While the federal government and health officials attempt to quell the rising rates of opioid overdose deaths, few physicians are actually licensed to treat drug addicted patients. According to the American Society of Addiction Medicine, less than 1 percent of primary care physicians are certified to prescribe buprenorphine, a drug shown to curb opioid dependence.
The shortage is particularly acute in Española, N.M., a 10,000-person town with one of the highest rates of opioid overdose deaths in the nation. In Española, only three physicians are certified to treat patients with opioid use disorders, according to STAT. Many can do little but refer the individual to addiction centers and Narcotics Anonymous before moving on to the next patient.
"We're just watching the ship sink, even though we have the pumps to easily keep the water out," R. Corey Waller, MD, an addiction-treatment specialist who leads the advocacy division of ASAM, told STAT.
The shortage of physicians certified to treat addiction with buprenorphine, most commonly known by the brand name Suboxone, persists in spite of federal efforts to increase certification numbers. Several factors dissuade physicians from seeking out training. For one, Medicaid systems in many states do not reimburse physicians for addiction treatment. Stigma can also be an issue when it comes to enticing physicians to seek certification.
"I've had conversations with a few hundred primary care doctors to try to figure this out," Dr. Waller told STAT. "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."
The training itself does not necessarily instill physicians with confidence.
The eight-hour certification course that must be completed before a physician can prescribe buprenorphine includes four hours of online training and four hours of in-person training. According to STAT, experts say this is not enough education to empower physicians to treat opioid addicted patients, who often suffer from cognitive impairments and mental health pathologies rooted in early-life trauma.
For these reasons and others, physician groups have tempered their support for the training programs.
While the American Medical Association backs increased training for the medication-assisted treatment of opioid use disorders among its members, it opposes mandatory training because not all physicians prescribe opioids and some medical practices might lose money on such treatments due to inconsistent insurance coverage regarding opioid addiction medication.
John Meigs, MD, president of the American Academy of Family Physicians, told STAT, "[Opioid abuse] is so rampant, and we're the specialty with the broad training in comprehensive, whole-person care, that it is appropriate for us to help take care of this need."
Dr. Meigs himself is yet to take the certification course, though he informed STAT it's something he intends to do in the future.
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