Primary Care Physicians Bench Themselves in Battle Over Opioid Crisis

‐

‘Watching the ship sink’: Why primary care doctors have stayed out of the fight against opioids.

This article first appeared on October 19, 2016 Kaiser Health News.

By Bob Tedeschi

Española, N.M. – For years, this town has withstood a torrent of opioid-related deaths, and now claims one of the highest rates of opioid overdoses in the country.

But the battle against opioids in Española is being fought with a paltry force: In a community of roughly 10,000, only three physicians are certified to treat patients with opioid use disorders.

The scarcity of doctors trained to deal with addiction may be particularly acute in Española, but the issue resonates in cities and towns across the country, where roughly 20,000 people die annually from opioid-related overdoses. In the face of one of the country’s most pressing and fastest-growing public health crises, few primary care doctors treat substance abuse disorders, even though they are uniquely positioned to recognize problems and help patients before it’s too late.

Instead, many primary care doctors follow an old script: Refer patients to addiction centers and Narcotics Anonymous, and move on.“We’re just watching the ship sink, even though we have the pumps to easily keep the water out,” said Dr. R. Corey Waller, an addiction-treatment specialist who leads the advocacy division of the American Society of Addiction Medicine, or ASAM.

Michael Botticelli, the director of the White House office of national drug control policy, agreed, describing the absence of a more vigorous response as “deplorable” during a recent forum on the opioid crisis in Albuquerque.

The federal government last year embarked on an effort to double the number of doctors certified to treat addiction with buprenorphine, a drug shown to curb opioid cravings in most patients. That effort has yielded some early success, but according to ASAM, less than 1 percent of primary care doctors are now certified.Much of the explanation is frustrating.

“I’ve had conversations with a few hundred primary care doctors to try to figure this out,” Waller said. “I get comments like, ‘I don’t want those people in my waiting room.’ Ones who are more well-meaning — which is most — say they have no training to treat this disease.”

There are few incentives to get trained, however, especially in the many states whose Medicaid systems do not reimburse physicians for addiction treatment.

“A lot of people want to malign primary care doctors for not owning their share of the problem, but it’s just not that simple,” Waller said. “We’ve set them up for failure.”