3 reasons primary care physicians should treat addiction

As communities and families across the nation continue to shoulder the burden of the opioid epidemic, many primary care physicians remain on the sidelines. According to the American Society of Addiction Medicine, less than 1 percent of primary care physicians are certified to prescribe buprenorphine, a drug shown to curb opioid dependence. This shortage persists despite federal efforts to increase certification numbers.

Several factors dissuade physicians from seeking out training: Medicaid systems in many states do not reimburse physicians for addiction treatment; the education required to achieve certification consists of eight total hours of training, which does little to empower physicians with confidence; and the stigma accompanying drug abuse can often influence primary care physicians to steer clear of treating addicts.

In a recent article published in STAT, Julian A. Mitton, MD, a senior resident in global medicine and primary care at Massachusetts General Hospital in Boston, contends primary care practitioners should be on the frontlines of the opioid epidemic, arguing insurance companies should increase payments for addiction services and medical schools should improve addiction training care.

Here are three reasons primary care physicians should take the lead in addressing the opioid epidemic.

1. A community problem: In the STAT column, Dr. Mitton references a statement from Michael Botticelli, director of the White House Office of National Drug Control Policy, during a recent forum in New England. The director referred to the opioid epidemic as "a national crisis that manifests itself as a local problem" and argued local problems require local solutions, suggesting the further integration of addiction treatment into primary care.

According to Dr. Mitton, primary care physicians, embedded in their communities, are experts at getting to know patients and providing longitudinal care for those with chronic conditions like heart disease and diabetes. Addiction is also a chronic condition, which, Dr. Mitton suggests, should be tacked on to the list of conditions primary care physicians treat.

2. Treating a patient's whole health: In STAT, Dr. Mitton argues, "We can help [patients] manage their diabetes or quit smoking. Paying attention to an individual's whole health, including opioid addiction, makes medical sense and is financially smart. In fact, research highlighted by the federal Substance Abuse and Mental Health Administration shows that caring for 'substance use and physical health together improves both physical health and substance use conditions.' In other words, treating addiction is good for diabetes and vice versa."

3. Integrated care: Interdisciplinary care teams consisting of primary care physicians, nurses, social workers, mental health counselors and health coaches with their own history of addiction who guide patients along their path to recovery have proven successful at Mass General.

In STAT, Dr. Mitton writes, "This shared responsibility model has been the norm for years in the management of diabetes, heart disease and other chronic conditions. It should become the standard of care for addiction treatment, too."

More articles on integration and physician issues: 
4 strategies for dealing with patient discrimination of trainees 
AAFP releases 2015 list of top family medicine programs 
CMS identifies significant inaccuracies in Medicare Advantage physician directories

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