Most Doctors Are Ill-Equipped to Deal With the Opioid Epidemic. Few Medical Schools Teach Addiction.

I encouraged as many doctors as possible to join the American society of addiction medicine and obtain a waiver from SAMHSA to prescribe buprenorphine as this is the most efficient treatment process to start for people with opioid use disorder. This is a chronic brain disorder and you are not substituting one opiate for another. This drug is saving lives and we need more physicians helping out. Get your butts in gear and help save a life ASAP.

An excellent book on this is "Dopesick" The epidemic started with big pharma scamming doctors, employing the usual freebees and misleading research, and continuing with those ubiquitous pain scale laminated wall mounts, and ending with computers suggesting everything is formulaic. We are now paying for years paying more attention to the bottom line than the patient. It will be very difficult to reverse with the systematic dehumanization of our clients.

It isn't just opoids. Doctors love to prescribe the class of benzodaizepines (Ativan,, Lorazepam, Diazepam,....) which are "habit-forming" and conducive to overdosing. A friend of mine literally calmed herself to her grave. I'd sooner deal with anxiety by non-drug means.

If doctors want to understand addiction then they need to listen and take their cues from recovered addicts. Anything else is pretentious conjecture.

You can add graduate clinical psychology programs to medical schools as well. Most programs do not require even one course on the topic. Some states do require that psychologists take a 6 hour course on addiction in order to keep their license to practice. But this is woefully insufficient. The result is that most clinical psychologists cannot even recognize when a client is abusing alcohol or drugs. Thus, they don't refer the client to appropriate services. And almost all the time they mistreat the client and enable him/her to continue with their addiction.

They agreed on temporary anti-anxiety medication. Dr. Wlasiuk also taught her breathing exercises. No,no,no. Swapping a Benzo addiction for an opiate addiction is Not progress. We doctors are part of the problem. Xanax is the crack of Benzo’s (benzodiazepines... the Valium like meds). Powerful and short acting. Treat opiate withdrawal with methadone or subozone taper... long acting no possible rush. We need to stop minimizing the effects of Benzos. Other better options, antidepressants, for some mood stabilizers. Gabapentin, exercise, rehab admit, NA. I now take care of elders , but find no helpful ongoing use for starting a patient struggling with addiction on another addictive medicine. Wee.elderconsult.com/medication.

Most people who use opioids as prescribed for temporary pain relief do not get addicted or develop dependency. Compared to alcohol & nicotine addiction, opioid abuse is relatively minor. All this hysteria over opioids ignores one of the major health problems facing Americans: obesity. The ideal of a healthy mind in a healthy body is a joke in a country where 2/3rds of adults are overweight or obese. Some 600,000+ people die of heart disease annually, another 600,000 die of cancers, both of which are related to obesity (and alcohol & nicotine use), yet where is the uproar about the obesity epidemic??? About 70,000 people a year die of overdoses; many of those are deliberate suicides; most involve heroin or fentanyl and not opioids prescribed for pain. Now with the increasing legalization of marijuana, the bloated law enforcement & prison industrial complex look to fill the prisons with opiate users instead. People use food, alcohol, tobacco & drugs to numb their pain & misery. This is where the roots of addiction lie. Dr. Gabor Mate has written about the relation of childhood trauma & sexual abuse to adult addiction. If doctors refuse to prescribe pain-killing medications, people turn to illegal street drugs. The whole society needs to address why it creates so many miserable suffering people. Addiction is far too complex for doctors to fix, noting however that France drastically cut heroin addiction by encouraging & allowing doctors to prescribe buprenorphine

It appears that the deaths have not peaked yet. At the curret rate of increase it appears we may loose more people to opiods that we lost in WWII.

Even the most renowned expensive rehab programs with the foremost experts have very high relapse and noncompliance rates.

Doctors are people too. Once a male dominated field they have become emasculated. In most specialities income has fallen, regulations and oversight has skyrocketed, and insurance companies now subject well meaning doctors to audits. Even worse they harass and intimidate doctors by reporting them to medical boards for alleged misconduct. Now you're surprised that there aren't enough physicians to treat addicts? A thankless field, with poor reimbursement, a population that's difficult to treat, with a low rate of satisfactory outcomes.

