Addiction specialists argue that substance abuse is best treated when it’s managed like any other chronic disease—with specialist care. But the country has a shortage of doctors trained in this specialty.
“There are more doctors out there prescribing heavy doses of narcotics than there are out there trying to help people get off of them,” says Richard Blondell, an addiction specialist who oversees an addiction medicine fellowship at the University at Buffalo in Buffalo, New York. He says most medical students receive only a few hours of education about addiction in school.
Blondell compares addiction to diabetes, a chronic disease that requires ongoing coordinated care with medical supervision. But few addicts get that level of care.
Seth Skinner, 28, says he started abusing opiates as a teen in Florida. He remembers spending time in detox centers there, packed with people addicted to opioids. “OxyContin, Percocet, or whatever, there’s such a need for treatment. I think it was hard for the providers, the doctors and the therapists to try to fulfill that need,” he says.
After nearly a decade trying to get sober, and several stints in rehab, Skinner was lucky. He moved to Rochester, New York almost four years ago and got into treatment with Dr. Timothy Wiegand, a board certified addiction specialist at the University of Rochester Medical Center. Under Wiegand’s care, he’s gotten his addiction under control. Unlike Skinner, many addicts will never see a specialist who’s trained to handle all aspects of care for their disease.
There are only 3,000-some board certified addiction medicine physicians, not enough to help the nearly 25 million Americans over age 12 with the condition, according to the American Society of Addiction Medicine (ASAM). Another organization representing the specialty, the American Board of Addiction Medicine, has started an effort to accredit more fellowship programs to train doctors to treat addiction.
Today, there are 36 fellowship programs that train addiction physicians, each graduating a couple of doctors a year. But ABAM is accrediting new programs each month. The group’s eight-year goal is to reach 100 programs total, graduating 250 doctors a year. And the specialty itself is on track to be fully accredited by the American Board of Medical Specialties within the year.
Not only are more trained doctors needed, but a culture shift is needed, according to Dr. Stuart Gitlow, the Immediate Past President of ASAM. “It’s very unlikely, in most parts of the country that they would think to send you to the addiction specialist physician,” he says. “And there’s a difference. If you go see a counselor, they can do some things, but not everything,” he says.
One thing a counselor can’t do is prescribe medication. Some patients trying to give up heroin—or other opioids—may be put on methadone, buprenorphine, or naltrexone. These medications help wean patients off the substances they’re abusing.
The role of the addiction physician goes beyond prescribing drugs—the doctor plays a key role in recovery, say Wiegand, Seth Skinner’s doctor. “The physician is like the quarterback in this setting, working with a lot of really important individuals: the counselors that are running the groups and the individual sessions, the social workers, the care managers,” he says.
Lack of awareness of the addiction treatment specialty leads to other problems. When the medical profession stigmatizes and misunderstands addiction, Wiegand says patients don’t get the treatment they need. If a diabetic came into the emergency department with a crisis related to their disease, they’d be set up with follow-up treatment. That’s not the regular course of action when someone in the ER has overdosed from heroin.
“They don’t leave with the medications they need to help stabilize the disease of addiction. They don’t leave with a physician appointment, typically, for an addiction medicine specialist, and that’s a huge disparity between these two medical conditions,” says Wiegand.
Some hospitals are now moving to link patients treated in emergency with a long-term treatment programs. But even with growth in the field, treating the 2.4 million Americans addicted to opioids remains a challenge.
Skinner is feeling optimistic about his recovery, but knows how hard it can be.
“It’s a combination of things. It really is. It’s not just one thing. There’s no miracle drug or miracle answer. And everyone’s different,” Skinner says.