Opioid overdoses continue to tear apart families and overwhelm the country, yet one of the most effective treatments remains out of reach for many. Most doctors aren’t qualified to prescribe FDA-approved drugs used to help ween people off of opioids, despite studies showing such medication-assisted treatment, when combined with counseling and therapy, is highly successful. That means those looking to break their addiction using these medications have to seek out the handful of specialists who provide it.
It is not hard for physicians to get qualified to properly prescribe buprenorphine and other approved drugs that help people get off opioids without the cravings and nasty side effects that are common during withdrawal. The educational group Providers Clinical Support System offers a free course funded by the federal government through the Substance Abuse and Mental Health Services Administration.
Advocates, including former State Health Secretary Dr. Joshua Sharfstein, have been pushing a proposal to make the course mandatory for medical residents. Dr. Sharfstein and his wife, Dr. Yngvild Olsen, penned a letter on the issue that ran in The Journal of the American Medical Association last week. They have asked that the Accreditation Council on Graduate Medical Education, which accredits residency and fellowship programs, to require the course.
So far, the group is non-committal, saying only that its president and CEO, Dr. Thomas J. Nasca, will review “information such as that provided in JAMA” as part of his work as co-lead of the National Academy of Medicine’s Action Collaborative on Countering the U.S. Opioid Epidemic. Not a strong endorsement to say the least.
Instead, the accreditation group adopted a weaker rule that will take effect July 1 calling on all residency programs to recognize the signs of addiction and provide “instruction and experience” in pain management.
That is a good start, but doesn’t go nearly far enough. To really get a grip on the opioid epidemic we need to not only recognize the problem, but get people into treatment, and the more doctors who can do this the better. Medication-assisted treatment has been proven time and again to be one of the best options.
The accreditation council shouldn’t shuffle its feet on doing this as the epidemic has reached epic proportions. More people die from overdoses than from car accidents, falling and guns, according to the National Institute on Drug Abuse. It has gotten so bad that drug overdoses have shortened the overall life expectancy of the United States, federal health officials have said. As of 2017 the average person is expected to live in the United States to 78.6 years, a decrease of 0.1 year from 2016, according to the Centers for Disease Control.
We’re not totally surprised that the accreditation agency isn’t ready to embrace medication-assisted treatment given the stigma that still surrounds it. Too many people are still concerned that it is just trading one drug for another. But the idea that a person must adopt long-term pharmaceutical treatment to manage a chronic condition is nothing new. Millions do that for high blood pressure, diabetes, high cholesterol and any number of other health problems.
More government institutions are slowly coming around to the treatment. The Maryland General Assembly passed legislation this year to begin administering three federally approved medications to treat alcohol and drug addiction to inmates in every county jail and Baltimore’s state run detention facility. We would also like to see this expand into prisons, but we have to start somewhere.
It’s time all doctors are trained in this treatment as well. They will come across such patients well before an addiction specialist might, given the shortage of such doctors and treatment programs. Currently, only about 6 percent of about 1 million physicians in the United States have taken the required training for prescribing buprenorphine, Drs. Sharfstein and Olsen wrote in the JAMA article. In nearly half of U.S. counties, there is not a single physician authorized to prescribe buprenorphine, and in 38 states, more than 3 in 4 programs that provide methadone operate at near capacity, the doctors found. Two-thirds of training programs do not support training in prescribing buprenorphine.
If addiction treatment is truly to be treated as a public health issue, we need all hands in the medical community on board.
Become a subscriber today to support editorial writing like this. Start getting full access to our signature journalism for just 99 cents for the first four weeks.