Raising her hand to help build U.S. addiction-medicine workforce


Board-certified addiction-medicine physician Cara Poland, MD, MEd, FACP, DFASAM, wanted her state of Michigan to train a future generation of physicians to treat substance-use disorders. But first, she realized, Michigan’s medical schools needed core faculty.

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Like nearly every state in the country, Michigan is seeing staggering increases in overdose due to illicitly manufactured fentanyl, fentanyl analogs, methamphetamine and cocaine. Prescription opioid-related overdose and alcohol-use disorder also remain top issues in Michigan.

“In 2018, during a statewide meeting of the seven medical schools, I asked how many schools had core faculty to teach addiction. Only one did,” Dr. Poland said. “Now, almost all do. It sounds obvious, but you can’t train medical students in addiction if you don’t have trained faculty.”

Dr. Poland, an AMA member who is assistant professor of women’s health at Michigan State University, said that the 2018 meeting was eye-opening for everyone. The state had been working through multiple efforts to increase access to evidence-based treatment for substance-use disorders (SUDs), but it hadn’t considered the role of medical schools and residency programs.

“We had a blind spot, but we all had that aha moment when we realized we could do better for our communities if we just built it into the curricula,” said Dr. Poland, who was nationally selected to the inaugural class of addiction-medicine fellows at Boston Medical Center.

Given the relative lack of examples across the board, the Michigan physicians and deans realized that it was up to them to act. Through use of State Opioid Response funds, a collaboration was born: MI CARES.

Led by Dr. Poland, the program trains physician-level addiction specialists in Michigan and across the country. Nearly 400 physicians in 43 states are on the pathway to becoming board certified in addiction medicine. Michigan State University’s MD and DO medical schools also began implementing curricular changes to offer more training in treating persons with substance-use disorders to their medical students.

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Student response has been overwhelmingly positive. Of the inaugural 36 first-year elective students taught by Dr. Poland and Jamie Alan, RPh, PharmD, PhD, all 36 stated that they would recommend the elective to a colleague.

“We didn’t figure it out overnight, but we’re on a great path. I also realize that not all of our students and residents will choose addiction medicine as their career,” said Dr. Poland, who is the principal investigator of multiple private and federally funded grants, including MI CARES, and a special interest grant, GREAT MOMs, treating pregnant people and their families living with a substance-use disorder.

“But all of them—whether they become surgeons, ob-gyns, family physicians, general internists or any other specialty—will be able to better serve their patients,” she added.

Dr. Poland emphasized that the training being done in Michigan builds on a foundation of medical evidence, nonstigmatizing practice, and the recognition that a patient with an SUD is like any other patient with a chronic disease. Follow-up surveys given to students are also helping Dr. Poland and other faculty evaluate the coursework and the students’ perceptions of patients with an SUD, the role of treatment and addiction medicine overall.

Among the students’ responses to the course, offered as an intersession:

  • Amazing intersession! Completely changed my mindset and understanding of patients with SUDs. The PCSS [Providers Clinical Support System] training we completed should be mandatory for all ECE [early clinical experience] students. Extremely valuable.
  • Dr. Alan and Dr. Poland are both extremely passionate about the topic, and it came through and made the class interesting and enjoyable.
  • This was fantastic! I absolutely loved this intersession, and Dr. Poland and Dr. Alan are amazing! They made the Zoom time together not only informative and engaging, but truly fun.
  • This was probably my favorite intersession and I can’t say enough positive things about it. Just keep it up! I appreciate the work that everyone put in to make this intersession possible.
  • This was the best intersession I have taken. The combination of patient care, board cases and training was great. Also, I wish Dr. Poland and Dr. Alan could teach all of my classes!

“I’m grateful for my co-faculty and the students who challenge themselves and are open to learning a field of medicine that is incredibly rewarding,” said Dr. Poland. “And as faculty, I need to learn how to continue to be better for my students. What we’re building at the medical school will resonate throughout the state, so we must always strive to improve.”

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The AMA believes that science, evidence and compassion must continue to guide patient care and policy change as the nation’s opioid epidemic evolves into a more dangerous and complicated illicit drug overdose epidemic. Learn more at the AMA’s End the Epidemic website, where a version of this article was initially published.

The End the Epidemic website was recognized by the Academy of Interactive and Visual Arts. As part of that organization’s 27th Annual Communicator Awards, End the Epidemic was honored with an Award of Excellence in the Cause & Awareness website category.