Our Future Doctors Are Not Learning About Addiction. That Must Change.

By Janneiry Garcia

You may be surprised to know that despite preparing for medical school for over 6 years—including pre-med classes, extensive global health volunteering, and MCAT preparation—to become an addiction medicine doctor, I did not have an experience or course that informed me about treating patients living with a substance use disorder (SUD).

This is unacceptable when you consider in 2021 alone, there were more than 107,000 fatal overdoses—a nearly 15% surge from the record numbers we saw in 2020.

I interned at the Drug Policy Alliance to learn what my education was not teaching me. As we continue to see record-breaking overdose deaths, we need to prepare America’s future doctors to treat people who use drugs (PWUD) and people living with SUD with dignity and care to save lives.

Less than 0.2% of the physician workforce in the United States is board certified in addiction medicine. Rural parts of the country are impacted the most since patients are unable to locally access needed resources. A study found that half of all U.S. counties did not have single physician to prescribe buprenorphine, the gold standard medication to treat SUD.

In addition, there are just 59 addiction medicine fellowships around the country. Until a few years ago, these fellowships were only reserved only for those who had completed a psychiatry residency program, which has significantly reduced the number of addiction medicine physicians throughout the country. As overdose rates soar to record highs, important steps must be taken to expand addiction medicine education and increase the number of physicians who specialize in treating SUD.

For one, increasing the number of addiction medicine specialists can help stigma against PWUD and people living with SUD. In the United States, substance use disorders are treated like moral failings to be punished in the criminal justice system rather than a clinical disorder.

The lasting impact of the war on drugs, enacted by President Nixon, has resulted in our government and judicial systems perpetuating stigma and over criminalizing drug use. According to the Prison Policy Initiative, one in every five individuals incarcerated is charged with drug-related crimes, and 450,000 of those individuals have non-violent charges likely stemming from simple possession.

Punitive drug policies have contributed to the stigma surrounding SUD. Discussions about addiction typically elicit adverse reactions where people judge and dismiss the lived experiences of those living with addiction, or those who are in recovery. Stigma has impacted the medical profession too.

Holding negative perceptions towards individuals living with SUD prevents healthcare professionals from providing empathetic and optimal care, further pushing individuals with SUD away from treatment. Stigma is arguably a significant factor of health inequities experienced by those living with SUD. Addressing stigma among physicians needs to be a public health priority. But how can this stigma be addressed if there’s little medical schools and residencies educating future doctors about addiction?

In addition to reducing stigma, training more medical professionals in this area will mean expanded access to health services at a time when treatment is hard to come by. According to the Association of American Medical Colleges, 21.1 million Americans live with SUD, however only 11% of those patients actually received the treatment they needed. In addition, one in five people living with addiction say they don’t know where to turn for help.

But there are potential solutions within reach. The Opioid Workforce Act of 2021, bipartisan legislation in Congress, would add 1,000 graduate medical education positions over the next five years in hospitals that have, or are in the process of establishing, accredited residency programs in addiction medicine, addiction psychiatry, or pain medicine.

This important piece of legislation would boost the number of healthcare workers on the frontlines of the overdose crisis –which is needed given the shortage of substance use treatment providers that leads to increased waiting periods for treatment as well as increased substance misuse and overdose deaths. This bill would take a major step towards improving access to SUD treatment and addressing the overdose crisis by increasing funding for residency programs in addiction medicine, addiction psychiatry, and pain management.

Interning at the Drug Policy Alliance has demonstrated to me the gaps in our judicial and healthcare systems. The War on Drugs continues to disproportionately impact Black, Brown, and low-income populations who face inequities across our society, making it incredibly difficult to access treatment and other needed services and increases their risk of falling victim to overcriminalization practices. But we can start to change this by ensuring our future doctors and healthcare providers understand the issues facing these populations as well as PWUD and people living with SUD. This can only happen when medical schools and residencies commit to providing adequate, meaningful training on SUD.