Where primary care doctors could use their existing relationships with patients to recognize and initiate earlier treatment for substance abuse disorders, most still wind up referring patients to specialists or send them to Narcotics Anonymous.
Despite efforts by the federal government to increase the number of doctors certified to prescribe buprenorphine, a drug that can help patients fight opioid addiction, the number of primary care physicians with such certification remains under one percent, according to the American Society of Addiction Medicine (ASAM).
There’s plenty of blame to go around with regard to the state of the system, R. Corey Waller, M.D., who leads ASAM’s advocacy division, said in an article in Stat. He points to a reticence among some doctors to bring addicts into their offices and a lack of training as major parts of the problem. STAT also notes that many state Medicaid systems offer no reimbursement for physicians who deliver addiction treatment.
Another part of the problem lies with the training process itself, composed of an eight-hour certification course split evenly between online and live instruction. Effective addiction treatments mirror those used for chronic diseases, and often require coordination among behavioral and mental health specialists in addition to writing a prescription, a combination Waller says can intimidate a primary care doctor who receives so little specific training.
The article also points out that while the American Medical Association supports greater addiction treatment training for primary care docs, it stops short of mandatory training on the grounds that it may not apply to, or be cost-effective for, all practices. Taken together, it all amounts to a recipe for frustration among advocates like Waller. “We’re just watching the ship sink, even though we have the pumps to easily keep the water out,” he says.