MD & DO Few Medical Schools Teach Addiction - NYT

[mentirita]

Most Doctors Are Ill-Equipped to Deal With the Opioid Epidemic. Few Medical Schools Teach Addiction

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[Rekt]

This is another useless anti-physician article from NYT and their clueless readers are eating it up judging by the comments. The reality is we cannot help patients with zero drive to want to better themselves or put any effort at all into their health.

 

[Psai]

Maybe they should stop asking people if they were satisfied with their care/if their pain is a zero and then we can stop giving them too many opioids

 

[VA Hopeful Dr]

Maybe they should stop asking people if they were satisfied with their care/if their pain is a zero and then we can stop giving them too many opioids

One of the doctors in my group is out on medical leave so we're all having to see her patients for refills.

Now that they are actually being drug tested, we've fired 12 patients in the last 3 days for either not taking their meds or doing cocaine in addition to their Norco.

The board should be going after her as none of these people have been drug tested in the last 2-3 years despite being on schedule 2 meds.

 

[Strider_91]

I hear this all the time. That and how docs dont learn anything about nutrition. I go to an average school and I have been lectured on nutrition and the opiate epidemic more than I ever wanted and I am only a 2nd year. It's just not true.

 

[nimbus]

The flip side of this is that many in the addiction treatment community don’t believe you can have expertise unless you have personal experience with addiction. The old,”you haven’t been there so you don’t know what your talking about” argument. Maybe they have a point.

At any rate, addiction is currently a problem without effective solutions, much like HIV/AIDS in the 1980s and early 90s. We spent a lot of time learning about HIV and the patients were still dropping like flies. Medical schools teaching about ineffective therapies will not save lives.

 

[AnatomyGrey12]

Medical schools teaching about ineffective therapies will not save lives.

This. I mean I'm sure schools will start filling time with random addiction stuff now, but the truth is that the "therapies" that exist for addiction are pretty terrible and ineffective. The studies published in addiction medicine journals are largely garbage. Before we can educate doctors on what to do then there needs to be something to actually teach them.

 

[NicMouse64]

This. I mean I'm sure schools will start filling time with random addiction stuff now, but the truth is that the "therapies" that exist for addiction are pretty terrible and ineffective. The studies published in addiction medicine journals are largely garbage. Before we can educate doctors on what to do then there needs to be something to actually teach them.

The studies in addiction journals are garbage, but the ones about addiction in neuropsych journals are helping us get closer to an understanding of addiction. Unfortunately, there aren't a whole lot of great solutions. Subnaloxone is a decent therapeutic, but requires close physician supervision. Patients are known to be difficult. The main problem with the patients on opioids is how to give them the quality of life that makes giving up the drug that has given the best feelings ever of their life worth it.

 

[NickNaylor]

I don't disagree with the thrust of the article that, in general, physicians are poorly trained in addressing and managing substance use disorders. There's a lot of angst about confronting substance use and being direct about it. I lol'd when I read the anecdote about confronting a patient's tox screen results and the response by the physician was "I don't know." What do you mean "I don't know?" You ask them about it in a way that's not judgmental or accusatory but with open curiosity. This isn't rocket science.

I'm not sure that it's necessary that everyone be educated about managing substance use disorders - that's probably a waste of time and unnecessary. But I do think that it's important that people be educated about appropriate use of opioids, BZDs, and other potentially addictive medications and to use them sparingly to prevent these iatrogenic cases in the first place. The comment above that implies that pain scores are why opioids are overprescribed is missing the point. They are only prescribed if you are doing bad medicine. Yes, it's easy to have that hydrocodone PRN ordered for "severe pain," but that isn't the appropriate treatment for most patients, and everyone knows that. The question is whether or not you want to deal with the fallout of not caving into requests for controlled substances even though you think it's clinically inappropriate and whether or not you want to spend the time necessary to discuss alternatives and put in a little more effort to try non-opioid treatment for pain. This is just one example, but the same can be said about situations during which BZDs are started.

