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As addiction rises, so does need for specialized doctors

Opioid overdose claimed the lives of more than 33,000 people in the U.S. in 2015, according to a report released by the Henry J. Kaiser Family Foundation.

That’s more than double the fatal opioid overdoses that occurred in 2005, found the report, which analyzed and compiled data from the Centers for Disease Control and Prevention’s National Vital Statistics System.

Over that same time period in Ohio, opioid-related deaths — including deaths from prescription opioids (such as oxycodone, hydrocodone and fentanyl) and heroin — rose 430 percent, from 489 in 2005 to 2,590 in 2015, according to the Ohio Department of Health.

The nation has taken multiple steps to curb opioid addiction in recent years, including the Comprehensive Addiction and Recovery Act (CARA), which passed in 2016 and allots $181 million per year to fighting the opioid epidemic. CARA was the first major federal addiction legislation in 40 years.

On March 30, Ohio Gov. John Kasich announced a measure that limits the maximum length of narcotic painkiller prescriptions from 90 days to seven days (five days for minors). The law would not apply in certain situations such as hospice/palliative care. While these are steps in the right direction, there are still areas of improvement that need to be addressed, according to addiction medicine doctors.

“No. 1, there aren’t enough quality treatment programs, especially for younger patients,” said Dr. Steven Matson, chief of Nationwide Children’s Hospital’s Division of Adolescent Medicine and medical director at Franklin County Juvenile Detention Center.

The patients Matson sees in Nationwide Children’s Medication Assisted Treatment for Addiction program typically began dabbling in drugs at around age 11 and gradually transitioned to using heroin, he said.

“When we see these youth, they’re in pretty bad shape, injecting eight to 10 times a day,” Matson said, adding that only around 9 percent of drug-addicted adolescents ever receive treatment.

Coupled with the lack of treatment options is a lack of public care for addiction, said Brittany Hovden, admissions and intake coordinator for Get Real Recovery, a detox and substance abuse treatment center in Orange County, Calif.

This is reflected in the high cost of addiction treatment for all ages, said Dr. Shawn Ryan, president of the Ohio Society of Addiction Medicine and assistant professor of emergency medicine at the University of Cincinnati.

“Insurance companies have somewhat begrudgingly started paying something, but there’s still not a robust reimbursement structure for addiction treatment, or mental health in general,” Ryan said.

Treatment costs associated with opioid addiction can add up fast, as the most successful approach involves a combination of medication — like methadone, buprenorphine and naltrexone — and psychosocial intervention, Hovden said.

“The incredible craving and withdrawal are so great that if you don’t quiet that [with medication], it’s really hard for patients to actually participate in any sort of behavioral treatment, which they need to get better,” Matson said.

Yet not enough doctors are educated in addiction medicine to successfully expand availability of quality treatment, Matson said. “Although most doctors can recognize addiction, I think most are pretty limited in knowing how to respond to it.”

The field of addiction medicine — which encompasses internal medicine, psychology, mental-health counseling and public health, among others — has been around for decades, but wasn’t recognized as an official medical subspecialty by the American Board for Medical Specialties until 2015.

“We have to look at the entire patient in the complex bio-psycho-social disease state,” Ryan said. “I spend my time trying to figure out how in the world we are going to train more physicians to do this.”

Many primary-care physicians lack the time or energy to go through 2,000-plus hours of training in addiction medicine, as most are expected to see 30 patients a day in order to maintain a viable practice, Ryan added. Even if they had the skills, “it’s not feasible to see a patient in 12 minutes and address their complex medical and psychological issues,” he said. “There’s a general failure of American medicine involved in this.”

Along with increasing accessibility of quality addiction treatment, Matson hopes to see more effort go toward prevention.

“There isn’t a lot of science that shows what works best to prevent addiction, and we need to keep searching to find that,” he said.