Primary care doctors would appear to be ideally placed to recognize the signs of a substance abuse disorder. Because they see patients often, sometimes even once a month, they may be the first to be aware of any symptoms of addiction or relapse, including changes in behavior and ill health effects. Primary care physicians can expect that 15 to 20 percent of their male patients and 5 to 10 percent of their female patients will be at risk for or already are experiencing problems related to substance abuse.
Unfortunately, not all of these doctors are trained in how to recognize or treat addiction. In one study on how primary care physicians address substance use disorders, less than 20 percent described themselves as very prepared to identify alcoholism or illegal drug use, and more than 50 percent of patients with substance use disorders said their primary care physician did nothing to address their substance abuse.
For example, there is a medication that can be used in doctors’ office and clinics to help with opioid addiction. It’s called buprenorphine, and it’s a partial opioid agonist, meaning it produces effects that are similar to opioids but weaker than those such as heroin and methadone. It can be a painkiller, but it’s increasingly being used to treat opioid addiction by reducing some of the cravings. Doctors can inject buprenorphine in the office, and some patients can take a supply home for a week or more.
Unfortunately, many doctors either don’t or can’t administer buprenorphine. Cost is one issue. In many states, Medicaid systems do not reimburse physicians for addiction treatment. Perhaps a larger barrier is that physicians who wish to prescribe buprenorphine for treatment of opioid dependence are required to complete eight hours of training and to obtain a waiver from the Center for Substance Abuse Treatment and Drug Enforcement Administration. Even if a physician does use buprenorphine or other addiction treatments, they often aren’t well-versed in follow up care. Addiction treatment requires weeks or months of rehabilitation and therapy, long after buprenorphine or other drugs are needed to control cravings and withdrawal symptoms. Of those who do receive comprehensive addiction treatment, less than seven percent access it through their primary care doctor.
Doctors are not typically taught addiction medicine in medical school. The National Center on Addiction and Substance Abuse analyzed the board certification exam requirements of several medical specialties and found that addiction was barely mentioned. Exam requirements for family medicine, for example, cover addictive substances only as a possible subtopic in an optional sports medicine class.
If a doctor is unfamiliar with addiction, he or she is more likely to blame substance users for their situation or handle the topic poorly, making treatment less likely. If you think you need to speak to a doctor about addiction, ask if they have any formal training in dealing with drug and alcohol problems, or at the very least if they are comfortable doing so.
If you or a loved one need help to quit drugs or alcohol, consider Asana Recovery. We offer medical detox, along with both residential and outpatient programs, and you’ll be supervised by a highly trained staff of medical professionals, counselors, and therapists. Call us any time at (949-438-4504).