I wrote back in October 2016 (“Primary Care Doctors Staying Out of Addiction Treatment”) about how primary care doctors have shied away from taking their place on the front lines of preventing addiction and helping patients who find themselves in its grasp, and have posted more recently on the science being pumped out by the government and academia that addiction is a brain disorder and should be medically treated as such.
However, there remains a core old school dispute over the “right” way to address the current opioid epidemic and SUD overall, as was recently addressed in a December 29, 2018 NY Times article, “In Rehab, Two Warring Factions: Abstinence vs. Medication” We seem to currently remain be at a stalemate of sorts.
While there can be no doubt of the efficacy of AA and other Fellowships in recovery from SUD, the outcome-based measurements from abstinence stem back to mostly alcoholism studies; success with heroin (dating back to the 1970’s) remains “hit or miss.” This is likely due, in part, to the “hijacking of the brain” that opioids has over its victims, contrasted with the psychological and biological impacts of other substances.
My response to this highly-charged discussion has always come down to a simple truth: we are still not in a position to medicalize addiction treatment without a sufficient medically-trained workforce.
And why don’t we?
It is because our society has shunned and stigmatized people with mental health issues and certainly ostracized (and jailed) people with SUD. People seeking professions in psychiatry themselves were relegated to “second class status” in medical school, and that small population stayed away from “addiction medicine” overall.
Even the scant few who were inclined to become involved in addiction medicine found that the science was woefully lacking (due to no federal funding or private grants for such science and research) and the reality that brain science requires higher levels of brain scanning technology (fMRI, etc.) to understand how the brain and addiction impact one another.
Simply stated, there was no money, science, nor glory, in addiction medicine, and therefore a large population of medical professionals have stayed away.
However, in response to this workforce shortage, on December 27, 2018, the National Health Service Corps (NHSC) under the umbrella of HHS, launched the “Substance Use Disorder Workforce Loan Repayment Program” to provide eligible health care clinicians with student loan repayment assistance in exchange for their service on the front lines of the opioid crisis in underserved communities. As a result, it is anticipated that more patients who need help with substance use treatment will have access to highly qualified clinicians. Clinicians accepted to the program may receive up to $75,000 for three years of full-time service at a health care facility that has been designated by HRSA as an NHSC-approved substance use disorder site. A part-time service option, with a maximum award of $37,500, is also available.
In the interim, even extremely populated states like Texas are finding that they are facing a shortage of SUD providers due to a shortage of professionals (which is also due, in part, the insurance carriers’ gamesmanship in reimbursement and violations of the Parity Act).
While this loan forgiveness program may not jumpstart the immediacy of need for a robust SUD workforce that is so desperately needed, it absolutely is a start in the right direction.