Who Owns Addiction Treatment?

Source: andrei_r/iStock

Addiction medicine encompasses the prevention, evaluation, diagnosis, and treatment of persons suffering from the disease of addiction and providing help to family members who are affected by a loved one’s substance use or addiction.

In October 2015, the American Board of Medical Specialties (ABMS) officially recognized addiction medicine as a subspecialty. And while it’s nice to have another certificate to put on your wall or an additional line on your curriculum vitae, the treatment of those suffering from the consequences of substance use disorder (SUD) is not and cannot be restricted to just “specialists.”

Addiction is a disease that now impacts more than 40 million Americans. That’s approximately 14.5 percent of the adult population. Meanwhile, overdose rates have continued to trend high, especially with the prevalence of the synthetic opioid fentanyl. There is no medical specialty that does not encounter patients and family members affected by addiction. We all have the opportunity to assess, intervene, and provide treatment for those afflicted with this disease.

SBIRT is a comprehensive, integrated, evidence-based approach for delivering early intervention and treatment services for individuals with substance use issues or those at risk for SUDs. Screening, brief intervention, and referral to treatment (SBIRT) is something we all should do – with every patient we meet – regardless of our specialty or what it says on the certificates on our walls.

We wouldn’t think of treating a patient without asking about allergies or other medications. Why would we not ask them about other substances they take? Not only does utilizing SBIRT help identify your clients at risk for addiction, but it also helps decrease the stigma and shame surrounding addiction issues. It lets them know that your office is a safe place to talk about substance use – and that you will get them to help if they need it.

But beyond training new (and old) doctors to screen for SUDs, we need to look for opportunities to expand the education and training on addiction in our medical schools and residency programs. According to the Association of American Medical Colleges, only about 3,100 medical professionals are trained in addiction medicine and addiction psychiatry. Additionally, researchers from Substance Abuse discovered that only 24 percent of residency programs nationwide dedicate 12 or more hours of their curricula to addiction medicine.

In April 2021, the Department of Health and Human Services (HHS) took steps to lower some barriers for doctors (and nurse practitioners and physician assistants) to prescribing buprenorphine. Buprenorphine, a partial opiate agonist, has been shown to reduce mortality and illicit opioid use in patients with opioid use disorder. Before this, only about 6 percent of active physicians in the U.S. held the Drug Enforcement Administration’s (DEA’s) “X-waiver,” permitting them to prescribe buprenorphine. Why not provide this education and training to every new doctor before they graduate from medical school?

Recent data from the CDC’s National Center for Health Statistics indicates an estimated 100,306 overdose deaths in the U.S. during the 12 months ending in April 2021, a 28.5 percent increase from the previous year. Deaths from opioids increased nearly 35 percent to almost 76,000 Americans during the same period.

The addiction and overdose epidemic does look bleak when we look at it in totality. But suppose enough new doctors are aware of the rewards of treating patients with SUDs and granted greater opportunities to sit with these human beings who suffer from addiction. In that case, we can save and transform even more lives, patient by patient.

In my training (admittedly 35 years ago), I was provided with a mere one-hour lecture on addiction. I now consider myself fortunate to interact daily with people who struggle with addiction and seek recovery from substance use disorders.

We, as doctors, should all be so fortunate to help make a difference in the lives of this resilient group of patients. And you know what? We all can be!