Should Primary Care Providers Start Treating Addiction?

Over the past several decades, addiction has grown from a major problem to a deadly epidemic. In just the amount of time it takes to read this article, another American will die of an opioid overdose, but overdose isn’t the only way that opioids kill. A number of other deadly afflictions are connected to opioid use, too, such as heart disease and other cardiovascular diseases.1

Cumulatively, nearly 130,000 people die from drug-related causes each year with close to 30,000 of those deaths being related to opioid drugs specifically.2 It’s currently estimated that there are over 14,000 addiction treatment facilities in the United States, but they still aren’t able to meet the demand. Unfortunately, the need for quality addiction treatment is growing faster than our capacity for treatment, making it necessary to look for additional ways of meeting this need.

Most people who need treatment for addiction either seek alcohol and drug rehabs on their own or they’re referred to addiction treatment facilities by general practitioners and primary care providers. In other words, the tendency has been to seek addiction treatment specialists when there’s a need for addiction treatment. While it makes sense to seek a specialist for all the obvious reasons, the fact that primary care providers aren’t providing any level of addiction treatment to those in need is a huge missed opportunity.

Why Don’t Primary Care Providers Offer Any Addiction Treatment?

The town of Española, New Mexico, had always had issues with opioid drugs due to its proximity to Mexico. However, Española — with its population of just 10,000 residents — now has one of the highest opioid overdose death rates of any town or city in the United States. Part of the problem is due to lack of treatment available as the town has only three physicians who are licensed to treat patients for opioid addiction.3 As is the case in the rest of the U.S., Española residents who suffer from addiction are continually referred to alcohol and drug rehabs or 12-Step programs like Narcotics Anonymous by their primary care physicians.

In the face of the current opioid epidemic, the Obama Administration recently made an effort to double the number of physicians who were certified to treat opioid addicts with buprenorphine, the active ingredient in Suboxone. While methadone has historically been the go-to pharmaceutical used in addiction treatment, buprenorphine has gained a major following among addiction treatment professionals because the medication has shown to be effective at curbing cravings for opioids. While this initiative to make buprenorphine more widely available has had some positive results, there’s still less than one percent of physicians who are certified to prescribe buprenorphine.

There have been a number of explanations put forth to explain why primary care providers seem to be so averse to treating addiction. In particular, a number of physicians have expressed their distaste at the thought of having addicts in their waiting rooms and associated with their practices, which shows that addiction is stigmatized even by healthcare professionals. Others are more well-meaning and explain that they merely lack the knowledge and training necessary to provide addiction treatment. Additionally, most states don’t provide much in the way of incentives for primary care providers to seek training and certification for addiction treatment, especially when most states’ Medicaid programs don’t reimburse physicians for the costs associated with treatment.

Is It Possible for Physicians to Become Effective Treatment Providers?

Some may want to respond to this situation by maligning primary care physicians for not taking advantage of the training and certification resources that are available. Some might go so far as to say this makes them complicit in the current addiction epidemic to a degree.

However, the prescribing of buprenorphine — for which there is currently an eight-hour certification course available to practicing physicians — should only be used as one part of a larger, more comprehensive treatment plan. While this particular course provides physicians with the basic ins and outs of buprenorphine use, it’s unreasonable to expect that such a course could make physicians knowledgeable when it comes to all the psychological and physiological intricacies of addiction. In other words, taking the certification allows physicians to prescribe buprenorphine, but it doesn’t give them the skills of an addictions counselor.

If a primary care provider is to treat a patient for addiction, he or she must, for instance, know what kinds of environmental and biological variables can contribute to the development of a substance abuse disorder. He or she should also be aware of the mental health pathologies and early-life traumas that are frequently associated with substance abuse. The knowledge needed to provide even the most basic addiction treatment is substantial and requires a greater time commitment than a brief training or certification course. However, a physician could coordinate with an addictions counselor and still be able to provide excellent addiction treatment without immediately issuing a referral.

How Some Addiction Treatment from Primary Care Providers Could Be Beneficial

Primary care providers are in an extremely advantageous position when it comes to treating addiction. Typically, physicians build relationships with their patients over extended periods of time, up to years or even decades. Therefore, physicians are in an ideal position to screen patients for warning signs of a substance abuse problem.

Having this relationship with the physician is also sure to make a patient more receptive and responsive than he or she might be if treated by someone unfamiliar. There’s also the issue of availability. If primary care providers offered some forms of addiction treatment, they could meet much more of the nationwide demand for addiction treatment services and improve access to treatment. After all, substance abuse problems are sometimes linked to other medical conditions, so being treated by a physician would ensure that all a patient’s health needs are being met, giving him or her optimal changes of staying sober.

Research detailed by the Substance Abuse and Mental Health Administration even indicates that providing care for substance abuse and general physical health simultaneously has been known to yield substantial improvements to both physical health and substance abuse problems.4 Obviously, this isn’t a strategy that can be implemented overnight. However, with some planning, incorporating addiction treatment into primary care could yield major gains in our nation’s ongoing battle against substance abuse and addiction.


Sources

1. https://www.statnews.com/2016/06/14/opioids-overdose-heart-death/
2. https://teens.drugabuse.gov/national-drug-alcohol-facts-week/drug-facts-chat-day-drug-abuse/
3. https://www.statnews.com/2016/10/19/primary-care-doctors-opioid-treatment/
4. http://www.integration.samhsa.gov/about-us/esolutions-newsletter/integrating-substance-abuse-and-primary-care-services/

Written by Dane O’Leary

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