I have these conversations all of the time and have to deal with getting people off ridiculous opioid/BZD/whatever regimens started by clueless docs. Yes, it's uncomfortable initially, and some people may bail on treatment, but that's on them. For the most part, people do actually feel better once they get off all this crap, but the way to get there is challenging and tense. The worst thing you can do is do nothing, because at that point you're very passively and indirectly contributing to the problem. At a minimum, sharing your concerns about their regimen, misuse, or whatever - even if you do nothing about it - is a step in the right direction. It at least starts a conversation that plants a cognitive seed in their brain that might cause them to really think about what they're doing, and it might open the door for talking with someone about engaging in substance use treatment, considering alternative treatments plans, etc.. Yes, many folks won't do any of that, but some actually will. But you never know that if you just shake your fist in the air in the workroom as you continue prescribing their ridiculous regimen without even talking about it.

 

[Peach Newport]

Article is spot on.

Doctors in general are clueless about addiction... and unfortunately this includes those whose job it is to prescribe opiates for pain.

Doctors know two things about opioid addiction:

1) opioids are addictive and I’ll get in trouble if I prescribe too many.
2) drug seeking patients are annoying and I don’t like them.

And it’s a big f**king problem that these doctors think that’s all they need to know - and this thread pretty much confirms that attitude.

It’s amazing what happens when you actually take the time to speak and counsel a drug-seeking patient instead of treating them like a rabid animal who’s managed to weasel past security into your ER.

 

[Wordead]

Article is spot on.

Doctors in general are clueless about addiction... and unfortunately this includes those whose job it is to prescribe opiates for pain.

Doctors know two things about opioid addiction:

1) opioids are addictive and I’ll get in trouble if I prescribe too many.
2) drug seeking patients are annoying and I don’t like them.

And it’s a big f**king problem that these doctors think that’s all they need to know - and this thread pretty much confirms that attitude.

It’s amazing what happens when you actually take the time to speak and counsel a drug-seeking patient instead of treating them like a rabid animal who’s managed to weasel past security into your ER.

Oh is the ED the best place for drug rehab? I learn something new every day

 

[Peach Newport]

Oh is the ED the best place for drug rehab? I learn something new every day

That’s not what I was saying at all. I used the ED in my example of a prevalent attitude among physicians because the “drug seeker in the ER” is a relatable stereotype.

Also, “speaking to and counseling” a drug seeker is not a “drug rehab.” It’s literally the bare minimum of your job description.

 

[VA Hopeful Dr]

That’s not what I was saying at all. I used the ED in my example of a prevalent attitude among physicians because the “drug seeker in the ER” is a relatable stereotype.

Also, “speaking to and counseling” a drug seeker is not a “drug rehab.” It’s literally the bare minimum of your job description.

So you do that in your practice I trust

 

[Peach Newport]

So you do that in your practice I trust

I’m still not sure what you guys are getting at.

What the hell are you guys doing if not speaking and counseling? Im not talking about a half hour of social work here. It’s not hard to offer symptomatic relief as indicated and a referral while treating the patient like a human being.

 

[VA Hopeful Dr]

I’m still not sure what you guys are getting at.

What the hell are you guys doing if not speaking and counseling? Im not talking about a half hour of social work here. It’s not hard to offer symptomatic relief as indicated and a referral while treating the patient like a human being.

So you counsel every drug addict in your practice?

 

[Save a life]

Article is spot on.

Doctors in general are clueless about addiction... and unfortunately this includes those whose job it is to prescribe opiates for pain.

Doctors know two things about opioid addiction:

1) opioids are addictive and I’ll get in trouble if I prescribe too many.
2) drug seeking patients are annoying and I don’t like them.

And it’s a big f**king problem that these doctors think that’s all they need to know - and this thread pretty much confirms that attitude.

It’s amazing what happens when you actually take the time to speak and counsel a drug-seeking patient instead of treating them like a rabid animal who’s managed to weasel past security into your ER.

Currently, a second-year medical student and I have to disagree. We are taught about addiction and it’s tested on board exams.

Moreover, many specialties in medicine are taught about addiction and it shows up on boards. For example, psychiatry, family medicine, and emergency-medicine. All three of these specialties have to know how to recognize and help patients with addiction.

If a patient presents to an ER saying they want help with their addiction, they will be helped, often by a social worker.

If doctors are “clueless” about addiction, why do we have a sub specialty devoted to it?????

