When it comes to the opioid epidemic, physicians are some of the best drug dealers around with almost unrestricted access to the purest substances. As the opioid epidemic spirals out of control, physicians continue to be able to provide their patients with a variety of options, including oxycodone, morphine and fentanyl. Many people would be surprised to know that physicians don’t need any additional training to prescribe opiates to their patients especially considering that 40 percent of opioid deaths last year involved a prescription medication. But paradoxically, if physicians want to treat opioid addiction, they are required to perform eight hours of special training. If this seems backward to you, you are not alone.
Moreover, this training requirement remains in place as the opioid epidemic continues to worsen. According to data released by the Centers for Disease Control and Prevention this past month, emergency room visits for opioid overdoses have skyrocketed. There were over 42,000 deaths due to opioid overdoses in 2016 alone which is comparable to the peak death rate seen in the AIDS epidemic. With that being said, we can safely say we are losing this crisis. But there are effective treatments for opioid addiction, so why aren’t we using them?
The story begins in 2000 when the Drug Addiction Treatment Act (DATA) was created to broaden access to medication-assisted treatment for opioid use disorder by allowing more providers to prescribe treatment. Prior to this, patients could only seek treatment at a certified methadone clinic. While an effective treatment, it required patients to attend clinic daily to receive their medication which for many proved an insurmountable barrier. DATA allowed physicians to prescribe treatments outside of the methadone clinic, including a revolutionary new medication known as buprenorphine. This medication was unique in that it allowed patients to continue treatment at home without daily visits and was reassuring to providers as it had a much lower potential for misuse or overdose. DATA, however, came with one fatal flaw.
In order to prescribe buprenorphine, practicing physicians were required to complete an eight-hour training on addiction medicine. This was in addition to the four years of medical school and three or more years of residency that all board-certified physicians must complete. The training is eight hours in length, half of which is spent in lecture and the other half finished as an online module. Given the limited availability of training sessions and difficulty with carving out time from busy practices, many primary care providers are not certified and are unable to prescribe these life saving medications. Instead, patients are being forced to turn to psychiatrists and addiction centers, two areas that are already overburdened and do not have readily available access for patients.
To be sure, given the scope of the opioid epidemic, physicians should be required to have up to date training on addiction medicine. However, requiring physicians to undergo this eight-hour training to obtain a waiver to prescribe buprenorphine is misguided. A much more rational system would require physicians to undergo special opioid training prior to prescribing medications that perpetuate the crisis rather than as a prerequisite to prescribing an effective treatment for addiction. Such training could easily be incorporated into existing medical school and residency curricula.
In a perfect world, a patient who wanted help with their opioid addiction would be able to schedule an appointment with their trusted PCP and leave the same day with treatment. Right now, our regulations restrict this possibility. There are already far too many barriers to seeking treatment for diseases of addiction, ranging from stigma to a shortage of appointments with addiction providers. And as of now, primary care physicians, the front line, have to pass through an unnecessary hurdle in order to gain a critical tool in helping fight the biggest public health crisis of our time. In these dire times, we should be removing as many barriers to treatment as possible. It is time for us to remove the onerous additional addiction training required to prescribe buprenorphine and instead incorporate this as standard curriculum in medical training.
Arjun Gokhale and John Huston are internal medicine residents.
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