According to the Association of American Medical Colleges (AAMC) 21 million Americans suffer from addiction; just 11% of those patients receive the treatment they need, and one in five wrestling with addiction say they do not know where to turn for help (Scutti, S., 2019).
To add to these alarming facts – there are only 3,000 physicians specially trained to treat these patients. The barriers to effective substance use disorder (SUD) care are already challenging, but the lack of addiction medicine physicians raises the stakes in this national crisis.
In this article, we examine the current barriers in SUD treatment and the risks of not having addiction medicine specialists on staff in hospitals and rehabilitation centers. We also highlight what is being done on a national level to increase the number of physicians with expertise in treating substance use disorders and the multifaceted benefits of this care.
Financial and Societal Barriers
Out of the twenty-one million Americans suffering from addiction, there are 9.2 million adults with a SUD and co-occurring mental illness. And only 4.7 million received either substance use treatment at a specialty facility or mental health care, according to the National Survey on Drug Use and Health (NSDUH). What are the factors preventing the other 5 million from getting the care they need? Lack of health insurance and the inability to afford in-patient treatment are at the top of a long list. According to the current U.S. census, 27.5 million people did not have health insurance at any point during 2018 (Berchick, E.R. et al., 2019). Even with the passing of the Affordable Care Act in 2010, which required insurance plans to cover mental health and substance use disorders, these current numbers highlight the urgent need for more affordable health insurance and addiction treatment services. In terms of societal factors preventing people from seeking treatment, the most common ones include:
- Stigma or fear of what others think if they enter a rehab program.
- Denial or belief that they do not have a drug or alcohol problem.
- Know they need help, but fail to seek it out as they are not ready to stop using, fear they may lose their job, or cannot afford the treatment.
- Feeling they can quit on their own and do not need help.
Challenges in the Medical Community
The lack of addiction medicine specialists in hospitals, ERs, and rehabilitation centers pose significant obstacles in the care of those battling drug and alcohol use disorders. An emergency department may be the first and only place a patient with a SUD receives care, making the hospital a critical intervention point for connecting people to treatment. Without an addiction physician on hand, the patient may not receive the proper screening, diagnosis, or medical care necessary to treat a SUD or co-occurring disorders, and assist them on the road to recovery. Rural communities are the most impacted in terms of lack of addiction specialists. National data from WWAMI Rural Health Research Center show that 60% of rural counties lack a physician able to prescribe buprenorphine for opioid use disorder (WWAMI, 2017).
Addiction medicine physicians are also urgently needed in rehabilitation centers. The National Center on Addiction and Substance Abuse at Columbia University reported, “Most of those who are providing addiction treatment are not medical professionals and are not equipped with the knowledge, skills, or credentials necessary to provide the full range of services to address addiction effectively (Wakeman, S., 2015). Some rehab centers exist in a space where evidence-based care is rare, licensed medical staffers are optional, conflicts of interest are rampant, and regulation is stunningly lax (Lurie, J., 2019). States are cracking down on these facilities, but the need for addiction specialists and quality care still exists in many rehab centers across the nation.
A Hopeful Future
In response to the shortage of physicians trained in addiction medicine, the Senate introduced the Opioid Workforce Act in November 2019. The bill aims to provide Medicare support for an additional 1,000 graduate medical education positions over five years in hospitals that have accredited residency programs in addiction medicine, addiction psychiatry, or pain medicine (Estes, C., 2019). Increasing the number of specialists will reduce the addiction treatment gap, as well as the stigma that still pervades many healthcare systems and physician practices. Unfortunately, there is still is no true standard in addiction screening, diagnosis, and treatment standards. Most intake assessments are based on yes or no answers without taking into consideration the whole patient from a cognitive, environmental, and psychological point of view. These limitations can result in patients not getting the comprehensive care they need – leading to higher relapse and overdose rates. Addiction relapse also comes with an increase in societal losses and healthcare costs, such as incarceration, workplace productivity, crime, ER visits, and in-patient treatment.
Hopefully, with the addition of specialty training programs, overseen by organizations such as the American Board of Preventive Medicine (ABPM), healthcare systems and rehab programs will create a set of common core standards for what addiction care should look like. Creating a more individualized treatment plan based on evidence-based practices and standards can lead to a reduction in relapse rates as well as lower societal and healthcare costs. Most importantly, it gives the patient the help he or she needs for a healthy life in long-term addiction recovery.
References:
Berchick, E.R. et al. (2019). health insurance coverage in the united states: 2018. Retrieved from https://www.census.gov/library/publications/2019/demo/p60-267.html
Estes, C. (2019, December 9). The opioid workforce act hopes to increase ranks in fighting the opioid epidemic. Retrieved from https://www.forbes.com/sites/claryestes/2019/12/09/the-opioid-workforce-act-hopes-to-increase-ranks-in-fighting-the-opioid-epidemic/#4cf8290158ea
Lurie, R. (2019). Mom, when they look at me, they see dollar signs. Retrieved from https://www.motherjones.com/crime-justice/2019/02/opioid-epidemic-rehab-recruiters/
Scutti, S. (2019, December 18). 21 million americans suffer from addiction, just 3,000 physicians are specially trained to treat them. Retrieved from https://www.aamc.org/news-insights/21-million-americans-suffer-addiction-just-3000-physicians-are-specially-trained-treat-them
The National Survey on Drug Use and Health (NSDUH) (2018). 2018 national survey on drug use and health. Retrieved from https://www.samhsa.gov/data/sites/default/files/cbhsq-reports/NSDUHNationalFindingsReport2018/NSDUHNationalFindingsReport2018.pdf
Wakeman, S. (2015, July 16). A modern epidemic – the case for addiction medicine. Retrieved from https://www.mdedge.com/internalmedicine/article/101275/addiction-medicine/commentary-modern-epidemic-case-addiction
WWAMI Rural Health Research Center (2017). Changes in the supply of physicians with a dea and data waiver to prescribe buprenorphine for opioid use disorder. Retrieved from https://depts.washington.edu/fammed/rhrc/wp-content/uploads/sites/4/2017/05/RHRC_DB162_Andrilla.pdf