Thanks to the war against pain patients, my sleep doc has cut back on the amount of methadone he will prescribe to treat my severe Restless Legs Syndrome. Before methadone, I tried every other traditional medication to quiet symptoms that Requip and then Neupro had augmented into full body jerks every 8 to 10 seconds whenever I sat or lay down for ~10 minutes. Now I'm required to replace part of the methadone with a medication that (like all others in its class) makes me too groggy to think and unable to walk without leaning on a wall. Many people assume that being able to think and walk no longer matters to those of us in our 70s or beyond; we're old! Yet we still hope to function like humans. To contribute. The new medication doesn't work as well as methadone: I'm groggy and posturally unstable, just like the last time I tried it (when my RLS wasn't quite this severe). And I have not slept more than an hour or two at a time for several days, thanks to RLS jerking and the pain it causes my arthritic limbs. Being thought "addicted" to a prescription with which I've always been fully compliant hurts less than looking ahead to the non-life that began last week.

Much like HIV/AIDS during the 1980s and early 1990s, we currently do not have effective medical treatments for addiction. In medical school we spent a lot of time learning about HIV but the patients always succumbed. Doctors can play a role in preventing addiction by scrupulously monitoring and not overprescribing opioids. With the exception of the mixed agonist antagonists and perhaps methadone, effective treatment with high compliance and low relapse rates are not currently available and no amount of education is changing that.

I wd like to applaud Gene and Gloria Bauer at Stanford. Gene is a former dean at Stanford Medical School and both he and his wife felt deep passion about teaching med students about addiction, particularly the genetics of addiction. Ta da....In about 2 yrs Stanford will open the Taube Youth Addiction Ctr for 10-24 yr olds. https://med.stanford.edu/news/all-news/2018/01/taube-gift-to-launch-addi... The Bauers, for over 20 yrs, have felt convictions re: addiction coming "out of the closet" so this is a dream come true. UCSF is also a trailblazer before Stanford when it comes to the neurobiology of genetics.

Good stuff...will help our docs greatly to "First do no harm!" I'm 15 years on doing a poor job of shepherding a good kid through a bad opioid nightmare. I count my lucky stars that he hasn't clocked out yet...though he's flat-lined at least three times that I know of. He has a slowly improving trajectory from what I can see, but it's a long march upcountry to be sure. Relapse lurks behind every life change. This disease scarcely existed (at least not in these parts) 500 years ago. There was no supply. Another malady of abundance, right along with coronary disease, diabetes, alcoholism, obesity, and likely cancer. We can and should teach our docs to treat, but to beat this we'll need to first heal our own appetites and attitudes. I'm grateful for my son. He's done the hard work of teaching me existential lessons I still didn't get even after walking through multiple active war zones. I hope he makes it.

Having been on both sides of the fence with regards to this article, there is one point that stands out. It is a difficult one. While the caregivers in the piece have wonderful intentions, it is clear that they do not have personal experience with addiction. That is a double edged sword, unfortunately. The reason being is that while inexperienced caregivers have true feelings with regards to their patients and can be unforgiving, addiction specialists have true feelings with regards to their patients and can be even MORE unforgiving. It is extremely hard to strike that balance between sobriety and addiction. Is maintenance sobriety or addiction? Yet sobriety certainly is abstinance. There are 2 schools of thought here. Which one works? Answer: both.

The women's clinic I go to simply stopped prescribing opioids and I was given a choice to stay or seek another facility/doctor. I decided I rather wean myself off my prescription and not take something with a high probability of having problems. Patients have to participate in their own care. I had a choice and I made a decision based on the information I was given by my doctor. I traded my prescriptions in for physical therapy and exercise. Not everybody on opioid abuses them. I took them as prescribed and was able to wean myself off of them when it was appropriate.

I’ll start paying attention to the opioid epidemic (lip service) when we get rid of the booze and cigs epidemic.

The medical model demands that all ailments can be solved by more/other medication. While medical doctors are on the frontline of addiction medicine addiction at its heart addiction is not about medical issues, it's about life issues.Certified and licensed addiction therapists can help people learn to cope without the crutch of addictive drugs. Mental health counselors and medical doctors should work together to treat a patient. One of the problems I've run into is that medical doctors do not want to talk to a Masters level therapist. Integrative medicine, where mental health counselors are part of a patient's treatment is essential.

The article doesn't address benzodiapines which are just as bad as opioids -- still trying to wean off 5 mgs of Valium-- my GP is no help at all. If you have anxiety -- Benzos are not the answer!

