Physicians' poor addiction training makes healthcare's opioid battle like 'fighting World War II with only the Coast Guard'

Comprehensive addiction training is rare in American medical education, which denies physicians the necessary diagnostic and communication skills required to treat patients with substance use disorder, according to The New York Times.

Here are six things to know:

1. Timothy Brennan, MD, assistant professor of psychiatry at Chicago-based Mount Sinai Health System, specifically directs an addiction medicine fellowship. He told The New York Times fighting the opioid epidemic with the current physician workforce, which is inadequately trained to treat addiction, is "like trying to fight World War II with only the Coast Guard."

2. Dr. Brennan directs one of only 52 addiction medicine fellowships nationwide. In August, a dozen of the fellowships received gold-standard board certification status from the Accreditation Council for Graduate Medical Education. In addition, only 15  out of 180 American medical school programs teach addiction as including alcohol, tobacco and drugs, according to Kevin Kunz, MD, executive vice president of the Addiction Medicine Foundation.

3. There isn't much incentive to study addiction medicine, due to large disparities in reimbursement between addiction care and physical healthcare, according to a 2017 study  published in Milliman Research Report. Addiction medicine is also a young field, so most medical schools can't rely on the expertise of fellows or post-graduate students.

"The biggest challenge now is how do you sustain it?" Daniel Alford, MD, a professor and associate dean at Boston University, told The New York Times. "Who keeps updating it? When faculty leave, who will replace them?"

4. Another reason for medical students' resistance to specialize in addiction care is due to the perceived stigma surrounding patients with substance use disorder. Patients are often dismissed as manipulative and addiction care can be seen as a thankless job for physicians, according to the report.

5. Boston University weaves addiction training into all four years of a medical student's residency. Lidya Wlasiuk, MD, an assistant professor at Boston University School of Medicine, created a fictional addiction case study that allows medical students to practice communicating with a patient showing signs of addiction. The fictional patient is meant to represent the standardized substance abuse disorder patient seen across almost every field of medicine.

6. Most medical students in addiction fellowships learn a communication tactic called a "motivational interview," which encourages patients to articulate health goals.

"Language matters," Dr. Wlasiuk told The New York Times. "Avoid saying, 'I found this out.' Instead, say, 'This was in your urine screen.' You want to keep that conversation going, not shut it down."

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