal (GI) tract, and vascular system. In the brain, MOR mediate opioids’ analgesic and other effects including euphoria, respiratory depression, and meiosis. Thus, through modulation of MOR, MAT medications are therapeutically effective in treating OUD.

From our Comprehensive Overview of MAT CME course for licensees, part of OMEP.

"Life is a state of endless becoming. It is vital not to forget where we’ve been, to take inventory of all that we currently have, and to envision bigger lives for ourselves.

I WAS — In a society that is forward facing and fast moving, there is value in pausing and looking back. The first phase asks us to rest and reflect. To acknowledge the stages we have survived, the people we have loved, and the losses we have accumulated.

We must make a home for all of our experiences and allow them to take shape. How will we let our past inform us? How will we carry it forward? How will we become bigger than what has hurt us?

I AM — The character sits centered, anchored in the present.

We must take the time to absorb what is happening now without letting life mindlessly pass us by. Pay attention, even to the hard parts.

I WILL BE — Evolution is inevitable. Should we ever feel stuck or trapped, we can seek comfort knowing we exist in a state of flux.

The character exits the frame, envisioning a life beyond what the viewer can see.

This piece serves as an homage to process, rather than outcome. Healing happens when we are able to incorporate the full spectrum of our experiences and integrate our collective selves. Instead of keeping parts of us in the dark, we deserve to live wholly and authentically. I hope you will honor every leg of your journey, knowing life is infinitely unfolding."

I had the pleasure of serving as the lead researcher/author for all predoctoral and CDE series, courses, and resources, effectively overseeing, strategizing, envisioning, and developing accurate scientific content, entrusted by my physician leadership and expansive stakeholder leadership team.

All excerpts from courses/content approved by our stakeholders.

From our Overview of Pain Medications and Opioid-Sparing Strategies CDE course for licensees, part of ODEP.

I'm forever grateful for my dedicated and intuitive intern team who supported coordination, formatting, and citations—these contributions cannot be understated. All content was final reviewed by the multidisciplinary project team of prescriber and policy experts, and approved for presentation and publication.

Curricula focuses on some of the most critical issues in dental medicine throughout the state and nation: evidence-based education and research on best practices for prescribing opioids; opioid-sparing strategies among common pain medication options; and screening and appropriate referral to medication for addiction treatment (MAT).

From our Overview of Pain Medications and Opioid-Sparing Strategies CDE course for licensees, part of ODEP.

Dental medicine education materials, and health communication materials for patients and loved ones/families, are available as part of the curricula.

Prototypes and adaptation resources created for students and dentists include printable and digital formats of the following items: concise policy reference charts; patient evaluation tools and scoring rubrics, adapted for dentistry practice settings; opioid prescribing protocols and guidelines; concise reviews of the most notable studies on dental pain research and dental pain management; and clinical workflow communication tools for integrated care teams.

From our Pain Management Strategies and Referral to MAT CDE course for licensees, part of ODEP.

For patients and loved ones/families, prototypes and adaptation resources created include both printable and digital shareable formats of the following items: journaling and goal-setting templates, tailored for dental patients at-risk of opioid dependence or opioid use disorder (OUD); safe opioid disposal education; and tailored peer education on naloxone.

The predoctoral dental medicine education version is available only to students as part of their curricula; however, course outlines are available to all here, here, and here. The asynchronous CDE version features open, cost-free registration here, with licensee participants eligible for cost-free CDE credits and certificates for submission to the State Board of Dentistry.