It’s amazing that physicians have been able to prescribe opioids to as many patients as they want without any special training on addiction. But Suboxone, a life-saving drug required 8 hours of training (or at least the computer had to be turned on for 8 hours) in order to prescribe it and then there were limits on how many patients each “trained” doctor could prescribe the drug. Do the math: No limits on how many patients you prescribe opioids but limits on how many could get the drug to help them get off heroin and opioids. Was it because there was fear that physicians would become Suboxone mills? And who would have guessed that physicians would charge $250 for a five minute appointment? New laws have forced doctors to accept a patient’s insurance for office visits, but that’s not the way it was in the beginning of this crisis. And unless the training has changed since I last spoke to an addicitionologist, nowhere in those 8 hours of training does it instruct physicians on how to taper Suboxone, leaving many patients being medically withdrawn way too fast, precipitating a relapse, sometimes fatal. Every physician, no matter what speciality, will see someone with an addiction problem every week, if not every day. Therefore every single residency program should be teaching their doctors about addiction. All medical students should be rotating through addiction treatment programs. We have a crisis in this country. Anything less is malpractice

TREAT addiction? But M.D.'s are the ones who CAUSED the epidemic. They can't say no to patients, which is why TV is full of pharma ads.

All primary medical doctors would benefit by modeling Dr. Wlasiuk.

The first patient described in the article was someone with chronic pain and a prescription for oxycodone. His urine drug test showed the presence of hydrocodone, which is chemically distinct from oxycodone. The conclusion: The patient is getting illicit drugs. But not so fast! The presence of hydrocodone in urine of a patient taking oxycodone without actually taking hydrocodone is uncommon but it does happen. See the article in the link, with the article coming from a large laboratory that does lots of urine testing for doctors across the country. The actual level of the hydrocodone relative to the oxycodone may give an indication that the patient is supplementing prescribed oxycodone with illicitly obtained hydrocodone, but the education of the doctor should include discussion of ALL possibilities.. Here is the link to the article on Anomalous Observation of Hydrocodone in Patients Taking Oxycodone. Perhaps the teachers of the new doctors need to go back to school too. https://www.deepdyve.com/lp/elsevier/anomalous-observations-of-hydrocodo...

Our country could really benefit from a well thought out and coherent approach run by qualified experts to deal with addiction. With all due respect neither Jordan or Kellyanne are qualified to take on the very complex and difficult addiction issue. Addiction is a complex and difficult disease that should not be taken lightly. It does not help to have people like Jeff Sessions saying 'Take some aspirin; tough it out' instead of using opioids. Vilifying people who take opioids and their doctors does not help deal with the issue.

The article completely sidesteps one of the roots of the problem- doctors prescribing known addictive drugs to treat pain in patients after an injury or surgery. After I broke my leg in two places and had surgery I was in considerable pain. I was sent home with bottle of oxycodone and prescription strength Advil. A week or so later I realized I had been give an addictive opiate with instructions to "take as needed" with no prescription refill. I became concerned and decided to wean my self off the oxycodone and started to alternate doses with the Advil. In about two weeks I had gradually replaced the oxycodone with Advil and had one pill the last day . The next day I felt like my skin was crawling and had mild shakes all day. When I described this to my pharmacist he said I had experienced a mild withdrawal. I can't imagine what it would have been like if I had taken the opiate as prescribed and finished the bottle. How irresponsible of the doctors not to know the effects of what they are prescribing and not to have a plan and followup for their patients.

We will never be able to address addiction until we get past the 12-setp rhetoric that asserts the ancient belief that addiction is only caused by moral-failure and that is what has to be treated. Of course, way back in time all diseases were moral-failures, but science eventually pushed back and showed the real causes and real treatments. Yet, addiction remains the last bastion of the moral-failure argument despite growing evidence that something else, something more basic and bio-chemical is at work. We know that only about 10% of people prescribed opiates become addicted while 90% get past the pain, stop the medication and move on. It is too easy to blame the 10% on moral-failure. To be sure 12-Step programs have helped some but their success rate is small and, unlike most treatments, it is a lifetime commitment because the root-cause is never addressed. Governments aren’t going to fund real research into the bio-chemical and genetic roots of addiction, because who wants to spend taxpayer dollars to study moral-failures? (Lovely circular argument.)

You haven't mentioned that there is no effective treatment for addiction, other than slow and excruciating withdrawal from the drug causing the problem. Many addicted people just can't take the withdrawal symptoms, and make no mistake, stopping an addiction drug doesn't just make the problem the drug was relieving come back. Withdrawal symptoms are a "disease" of their own, and the effects are far, far worse than the problem you took the drug for. Add the withdrawal symptoms to the pain you were trying to alleviate in the first place, and it is too much for many people to bear. Until there is an effective treatment to alleviate the agony of withdrawal symptoms, many people will not be getting off the problem drug, no matter how understanding the physician sounds.

