October 31, 2016

More than an Rx: How Can Doctors End the Opioid Epidemic?

More than an Rx: How Can Doctors End the Opioid Epidemic?

How can we combat addiction? While nearly 20,000 people died from a prescription opioid-related overdose in 2014, community leaders and elected officials are still scrambling to answer this question. Some advocates point to physicians in their role as key suppliers of prescription opioids as the group best positioned to make a dent in one of our country’s most pressing public health issues. But are doctors really empowered to end the opioid addiction crisis, or are we setting them up for failure? 

For people who haven’t been through medical school, doctors can seem like superheroes capable of curing anyone who crosses their path. In reality medical science is a highly specialized area of study and practice with wide gaps of training between one concentration and another. Just because a doctor is trained to fix a broken limb or even operate on your brain or beating heart does not mean they are qualified to treat a patient’s suicidal ideation, body dysmorphia or drug addiction. Physical and psychological illnesses and injuries can both be devastating to an individual, but depending on what illness you have, you could need different doctors. Drug addiction in particular is not an acute physical wound, but a chronic behavioral and psychological dysfunction that can’t be effectively treated in any one visit to the doctor.

Many doctors enter the profession without enough training to help them recognize the signs of drug misuse and dependence, leaving them blind to one of the most harmful health conditions in our country. Where doctors are not given medical training to understand and appropriately treat addiction, social stigmas from popular culture can take over. Misguided stereotypes of drug users as immoral, untrustworthy and weak can lead doctors to punish those addicted to opioid-based medications instead of connecting them to addiction treatment services like medically-supervised detox and rehabilitation centers. If we are serious about ending the opioid addiction crisis, we must find a way to train all doctors, experienced practitioners and residents alike, to recognize and properly handle addiction in their patients. Addiction training needs to go along with prescribing privileges.

Giving doctors better options to treat addiction could increase their willingness to learn about the medical origins of this health condition. As it stands, most doctors have relatively few ways they can intervene to interrupt an opioid addiction. Even the most considerate doctor can be left scratching her head when she meets a patient she suspects of abusing prescription opioids.

On top of that, many states don’t reimburse Medicaid claims for addiction treatment services, disincentivizing doctors to take such cases at all and creating friction between patient-oriented doctors and administrators looking to keep costs down. At best, doctors who suspect that a patient is abusing an opioid-based prescription can refer them to an outside addiction treatment center or twelve-step group to attend at the patient’s discretion.

People trust doctors to know what’s right. If a patient is in pain, or if they strongly insist that they need a prescription painkiller, doctors can feel extremely pressured to write that prescription despite the rampant abuse of opioids in our country. Giving our doctors better tools to identify and treat opioid addiction will save countless lives. We have to help our doctors better understand and treat addiction if we want to help our country end the opioid epidemic for good.

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About Constance Scharff PhD