As the rate of illicit drug use continues to rise in the United States, not enough primary-care providers understand how to identify and treat addiction in their own patients, said Pamela Shultz, medical director of recovery services at Hazelden Betty Ford in Center City, Minn.
“If more primary-care docs understood how to spot the signs of addiction and how to help their patients get the help they need,” she said, “we could make a difference in the quality of so many lives. All they need is a little bit of training.”
Last year, with this goal in mind, Shultz organized the first Addiction Medicine for the Primary Care Provider conference, a two-day opportunity for medical, nursing and mental health professionals in primary-care settings to learn more about the latest research and best practices for identifying and treating substance-use disorders. This year’s conference will be held Dec. 3-4 at McNamara Alumni Center on the University of Minnesota’s Minneapolis campus.
Clinging to the outdated notion that addiction is a purely psychological issue of “weak willpower” with no biological underpinnings, few medical schools address it during the training process, Shultz said. That lack of educational background means that many primary-care providers are not trained to identify the signs of addiction in their patients.
Ignoring primary-care providers and leaving addiction treatment solely to addiction professionals creates “a true gap,” Shultz said. “It’s important to recognize and screen for addiction and know that there are treatments that can be done in primary care just as well as they can be when patients are referred to a specialist.”
Schulz believes that primary-care providers are well suited to this key role simply because they are on the front lines of health care, seeing people for issues seemingly unrelated to addiction. This gives them the opportunity to make links between common health concerns and addictive behaviors. If they are trained to recognize the signs of addiction, providers may be able to identify those behaviors in their own patients.
“Say a provider is seeing a patient who presents with high blood pressure,” Shultz said. “They say they can’t get it under control. If the provider thinks to ask the patient about their alcohol intake, they may find out that the patient is abusing alcohol and that’s why their blood pressure is not coming under control.”
The pain-med connection
Another way primary-care providers encounter patients with substance-abuse disorders is through the use of highly addictive medications used in the treatment of chronic pain. Many conference offerings will focus on this issue.
“We have several talks scheduled that address the opiate and prescription pain medication problems that are in the news right now,” Shultz said. “We have an expert speaking on non-medication ways to treat addiction. We also have somebody who’s talking about pain management in a primary-care practice and a talk about overdoses and the opiate-use disorder problem. And we have a speaker who will address what makes an individual at risk of developing an addiction if they are prescribed opiates. We will talk about how to recognize if a patient is misusing opiates and becoming dependent.”
Shultz recognizes that primary-care providers go into this line of work because they want to help people. With so many highly effective yet highly addictive prescription pain medications available, a well-meaning provider may be unwittingly creating addiction problems in their patients.
“Doctors need the support to realize, ‘It’s OK if I say no,” Shultz said. “‘If I recognize this is happening I can address it with my patient.’”
Medical treatments for addiction
A new development that many primary-care providers may not be aware of is the increased availability of effective medical treatments for addiction, Shultz said.
“In the past, treatments for addiction were more psychosocial in nature. There weren’t medications available. Those things are changing. There are now medications available to help treat addiction, but if they didn’t learn about them in medical school, docs in practice may not be aware that they exist.”
At the conference, Shultz will be giving a lecture on medication therapy for addictive disorders, an approach many primary-care physicians may be able to take when treating patients with substance-use issues.
“We now have a number of medications that have shown to be of benefit for alcohol, opiate and cannabis abuse,” she said. “Thanks to these advances, providers are now able to design more specific treatments.”
A new perspective
Last year’s conference was successful, Shultz said, with about 125 providers in attendance. This year, the goal is growth, to some 150 attendees. Most will come from the five-state region, she explained, but there have also been registrants from other states, especially those with Hazelden Betty Ford treatment centers, including California, Oregon and Florida.
Response from last year’s participants was enthusiastic, and Shultz hopes that will translate into more sign-ups. She wants to educate as many primary-care providers as possible.
“We did an evaluation last year, and 99 percent of the people who attended said they would recommend the conference to a colleague,” Shultz said. “I’m hoping we’ll see some of those colleagues this year.”
In the end, the conference’s message will be both informative and hopeful, Shultz said. The opening-night dinner’s speaker will set the tone.
“He is a health care professional in recovery from his own addiction,” she said. “He is going to be telling his story. That’s an important message for attendees: to see somebody who has a successful medical career but has gone through addiction. It’s important for providers to see that there are treatments that are effective and people can and do recover. I want them to pass that message on to their patients.”
For more information about the Addiction Medicine and the Primary-Care Provider conference, go here.