This morning I was greeted by a message from another mom who tried to save her daughter’s life – her beautiful girl who was addicted to pain pills. First she sought help from the family’s pediatrician who admonished her daughter – told her that drugs were bad for her and she should stop, that she was worrying her mother. After an overdose, her mom got her into the first of three rehabs, but they didn’t help. On Saturday her beloved daughter overdosed again, but this time she died.
She died because she was failed by what passes for a treatment system in our nation. She received no science-based treatment whatsoever. She never saw a doctor trained in addiction medicine.
Instead, she was lectured, shamed and threatened. She was told she had to turn her life over to a higher power and make a moral inventory. She was berated when she questioned the treatments she was forced to participate in, and she was blamed when she relapsed. She was told that it was her fault that she didn’t get well because she didn’t try hard enough, she didn’t want to stay sober badly enough. But she desperately wanted to stay sober. She was desperate to get well.
To you in the rehabs that failed her: Her mother came to you because she trusted your promises and you forced a very ill child to do chores, cry, and pray as if that would treat her disease.
You offered her none of the treatments that have been proven to treat the addicted. She never saw a doctor trained in addiction medicine.
This will not stop until the treatment system is fixed.
This morning on twitter I asked, MDs, what should you do if a patient has signs of substance misuse? What would you do if one had signs of cancer or schizophrenia?
The answer is the same: Refer them to a specialist for assessment and treatment.
(In this case, specialists are certified by the American Academy of Addiction Psychiatry (AAAP), American Board of Addiction Medicine - ABAM, American Society of Addiction Medicine.)
A physician, Peter Grinspoon, M.D., responded, “Specialists available to me as PCP don’t have capacity for even five percent of my substance misuse patients!”
He’s right. The shortage of addiction specialists is a travesty; as a result people are dying.
Those with addiction should not be admonished. They need treatment. However, in CA, for example, there are only 29 AAAP psychiatrists, 470 ABAM docs, 400 ASAM members.
Dr. Tom McLellan reports that fewer than ten percent of medical, nursing and pharmacy schools offer even one course in addiction medicine. It’s no wonder that so many people in dire need receive no or poor treatment.
As a result of this abomination, according to the American Society of Addiction medicine, a person dies approximately every 16 minutes. The number is actually far higher; the most recent statistics available are from 2014.
People who have any disease need the best treatment available. Most people with addiction receive no treatment. Of those who do, most receive terrible treatment based on ignorance about addiction, vestiges of the view that addicts are weak and selfish, choosing pleasure over everything else, even when it hurts their loved ones and themselves. But no one chooses addiction. Sufferers of this disease need treatment based on the latest medical science, not superstition and judgment. We need doctors trained so they can recognize substance-use disorders and refer to appropriate treatment. And we need qualified doctors to whom they can refer.
President Obama, White House Office of National Drug Control Policy under Michael Botticelli, National Institute on Drug Abuse (NIDA) under Nora Volkow, U.S. Department of Health and Human Services, and others are moving the field forward, but they can’t do it on their own.
The medical establishment must accept their responsibility and work to move addiction medicine fully into the mainstream health care system, replacing best guesses, prejudice and tradition with science. Medical schools must recognize their responsibility. So must organizations of medical professionals – American Medical Association (AMA), Association of American Medical Colleges, American Academy of Pediatrics, APA – Academic Pediatric Association, etc.
I’m ranting because I’m angry. I’m tired of the carnage – the broken moms and dads who are burying their children.
Need help with substance abuse or mental health issues? In the U.S., call 800-662-HELP (4357) for the SAMHSA National Helpline.
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