It’s 10:32 p.m. during peak flu season at the hospital emergency room. The entire department is a bustle with fever, cough and wheezing; stable patients have a three hour wait time. The doctors and nurses scarcely have the opportunity for bathroom breaks, as their few brief reprieves are routinely interrupted. This time, an unresponsive patient covered in vomit rolls through the door from the ramp.
It’s not the first overdose that day. With a mask seal on the face, the clinician begins to pump life-saving oxygen into the patient’s lungs while a nurse starts an IV. As the patient turns from blue to pink, the nurse pushes a dose of naloxone into the newly launched IV. Immediately, the patient sits straight up on the gurney and rips the mask from his face and the IV from his arm.
{mosads}Everyday this scenario plays out in hospital emergency departments and rehabs all across the country. In the United States today, about 16 percent of the population (21 million Americans), 12 and older, meet the criteria for a substance use disorder.
We know that each day, 10,000 people around the world die of substance abuse and that addiction affects one in five people over the age of 14. So far, substance use disorders are costing society almost five times the cost of HIV/AIDS and twice as much as cancer.
As physicians specializing in addiction treatment, our efforts to serve our patients are best assisted by policies which, as outlined by the American Society of Addiction Medicine, place an emphasis on teaching addiction medicine to increase and strengthen our workforce, standardizing the delivery of addiction medicine and expanding access to high-quality, evidence-based care.
These policies should also cover addiction medicine in a way that facilitates the delivery of coordinated and comprehensive treatment and integrates addiction medicine treatment into the established healthcare system. These imperatives — to teach, standardize, cover and integrate — all further the additional purpose of destigmatizing the patients who suffer from substance use disorders, the disease of addiction itself and its treatment.
It is for these reasons that we applaud Congress for passing SUPPORT for Patients and Communities Act, which will bolster our efforts to ensure that patients with substance use disorder will get the help and evidence-based treatment they need. However, additional measures must be taken in our efforts to help patients with substance use related and addictive disorders:
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We need continued funding that will allow us to grow the Addiction Medicine Workforce. Through SAMHSA and NIDA, Congress can authorize increased financing to support these three areas of medical training:
a. Increasing the number of training fellowships in U.S. medical schools.
b. Supporting the development of programs that provide sub-specialty training in addiction medicine to physicians in primary fields (such as internal medicine, family medicine, pediatrics, ob-gyn, anesthesiology and physical medicine and rehabilitation).
c. Training in addiction psychiatry for physicians who have completed training in general and/or child and adolescent psychiatry.
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As essential as training in addiction psychiatry is for those physicians who have pursued training in child and adolescent psychiatry, it is clear that the numbers of non-psychiatrist physicians dwarf those of psychiatrists. Hence, it is crucial that Managed Behavioral Health Care Organizations (MBHCOs) be required by Congress to include non-psychiatrist, addiction-board certified physicians and non-psychiatrist physicians who have completed an accredited residency/fellowship in addiction medicine to their in-network provider panels, so that they can provide treatment to members with substance use related and addictive disorders.
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Related to that issue, MBHCOs should also be required to process claims submitted by addiction medicine physicians who typically use evaluation and management (E&M) codes rather than mental health codes.
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The substantial and rapidly growing mountain of available research evidence, widely supported and distributed by NIDA and SAMHSA, has made it clear that addiction is a chronic, potentially relapsing brain disease, which can be treated and controlled but not typically “cured.” Hence, treatment of patients with substance use-related and addiction disorders must, by definition, be a treatment of a chronic disease which typical patients will need indefinitely. It follows, then, that we will need generous funding — billions of dollars over many years — to support the ongoing chronic care management approach that people with opioid use disorder will need to help them achieve and maintain long standing recovery and wellness.
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Finally, several bills are being proposed by members of the United States Senate to lower prescription drug costs. Examples include legislation introduced by several senators that would allow the HHS secretary to negotiate lower prices for prescription drugs and a bipartisan bill that would allow generic drugs to compete with brand name pharmaceutical products. To the extent that these bills can be passed in a bipartisan fashion and ultimately signed by the president — who has also indicated a desire to lower prescription drug costs — this would benefit the patients we serve.
It is clear that Congress has a critical role to play in helping those of us who are on the “front lines” of caring for patients with opioid use disorder and other substance-use related and addiction disorders. We look forward to continuing to work with the members of Congress to serve people like the one who had to leave treatment because it was too expensive – the kind of treatment that stops the cycle of overdose and places more people on the pathway of recovery. Let’s help more people by making the right kind of policy improvements.
Brent Boyett D.O is the founder and chief medical officer, medical division, for Pathway Healthcare. Stephen M. Taylor, M.D, M.P.H, is the chief medical officer, behavioral health division, for Pathway Healthcare.