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By Will Stone, KJZZ, NPR, Kaiser Health News
The US Surgeon General's office estimates that more than 20 million people suffer from a substance use disorder. Meanwhile, the country's drug overdose crisis shows no signs of slowing down.
Yet, there are not enough doctors specializing in addiction treatment – physicians with extensive clinical training and board-certified addictions.
The epidemic of opioids has made this deficit cruelly painful. And it encourages medical institutions across the country to create scholarships for future physicians wishing to treat substance-related disorders with the same precision and science as other diseases.
These scholarship programs, which now number more than 60 students, offer physicians a year or two of postdoctoral training in clinics and hospitals where they learn evidence-based approaches to treating addiction.
Such programs attract a new generation of talented idealistic doctors, idealists like Mrs. Hillary Tamar.
Driven To Connect with patients in need
Tamar, now in her second year of family medicine residency in Phoenix, was not thinking of addiction medicine when she started her first medical school in Chicago.
"As a medical student, honestly, you do your emergency rotation, people refer to a patient as" looking for pain medication "and that's bad," Tamar said. "And that's all you do about it."
But in fourth year of medical school, she was assigned to an internship in a rehab center in southern Arizona.
"I was able to make contact with people in a way that was not possible for me in another specialty," recalls the 28-year-old.
Working with patients there has transformed Tamar's understanding of substance abuse, she said, and showed that doctors can transform lives.
"They can spend all their time acquiring a substance to be brothers, sisters, daughters [and] fathers are preparing breakfast for their children again, "she said. "It's really powerful."
When Tamar has completed her residency, she plans to pursue a fellowship in addiction medicine. She sees addiction medicine, like primary care, as a way to build lasting relationships with patients – and focus on multiple diagnoses.
"I like it when I see addicts in my schedule, even if they're pregnant and they're on methamphetamine," she said. "No more room to do good – it's exciting."
Build a program and they will come
Doctors with Tamar's enthusiasm are sorely needed, said Dr. Anna Lembke, medical director of addiction medicine at the Stanford University School of Medicine and a long-time researcher in the field. .
"Even 10 years ago," said Lembke, "I could not find a medical student or resident interested in learning more about addiction medicine if I looked under a rock. They were just not there.
But Lembke sees a shift in the next generation of doctors drawn to the field because they care about social justice.
"I now have medical students and residents knocking on my door and e-mail me. they all want to know more about addiction, "said Lembke.
Historically, addiction medicine went through psychiatry. This model began to change in 2015, when the American Board of Medical Specialties – considered the benchmark for physician certification in the United States – recognized addiction medicine as a bona fide subspecialty and opened the training for physicians in other medical fields.
Until then, said Lembke, there was no way to get drug addiction scholarships through the nationally recognized Accreditation Council for Graduate Medical Education. And this made it difficult to recruit young talent – and to seek funds for their grants.
Last year, ACGME began accrediting its first series of addiction medicine fellowships.
"We have a huge gap between the need and the doctors available to provide this treatment," Lembke said.
"At least, the medical community has begun to wake up to consider not only its role in triggering this opioid epidemic, but also the means it needs to intensify its efforts to solve the problem," she said. she declared.
Laying the foundations
When Dr. Luke Peterson completed his family medicine residency in Phoenix in 2016, there was no Arizona Addiction Medicine Scholarship.
He moved to Seattle to complete a one-year fellowship at the Swedish residence Cherry Hill Family Medicine. In particular, he learned how to treat pregnant women recovering.
"I really needed to make a scholarship if I wanted to have an impact and be able to teach others to make the same impact," said Peterson, who then helped create a scholarship program. addiction in Arizona. His program is based in Phoenix, the faculty of medicine at the University of Arizona and his university hospital, run by Banner Health and the VA of Phoenix.
Arizona's two drug research fellowships received ACGME accreditation last year – an endorsement stamp that made programs a desirable choice for future physicians, said Peterson.
All doctors who are considering treating a substance use disorder do not necessarily have to go on a scholarship, he said. In fact, its goal is to integrate addiction medicine into primary care settings.
But a specialist can serve as a referral center and resource center for community physicians.
For example, a specialist such as Peterson can teach doctors how to administer medication-assisted treatment such as buprenorphine.
Public health officials are striving to train more doctors in evidence-based treatment, such as buprenorphine, which reduces the risk of death in people cured of an overdose of alcohol. opioids.
"As we provide more education and support to primary care physicians, they will feel more comfortable tracking and treating addictions," Peterson said.
Peterson's own pathway in addiction medicine began during a rotation with a family doctor in rural Illinois.
"In times that most doctors find uncomfortable – maybe a patient comes to ask for pain medication and you notice negative side effects – he has not fled from this situation," said Peterson. "He tackled it head-on."
It was a formative experience for Peterson – an experience he wanted to see held by other young doctors. And he recognizes the urgency.
Peterson said, "These medical students will be looking at my current generation of doctors and we will be judged on how we responded to this epidemic," in the same way that he and his peers are now looking at how whose doctors have managed the HIV epidemic.
One of the first steps in curbing the epidemic, he said, is to make sure there are enough doctors on the ground who know how to respond.
Many medical students today, people like Michelle Peterson (no relationship with Luke), also claim to feel this call.
She is in her first year at the University of Arizona College of Medicine and has been involved with substance abuse after working in an outpatient treatment center.
She said that she had already learned about addiction in her classes, heard doctors in the field and saw other classmates involved.
"It's certainly not just me," she said. "There are a lot of people here who are really interested in addiction."
It's a trend she and her mentors hope to see continue.
This story is part of a partnership that includes KJZZ, NPR and Kaiser Health News.