As the newly-appointed Chief Addiction Medicine Advisor (CAMA) at Safer Care Victoria, Dr Paul MacCartney is working to reshape how general practitioners (GPs) engage with addiction medicine.

The role – new to Victoria but long-established in New South Wales – places him at the forefront of providing expert clinical and strategic advice, fostering sector collaboration, and connecting healthcare professionals who often work in parallel without awareness of each other’s efforts.

“I am really enjoying being able to help connect people – particularly clinicians and non-clinical researchers – who are working on similar issues but may not be aware of each other’s work,” Dr MacCartney says.

Dr MacCartney’s career in addiction medicine was shaped by early experiences that exposed him to the realities of homelessness and substance use.

During medical school, he took a year off to work with people experiencing homelessness in the Melbourne CBD, followed by an elective placement with the Healthcare for the Homeless Project in Washington, DC.

“I realised that I needed to be able to assist people with issues related to substance use,” he recalls.

“That led me to Western Health, where I worked with an excellent Addiction Medicine specialist.

“I then moved into general practice because I felt that was the best specialty to continue that kind of work.”

For decades, Dr MacCartney has practiced addiction medicine in an inner-city GP setting, even recently establishing a clinic attached to the Salvation Army café in Melbourne’s CBD.

“I still see a couple of people I met on the streets nearly 30 years ago,” he says.

“In the end, I was doing so much addiction work that it made sense to complete the Addiction Medicine training program. But I returned to primary care because I believe it is the best place to manage addiction issues.”

Addiction-related health concerns are widespread, yet many patients struggle to access medical support.

“The medical profession almost abandoned the treatment of addiction for many years,” Dr MacCartney notes. “My aim is to get GPs involved again.”

Treatments for substance use disorders – such as opioid and alcohol use disorder – are highly effective.

“The medications we offer can be transformative and lifesaving,” he says.

“For alcohol use disorder, treatments like Naltrexone are incredibly effective but underutilised.

“Less than 5% of people with alcohol problems have access to first-line medications that are safe, available, and effective – this is not good enough.”

Dr MacCartney emphasises that GPs should feel confident managing at least the most prevalent substance use issues: alcohol and nicotine.

“Many doctors feel like addiction medicine is a hopeless cause, but that is far from the truth,” he says.

“It’s incredibly satisfying to engage with patients in a non-judgmental way and provide treatments that are often more effective than many of the other medications we prescribe.”

One of the biggest challenges GPs face is the perception that patients with substance use disorders are particularly difficult.

“While there are always challenging cases, when people are treated with respect and care, they generally respond in kind,” Dr MacCartney says.

He also highlights the strong link between substance use and trauma.

“A recent study at the medically supervised injecting room in Richmond found rates of PTSD 40 times higher than in the general community,” he explains.

“Many patients use substances to manage physical or psychological pain – these are people who deserve the best care and most understanding we can give.”

Programs like the CoHealth GP Registrar Exposure Program and GPRA’s work with St Vincent’s Health Australia (SVHA) on the ECHO program (LINK TO GPRA EVENT WEB PAGE) provide valuable training in addiction medicine.

Dr MacCartney encourages GP registrars to take advantage of these opportunities.

“Our experience is that when doctors gain exposure to addiction medicine, they realise how rewarding it is,” he says.

“Their perceptions of patients with substance use disorders shift, and they see first-hand how much can be done to help.”

For registrars looking to build skills in addiction medicine, Dr MacCartney suggests taking small, actionable steps.

“Even brief interventions make a difference. Start by asking patients about their substance use – what do they like about it? Are there downsides? Are they interested in making changes?”

He also recommends becoming familiar with treatment options like nicotine replacement therapies, Naltrexone, and Campral for alcohol use disorder.

Completing Medication Assisted Treatment for Opioid Dependence (MATOD) training can provide additional confidence in managing substance use concerns.

With increasing awareness around harm reduction, Dr MacCartney sees a significant opportunity for GPs to play a more active role in addiction treatment.

“For decades, treatment has focused on abstinence,” he says.

“But we now know that harm reduction approaches – such as medication-assisted treatment – help people gain control over their substance use.”

He believes GPs can contribute to harm reduction by providing informed health messages.

“For example, with the rise of drug checking services at festivals, people want to know what they’re dealing with,” he says.

“GPs should be a trusted source of information – advising patients on how to minimise risk and recognise dangerous substances.”

Dr MacCartney also stresses the importance of making addiction medicine a routine part of primary care.

“People should feel comfortable discussing their substance use with their GP without fear of judgment,” he says.

“We need to shift the conversation so that GPs see addiction medicine as a natural extension of the care they provide.”

For registrars interested in making a meaningful impact, Dr MacCartney’s advice is simple: get involved.

“Spend time in an addiction service, participate in programs like CoHealth or ECHO, and talk to those working in the field,” he encourages.

“The more exposure you get, the more you’ll see how rewarding this work is.”

As addiction medicine continues to evolve, GPs have an essential role in shaping its future.

With leaders like Dr MacCartney at the helm, the medical profession is moving toward a more integrated, proactive approach – one where GPs are empowered to provide life-changing care for patients struggling with substance use disorders.