Opioids

Opioid crisis needs training emphasis in GME

Amid the opioid epidemic, the need for highly trained physicians capable of treating opioid use disorders has never been greater. Physicians this week adopted policy to expand residency and fellowship training opportunities so that trainees can gain clinical experience in the treatment of opioid use disorders.

The Centers for Disease Control and Prevention (CDC) recently announced that drug overdose deaths reached an unprecedented 14.7 per 100,000 in 2014, with 61 percent of deaths involving some form of opioid.

In the wake of these sobering statistics, delegates at the 2016 AMA Interim Meeting adopted policy to encourage the expansion of residency and fellowship training opportunities to provide clinical experience in the treatment of opioid use disorders under the supervision of an appropriately trained physician.

Buprenorphine and naloxone are effective components for treatment of opioid use disorders. The Department of Health and Human Services recently announced a new rule expanding the patient limit for qualified physicians to use buprenorphine treatment in an effort to increase access to care for patients with opioid abuse and dependence.

Helping residents gain clinical experience in treating addiction will augment the number of qualified clinicians and expand patient access to needed services.

“The AMA supports efforts to confront the opioid and prescription drug epidemic so physicians who are on the front lines have the ability to best meet patient needs,” AMA Board Member Jesse M. Ehrenfeld, MD, said in a statement. “With an unprecedented need for treatment of opioid use disorders, it is critical that we do all we can to expand residency and fellowship training opportunities so patients have increased access to the treatment they need.”

Funding buprenorphine training

Addiction clinics where residents prescribe buprenorphine are prevalent, but barriers to resident prescription of the medication remain, including a lack of funding for buprenorphine waiver training, the absence of supervision by a certified addiction medicine physician, low patient continuity and inadequate support staffing for scheduling, billing and urine drug testing.

The new AMA policy calls for additional funding to overcome the financial barriers to trainees’ seeking clinical experience in the treatment of opioid use disorders.

Urine drug tests

Additional policy addressing urine drug testing points out that results from drug testing programs can yield evidence of prior exposure to drugs, but drug testing does not provide any information about pattern of use, dose, physical dependence, the presence of a substance use disorder or the mental or physical impairments that may result from drug use.

The policy offers guidance for physicians on implementation of drug testing programs. Physicians should first:

  • Understand the objectives and questions they want to answer with testing
  • Understand the advantages and limitations of the testing technology
  • Be aware of, and educated about, the drugs chosen for inclusion in the drug test
  • Ensure that the cost of testing aligns with the expected benefits for their patients

Physicians also should be familiar with the disposition characteristics of the drugs to be tested before interpreting urine drug test results. And if interpretation of any given result is outside of the physician’s expertise, assistance from appropriate experts, such as a certified medical review officer, should be pursued.

Surgeon General weighs in

The surgeon general, Vice Admiral Vivek H. Murthy, MD, released a report highlighting the scope of the addiction crisis, an issue of vital importance to patients and communities across the nation that Dr. Murthy also detailed in a JAMA Viewpoint article. The report’s findings and research offer guidance that addiction is a chronic disease and should be treated as such. 

“The AMA supports the report’s emphasis on early detection and evidence-based interventions rather than providing treatment only after a crisis,” AMA President Andrew W. Gurman, MD, said in a statement. “The report clearly explains how alcohol and certain other drugs affect people’s brains and can develop into substance use disorders.”

There is no single solution, the report recognizes. But there are many science-based approaches that can help patients and “we agree that there needs to be an increase in access to proven treatments as well as an increase in research,” Dr. Gurman said.

“We need to narrow the gap between the number of people who need treatment and the resources available for substance use disorders,” he added. “We need to remove arbitrary limits on coverage and barriers to care.”