Addiction psychiatry - Wikipedia

 

[Peach Newport]

So you counsel every drug addict in your practice?

No dude, I’m a 3rd year student, but I’m guessing that’s your point. I get it, I don’t know what I’m talking about. Will you please enlighten me as to why spending 5 minutes counseling a patient on treatment options or a referral is the wrong way to go?

Currently, a second-year medical student and I have to disagree. We are taught about addiction and it’s tested on board exams.

Moreover, many specialties in medicine are taught about addiction and it shows up on boards. For example, psychiatry, family medicine, and emergency-medicine. All three of these specialties have to know how to recognize and help patients with addiction.

If a patient presents to an ER saying they want help with their addiction, they will be helped, often by a social worker.

If doctors are “clueless” about addiction, why do we have a sub specialty devoted to it?????

Addiction psychiatry - Wikipedia

Yes, some select specialties do understand addiction. That’s not the problem. This is.

1) the antagonistic, us-vs-them attitude that IS prevalent in medicine. Not to be cliche, but the lack of anything resembling empathy is glaring when it comes to addiction.
2) the enormous assumptions about a patient that are made when they admit to having a problem, that DO affect care.
3) the fact that the basic medical education curriculum still contains long-dispelled myths about addiction.
4) the lack of practical education in the psychodynamics of addiction. When a PCP tells a smoker “you should just quit” and can’t name a single treatment option other than nicotine gum, there’s a problem.

 

[VA Hopeful Dr]

No dude, I’m a 3rd year student, but I’m guessing that’s your point. I get it, I don’t know what I’m talking about. Will you please enlighten me as to why spending 5 minutes counseling a patient on treatment options or a referral is the wrong way to go?

I have 10 minutes per patient including documentation. So I can either address their complaint or lecture them on their drug abuse.

Wonder which of those will go well and which won't.

 

[sunshinefl]

I hear this all the time. That and how docs dont learn anything about nutrition. I go to an average school and I have been lectured on nutrition and the opiate epidemic more than I ever wanted and I am only a 2nd year. It's just not true.

Currently, a second-year medical student and I have to disagree. We are taught about addiction and it’s tested on board exams.

Moreover, many specialties in medicine are taught about addiction and it shows up on boards. For example, psychiatry, family medicine, and emergency-medicine. All three of these specialties have to know how to recognize and help patients with addiction.

If a patient presents to an ER saying they want help with their addiction, they will be helped, often by a social worker.

If doctors are “clueless” about addiction, why do we have a sub specialty devoted to it?????

Addiction psychiatry - Wikipedia

Same here. 2nd year at average DO school. We have had a reasonable amount of education on addiction (and nutrition, since first person I’m quoting mentioned it). As much as anything we are introduced to in the first 2 years.

 

[nimbus]

Oh is the ED the best place for drug rehab? I learn something new every day

It’s a worthy endeavor if drug addicts make up a large proportion of your patient population. However it requires some interest, will, effort and coordination. Definitely not for everyone. Still I imagine the long term outcomes are poor.


This E.R. Treats Opioid Addiction on Demand. That’s Very Rare.

ED-Initiated Treatment for Opioid Dependence

 

[Wordead]

That’s not what I was saying at all. I used the ED in my example of a prevalent attitude among physicians because the “drug seeker in the ER” is a relatable stereotype.

Also, “speaking to and counseling” a drug seeker is not a “drug rehab.” It’s literally the bare minimum of your job description.

Dude, there's no such thing as a quick 5 minute counseling on drug abuse that is going to do ****. Come on. This guy has been abusing drugs half his life and you think your elevator speech is going to turn his life around? Are you sure you should be accusing anyone of not understanding addiction? It takes a lot of time and resources to affect change.

It’s a worthy endeavor if drug addicts make up a large proportion of your patient population. However it requires some interest, will, effort and coordination. Definitely not for everyone. Still I imagine the long term outcomes are poor.


This E.R. Treats Opioid Addiction on Demand. That’s Very Rare.

ED-Initiated Treatment for Opioid Dependence

Those are interesting articles for sure. I'm still not convinced that the ED is the best or even a good place for them to get treatment. ED docs are just not going to take the time that's needed for these patients. There's just no way they can unless you're in a slow ED. There are going to be too many psych and social factors that will be ignored and these patients are just gonna get slammed with suboxone and sent off. Not to mention the astronomical amount of money this would cost.

