Imagine a young man walking into the emergency room of his local hospital one night, accompanied by his very worried siblings. They know their brother has struggled with substance use disorder related to opioids for months — maybe even years — and that his disease has reached a crisis level. The man, just like someone who goes into cardiac arrest, is in immediate need of treatment.
But while the emergency room doctors recognize the patient is at risk of a deadly overdose, they are woefully limited in how they can help. Their community hospital staff is not trained to prescribe a medication used to control cravings and withdrawal symptoms of an addiction involving opioids. The only outpatient addiction treatment facility in town is overwhelmed and not accepting new patients.
Absent adequate training and resources, the ER doctors discharge the patient with a stack of brochures and 1-800 numbers. It is impossible to know whether he will die before getting the medical care he needs.
Across the United States, this type of scenario plays out daily. Even with skyrocketing numbers of drug-related deaths, there are too few physicians and other clinicians with the requisite knowledge and training to prevent, diagnose and treat addiction — a chronic disease that, like heart disease or diabetes, requires ongoing care.
In 2017, an estimated 20.7 million Americans needed treatment for SUD, but only 4 million reported receiving any form of treatment. It’s no wonder, since there are only about 4,400 actively practicing certified addiction specialist physicians in the United States, far below the number needed to address the current opioid overdose crisis.
At a time when millions of Americans are in desperate need of help, addiction training is still rare in American medical education. As of January 2019, only 66 of the nation’s 187 accredited medical schools offer addiction medicine fellowships (40 of which are accredited by the Accreditation Council for Graduate Medical Education). The SUD workforce pipeline is lacking, and the need for frontline intervention is dire.
It is clear that action is needed now to increase the ranks of qualified, well-trained addiction treatment professionals in high-need communities across America. As an addiction medicine doctor who is intimately familiar with our workforce challenges, I know the solutions must be both structural and strategic. We need a two-pronged approach that incentivizes more prospective students to enter the addiction treatment field, while expanding the availability of educational opportunities for medical professionals seeking to specialize in addiction treatment.
As a first step, Congress should fully fund a new student loan repayment program for SUD treatment professionals who serve in high-need communities. As a part of last year’s landmark opioid law, Congress authorized $25 million toward student loan repayment for addiction medicine professionals who agree to work in one of the country’s many Mental Health Professional Shortage Areas or in a county where the average overdose death rate is higher than the national average. Now, the money must be allocated.
At the same time, lawmakers should bolster existing efforts to expand opportunities for medical professionals to obtain specialized training in the prevention and treatment of addiction. This will take millions of dollars in additional investment over time, but Congress can start now by funding programs such as the Mental and Substance Use Disorder Workforce Training Demonstration Program, which was authorized in the 21st Century CURES Act. Now more than ever, the United States needs a greater number of physicians and health care professionals trained on the full spectrum of addiction care: prevention, treatment, remission and recovery.
Americans suffering from addiction do not have time on their side — and we simply cannot continue with the status quo. We must carry on the momentum from last year’s congressional action and equip this nation’s medical workforce with the education and training it needs to save lives.
Kelly Clark, MD, MBA, is president of the American Society of Addiction Medicine based in Rockville, Md.
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