https://www.medpagetoday.com/psychiatry/addictions/82477

Comment; Brief review of the problems treating addiction in the US from the front line, a physician addiction specialist with decades of practice AND personal decades of recovery.

y Paul H. Earley, MD, DFASAM September 30, 2019share to facebookshare to twittershare to linkedinemail article

A group of people clapping for a standing man in a recovery group

Regardless of race, income, gender, or profession, addiction is a complex medical disease that can affect anyone.

Take, for example, a young doctor I watched fall into its clutches. Like most college students, he experimented with alcohol. When his post-college experimentation expanded to cocaine and opioids, his judgment left him, but his false confidence — fueled by his training in neurophysiology — did not. As he moved into medical school and then residency, he found himself caught between a drive to acquire the skills of his profession and the incessant hunger of his illness.

But with addiction, the end result is quite predictable. His accelerating substance use disorder caused him to lose himself, his job, and eventually his freedom. He would have lost his medical license, too, if he had not received a sustained tapering course of addiction care and ongoing support by family, friends, and others on the same journey of recovery. The result of proper treatment was nothing short of a miracle. This physician found a life filled with joy and an amazing new medical specialty, treating others who have been diagnosed with substance use disorder (SUD).

But I didn’t see that man in my office. I saw him in the mirror. My story underscores the fact that recovery is possible — if the right treatment and support is provided at the right times.

Unfortunately, our nation’s response to the addiction and overdose crisis is inadequate. In 2017, nearly 21 million Americans needed treatment for SUD, but only 4 million reported receiving any form of SUD treatment or ancillary services. During the same year, over 70,000 Americans lost their lives due to a drug overdose. Two-thirds of those deaths involved opioids. Despite preliminary signs that drug overdoses may be starting to ebb, new reports show that some states are actually seeing an increase in their overdose death rates.

The statistics are grim, but there is hope. We know what needs to be done to save lives. Thanks to a growing body of scientific research, there is a roadmap to recovery. Now it is up to Congress to follow it.

Teach Addiction Medicine

Few Americans with SUD have access to high quality, evidence-based addiction treatment. According to the 2017 final report of the President’s Commission on Combating Drug Addiction and the Opioid Crisis, there were roughly 4,400 certified addiction physician specialists actively practicing across the country, but based on a 2009 estimate — well before the surge in overdose deaths hit record levels — the U.S. needed at least 6,000 of those specialists to meet the demand for treatment. Put simply, the addiction specialty treatment workforce is catastrophically insufficient to address addiction.

Stigma and misunderstanding about addiction — particularly within the medical community — compounds the problem. According to a recent survey of healthcare professionals in Massachusetts, only one in four had ever received any type of addiction medicine training during medical education, while more than half of the emergency medicine, family medicine, and internal medicine providers (falsely) believed that opioid use disorder (OUD) is not treatable. Addiction is a complex disease, not a moral failing. We need many more in the medical community to understand this.

Congress can be part of the solution by passing legislation and funding programs that promote education and training in addiction medicine and incentivize more medical students and professionals to serve in high-need areas.

Standardize Addiction Medicine

Like other medical specialties, addiction medicine is based on a broad and ever-growing body of scientific research. Patients need to feel confident that their healthcare providers can deliver personalized, evidence-based care. This includes offering access to affordable addiction medications, when appropriate, that are proven to save lives. When crafting policy, Congress should lead with science and encourage the adoption of standards and research-validated guidelines for treating Americans with addiction.

Cover Addiction Medicine

Finally, Congress must help remove the barriers that prevent people with SUD — including people who are incarcerated — from accessing and affording care that could save their lives and make our communities safer. Today’s healthcare system provides insufficient support for the coordination of behavioral, social, and psychological services that patients often need in addition to medication. And there is a particularly urgent need to reform payment policies so that more Americans who are incarcerated can access evidence-based medical care. Research estimates that 65 percent of individuals in prisons or jails meet the clinical criteria for SUD and that these individuals are 129 times more likely to die from drug overdose within the first two weeks after release, as compared to the general population.

The road to recovery is never easy — I know this from experience. I also know that it’s possible. We must give a roadmap for this journey to all Americans struggling with addiction. Together, we can build a prevention and treatment infrastructure and a more compassionate society that will end this crisis — and we need Congress to help finish the job.

Paul H. Earley, MD, DFASAM, based in Atlanta, is the president of the American Society of Addiction Medicine and has been an addiction medicine physician for 30 years.

Dr. Raymond Oenbrink