According to Substance Abuse and Mental Health Services Administration (SAMHSA), in 2018, approximately 21 million individuals needed treatment for a substance use disorder, but only 11% received treatment.
One of the main barriers to addiction treatment in the United States is the lack of qualified healthcare providers in the field of addiction medicine.
The opioid epidemic is continuing to rise, and there are not nearly enough physicians who specialize in treating addiction.
The demand for treatment far outweighs the supply. The opioid epidemic has made this doctor deficit painfully apparent.
The opioid epidemic is plaguing the United States, and it began with the overprescribing of opioids for unnecessary reasons.
Today, addiction treatment is not only expensive. It has a significant stigma attached to it.
Still, this field of medicine is not employing enough trained physicians to help stop this epidemic, ironically, which was accidentally started by doctors in the first place.
- Roughly 21 to 29 percent of individuals prescribed opioids for chronic pain misuse them
- An estimated 4 to 6 percent of individuals who misuse prescription opioids transition to heroin
- Opioid overdoses increased 30 percent from July 2016 through September 2017 in 52 areas in 45 states.
- On average, 130 Americans die every day from an opioid overdose
- The first wave of the opioid overdose began in the 1990s with overdose deaths involving prescription opioids
The Opioid Workforce Act
Senators Maggie Hassan (D-NH) and Susan Collins (R-ME) are hoping to up the ranks in fighting the opioid epidemic by introducing the Opioid Workforce Act of 2019 as a way to employ more doctors in training in an accredited residency or fellowship program in addiction medicine, addiction psychiatry, or pain medicine.
This bill aims to provide Medicare support for an additional 1,000 graduate medical education (GME) positions over five years in hospitals that have the above-mentioned residency or fellowship programs.
Medicare funds residency and fellowship programs through Graduate Medical Education (GME), and currently, Medicare continues to distribute nearly $10 billion to teaching hospitals across the United States to cover the costs of training physicians.
Without this funding, resident doctors and fellows could not receive the training required to become practicing physicians.
“It is troubling that in the midst of the opioid epidemic and growing demand for treatment services, our country is facing a shortage of physicians trained in addiction medicine, addiction psychiatry, or pain management. In Maine, there is only one addiction medicine program. Our bipartisan bill would help increase the number of these providers by expanding and creating new residency programs in Maine and across the country, helping the millions of Americans who are struggling with substance use disorders achieve recovery and healing.”
Shortage of Addiction Specialists: Lack of Training Programs
Unfortunately, there is a massive shortage of addiction medicine fellowships across the country, mainly because funding is lacking to support these fellowship programs, and the demand is not there.
Medical students are not seeking out these fellowships for many reasons, including low pay, the stigma associated with addiction, and the lack of knowledge about this field of medicine.
Historically, the path to addiction medicine was through psychiatry, meaning that if an individual must complete a psychiatry residency in order to practice in addiction medicine or any form of mental health treatment.
In 2015, this began to shift when the American Board of Medical Specialties recognized addiction medicine as a legitimate subspecialty and opened up the training to physicians from many other medical fields.
Individuals who completed their residencies in family medicine and internal medicine now had the option to enter into an addiction medicine fellowship.
Not every doctor who plans to treat substance-use disorders needs to do a fellowship. Addiction medicine can be integrated into primary care settings.
For example, primary care physicians can learn from addiction medicine specialists on how to provide medication-assisted treatment such as buprenorphine.
Community doctors can reach out to addiction specialists for help and resources.
Another reason why medical students are not flocking into addiction medicine subspecialties is due to the lack of information and ongoing stigma regarding addiction.
Very few medical schools spend an adequate amount of time, if any, teaching about substance use disorders in the first two years of medical school.
Mental health is taught in a psychiatry course that is one semester. Medical students go on to complete their clinical rotations with minimal knowledge of mental health and substance use disorders.
They will often come across patients struggling with opioid use disorder in the hospital or emergency room.
The truth is that medical students rotate through the emergency room, people label a patient as ‘pain-seeking’ and very rarely will an attending physician take any time to teach about the underlying triggers associated with addiction.
Attending physicians, especially in hospital wards or in the emergency room are constantly burned out from taking on a large patient load while simultaneously having the task to teach medical students and residents.
They find it easier to label a patient as “pain-seeking” instead of acknowledging that their addiction could have easily started from the overprescribing of pain medications.
Many physicians shame addiction in the presence of medical students and residents, whether it is intentional or unintentional, does not matter.
Still, this ongoing stigma creates a mindset that addiction medicine is not essential.
Turning A Corner: The Medical Community is Starting To Wake Up
Individuals in the medical community are now not only beginning to take an interest in addiction medicine, but the medical community as a whole is becoming more aware of the opioid epidemic and how they may have played a role in triggering this problem.
Many medical professionals are beginning to work towards ways they need to step up to solve the problem, including limiting opioid prescriptions and educating patients on the dangers of abuse.
Physicians are also taking more steps to talk about mental health during a routine visit; however, they still have a long road ahead.
In 20 or 30 years from now, the new generation of medical students and young doctors are going to look back at this current generation of doctors.
This current generation will be judged by how they responded to this opioid epidemic in the same way our current generation of doctors now look back at how doctors handled the HIV epidemic.
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