 

[deleted480308]

No dude, I’m a 3rd year student, but I’m guessing that’s your point. I get it, I don’t know what I’m talking about. Will you please enlighten me as to why spending 5 minutes counseling a patient on treatment options or a referral is the wrong way to go?



Yes, some select specialties do understand addiction. That’s not the problem. This is.

1) the antagonistic, us-vs-them attitude that IS prevalent in medicine. Not to be cliche, but the lack of anything resembling empathy is glaring when it comes to addiction.
2) the enormous assumptions about a patient that are made when they admit to having a problem, that DO affect care.
3) the fact that the basic medical education curriculum still contains long-dispelled myths about addiction.
4) the lack of practical education in the psychodynamics of addiction. When a PCP tells a smoker “you should just quit” and can’t name a single treatment option other than nicotine gum, there’s a problem.

You would probably learn more as a student if you toned down the lecturing to doctors

We all have strong philosophical opinions, but there is something to be said for having been in those trenches

 

[Peach Newport]

Dude, there's no such thing as a quick 5 minute counseling on drug abuse that is going to do ****. Come on. This guy has been abusing drugs half his life and you think your elevator speech is going to turn his life around? Are you sure you should be accusing anyone of not understanding addiction? It takes a lot of time and resources to affect change.



Those are interesting articles for sure. I'm still not convinced that the ED is the best or even a good place for them to get treatment. ED docs are just not going to take the time that's needed for these patients. There's just no way they can unless you're in a slow ED. There are going to be too many psych and social factors that will be ignored and these patients are just gonna get slammed with suboxone and sent off. Not to mention the astronomical amount of money this would cost.

You don’t treat addiction in the ED with a 5 minute consult. Obviously. I never said, that and I don’t know why you guys think I am.

My point is just to treat them like people and be empathetic so as not to scare them away from treatment. My main point was “don’t treat addicts like rabid animals who are trying to ruin your day.” I don’t know why this is such a controversial statement.

Maybe we have different definitions of the word “counseling?”

 

[Wordead]

You don’t treat addiction in the ED with a 5 minute consult. Obviously. I never said, that and I don’t know why you guys think I am.

My point is just to treat them like people and be empathetic so as not to scare them away from treatment. My main point was “don’t treat addicts like rabid animals who are trying to ruin your day.” I don’t know why this is such a controversial statement.

Maybe we have different definitions of the word “counseling?”

I mean everything you're saying is nebulous and has no substance. What are you proposing? That ED docs be nice to them? They often are. Are you saying you think the ED is discouraging people from getting treatment? I'm unclear what you're trying to say.

 

[aim-agm]

You don’t treat addiction in the ED with a 5 minute consult.

There is evidence that brief operative intervention (AKA a 5-minute consult) is about as effective as most any other intervention (at least for alcohol).

 

[W19]

I have these conversations all of the time and have to deal with getting people off ridiculous opioid/BZD/whatever regimens started by clueless docs. Yes, it's uncomfortable initially, and some people may bail on treatment, but that's on them. For the most part, people do actually feel better once they get off all this crap, but the way to get there is challenging and tense. The worst thing you can do is do nothing, because at that point you're very passively and indirectly contributing to the problem. At a minimum, sharing your concerns about their regimen, misuse, or whatever - even if you do nothing about it - is a step in the right direction. It at least starts a conversation that plants a cognitive seed in their brain that might cause them to really think about what they're doing, and it might open the door for talking with someone about engaging in substance use treatment, considering alternative treatments plans, etc.. Yes, many folks won't do any of that, but some actually will. But you never know that if you just shake your fist in the air in the workroom as you continue prescribing their ridiculous regimen without even talking about it.

I really don't think they are clueless; it's just easier for them to prescribe it and move on...

 

[Giovanotto]

FWIW, as a 4th year medical student I feel woefully under prepared to handle most pain cases, never mind addiction. I've been tylenol PRN-ing my way through the year. Maybe it's something you learn in residency? I'm open to being educated if anyone wants to chime in.