Editor’s note: The opinions expressed by the authors do not necessarily reflect the opinions of the AAMC or its members. This article was updated May 15, 2018, to reflect the current number of fellowship opportunities available.
The country is struggling to reverse the devastating opioid epidemic, which has its roots in many places and requires a collective response across multiple sectors. For their part, medical schools and teaching hospitals are actively working to address the crisis in their communities. But to be maximally effective, we must ensure these efforts go beyond academic medicine’s traditional commitment to increasing knowledge and finding best practices we can “import” to our own environments. We must ensure we are translating that knowledge into real change in the community.
For change to happen, we need more physicians who are trained in addiction medicine and addiction psychiatry. According to the 2015 National Survey on Drug Use and Health, more than 20 million Americans need treatment for substance use, and 2 million Americans have an opioid use disorder. Yet the United States has only about 2,000 physicians trained in addiction psychiatry and 3,500 trained in addiction medicine. It can be incredibly hard for patients suffering from opioid addiction to find a doctor who can treat their special needs.
U.S. culture tends to view unhealthy substance use and addiction as a moral failing or a criminal or behavioral problem. But we now know this perception is not accurate. Addiction is a chronic brain disorder with environmental and genetic influences. Patients who have addiction to opioids and other substances can recover, but they also are at risk for relapse and require ongoing, often lifelong, treatment. We also now know that addiction is a preventable disease, is amenable to successful intervention early in its course, and can be an expensive, challenging chronic disease if left unaddressed.
The academic medicine community must help our country address this public health crisis. Some proposed solutions would increase access to treatment, but that will help only if physicians are trained in evidence-based addiction therapies. We are on our way there. In 2016 the American Board of Medical Specialties recognized addiction medicine as a new subspecialty. Such acknowledgment shows that the academic medicine community is committed to approaching addiction as a treatable disease and not perpetuating the stigma of addiction as a moral failing, bad behavior, or a crime.
“By training more physicians in addiction medicine and developing new treatments for addiction and pain management, the academic medicine community can help fight this epidemic.”
At The Addiction Medicine Foundation, we have helped establish 45 fellowships in addiction medicine at institutions across the country, and we expect to have a total of 125 such fellowships by 2025. The Accreditation Council for Graduate Medical Education (ACGME) approved program requirements for addiction medicine earlier this year and applications are available on the ACGME website. In our view, every medical school should have a fellowship in addiction medicine, and every hospital and health system should have an addiction medicine program, and the cap on federal support for graduate medical education (GME) positions decreases the ability of institutions to establish these critical training programs.
There are already 102 ACGME-accredited pain medicine fellowships in the country. The new GME positions in addiction medicine will produce specialists who are prepared not only to treat patients with substance use disorders, but also to educate faculty, medical students, and residents. Graduates are also needed to serve as change agents, so that heath care providers can invest more time and money educating, preventing, and treating addiction than dealing with the sequelae. As the opioid crisis continues to be a problem across our communities, we must expand the field of addiction medicine as quickly as possible and involve junior faculty who can build momentum and become leaders in this new specialty.
While we build this workforce, there are other things we can do to help our institutions address this problem and treat those who are suffering now. Opioid addiction cannot not be medically addressed in isolation; education and training in substance use disorders must be comprehensive, addressing all substances, as well as prevention and chronic disease management.
Our colleagues who have experience treating patients with opioid addiction need to speak out about effective evidence-based treatments and against laws that keep people from receiving treatment. We can include this education in talks and at grand rounds. Our medical schools and teaching hospitals have responded by integrating pain management education across the continuum of medical education. This integration needs to be expanded. Physicians in the community also need access to this type of excellent continuing education, and we should expose students to this topic as we encounter patients with addiction in student-run free clinics and during clinical rotations. Through new research opportunities at the National Institutes of Health, we can promote innovation for new treatment solutions.
All physicians—not only those who plan to specialize in addiction medicine or pain medicine—must be able to recognize the signs of opioid addiction and other substance use disorders, so they can refer patients to addiction or pain specialists when necessary. Every trainee also must understand how to prescribe opioids and other controlled dependence medications appropriately, so we can minimize the number of patients who develop addiction to opioids and other substances in the future.
By training more physicians in addiction medicine and developing new treatments for addiction and pain management, the academic medicine community can help fight this epidemic. Our patients and our country require that we do everything we can.
Robert J. Sokol, MD, is the president of the Addiction Medicine Foundation, and Kevin Kunz, MD, is the executive vice president of the Addiction Medicine Foundation.