I am discovering as of late, as I increase in age, that most doctors today are ill equipped to deal with just about any problem that patients have. The wheels of medicine turn VERY slowly. Nothing is done within a reasonable amount of time for most of us. Waiting many, many months to get in to see a specialists, you could die while just waiting for your appointments. Remember that they are all "practicing" medicine. I have gotten so many mis-diagnosises, redundant questions, too many ridiculous tests and improperly prescribed medications. On top of the billing /referral/ insurance quagmire, I am surprised anything gets done within the medical 'industry'. Addicts unfortunately are at the bottom of their priorities. Unless you have a platinum health plan.

The core of the problem is stated in the middle of the article. Insurance reimbursement for mental health is so low and contentious that few practitioners choose to specialize in psychiatry or addiction medicine. Until mental health is regarded the same as physical illness by medical payors, there will continue to be a chronic shortage of psychiatrists.

I believe this problem is even bigger than what the current evidence suggests. Three weeks ago I lost a co-worker to this problem. His wife tells everyone he had a heart attack, but there was no autopsy. She had him buried in four days. He was known to try and purchase prescription pain killers from people at work. He was 44 years old, a father and a church going person. One of those people everyone liked. I wonder how many other deaths are covered up like this?

What a mess pharmaceutical executives have created in pursuit of profits for themselves and their stockholders. Physicians now have to learn how to handle the throng of opioid addicts, an entirely avoidable crisis created by big pharma, which adds e been more burden to the incredible demands of patient care. Empathy burnout will be swift. One of my friends saw this coming. She has been an attorney working in Social Security Disability law since the mid1990s. She recalls seeing a fairly sudden shift in the early 2000s in how physicians treated her clients, who were mostly older blue collar men with chronic pain from work-related injury and degenerative disease. Physicians began referring these patients, often post-surgery, to pain management clinics, which began popping up in poor and rural areas around that time. Now, many of these types of clients, who would otherwise qualify for SSD, are not eligible for help because they are addicted to the opioids prescribed by physicians at these pain clinics.

People with Serious Mental Illness often have substance challenges. Every psychiatrist should be trained in Evidence Based Therapies, CBT, DBT and motivational interviewing along with addiction training. Trying to help people with co occurring disorders is very difficult due to the various needs of the patients and the fragmented mental health system. We also need to raise reimbursement rates and allow APN’s to be trained in evidenced based therapies. The training in medical school needs to be evaluated based on our needs as a society.

Four years of medical school leading to the MD degree is already "5 Tons packed into a 20 pound sack." Most people don't realize most medical training is more of an apprenticeship...they learn by seeing, doing and teaching. One 4 or 6 week rotation through the emergency medical department of any hospital exposes students, interns and residents to the dilemma any physician faces dealing with substance abuse addiction. The primary care physician shortage is real and will only grow and they are the front line dealing with the opiod crises in most communities. Unfortunately, substance abuse prevention and treatment are also unintended victims of our nation's decades long drug wars. There are no quick fixes. It takes a minimum of 7 years to train a physician and the number of medical residency programs have been controlled for years by federal and state policy makers. Prevention work is often supported by charity and philanthropy--when those resources decline, the extraordinarily hard, demanding work ceases.

FYI, Massachusetts requires courses on addiction every two years to maintain your medical license. and end of life care. maybe other states should follow suit. this is far more relevant than teaching this in medical school..

Congress allowed Big Pharma to cause the opiate crisis, Big Pharma should be paying for treatment.

I was taught in high school 50 years ago that opiates were addictive and that if a doctor prescribed them to take as few as possible. Better to feel a little pain than to lose yourself to addiction. But somehow in the last half century, that wisdom has been lost. Doctors weren’t taught the potential addiction of some pharmaceuticals and patients came to believe that if a doctor prescribed it and a pharmacist sold it, that it must be good. As a society, we need to relearn what was common knowledge a couple generations ago.

The article fails to mention another issue that goes hand in hand with this: the lack of education most physicians receive in pain management. Sadly, in most medical schools, pain management is under control of anesthesiology whose practitioners know little about either treatment of chronic pain much less substance abuse about which they know nothing at all. And although the article suggests there is a vast difference between addiction medicine and addiction psychiatry, there isn't other than certification in the latter first requires training and certification in general psychiatry. And it is worth noting certification for addiction psychiatry has been available for 25 years so it is hardly a new thing. Furthermore, in most medical schools, during their rotations in psychiatry, students receive a least some training in substance abuse. That they don't receive it during their rotations in medicine or other specialties doesn't mean they don't receive any at all. When I was in medical school in Baltimore 40 years ago, one day each week during our 6 week psychiatry rotation was dedicated to teaching about substance abuse including opioid abuse which was a major problem even back then.