Teach us to treat: Making addiction treatment a medical core competency

October 04, 2018

By: Siva Sundaram

Imagine you’re a primary care doctor seeing a patient one week after his first heart attack. You know the latest evidence, so you tell your patient about a cheap, safe medication that cuts his risk of dying from a second heart attack in half.


But there’s a catch: You were never trained to prescribe this medication in medical school or residency. In fact, only one physician in your area has gone through the required training and certification, and your patient might have to wait weeks for an intake with her.


If this happened to a heart attack survivor, it would be an abomination. If you replace “heart attack” with “opioid overdose,” however, this experience is all too common.


Heart attacks and opioid overdoses are both acute exacerbations of common chronic medical illnesses. Yet while every medical student graduates with the preparation needed to treat heart disease, fewer than 6 percent of physicians in the U.S. are trained and certified to prescribe buprenorphine, a medication proven to halve the overdose death risk for patients with opioid addiction.


With 115 Americans dying each day from opioid overdoses, evidence-based treatment for opioid addiction needs to be a standard medical competency, not an optional supplement. How can we make sure that our generation of physicians is prepared to address the defining public health crisis of our time?


One provision in the massive opioid legislation package that Congress just passed may help. Once the law is implemented, if your medical school curriculum provides you adequate training, you will be able to apply for a waiver to prescribe buprenorphine as soon as you get your medical license, without needing to complete the standard 8-hour course. (See Section 3202 in the full text of the bill for details.)


But as things currently stand, most medical schools won’t qualify: their curricula on simply aren’t robust enough when it comes to addiction treatment.


As medical students—the future of American’s physician workforce—we have a unique role to play in changing the status quo. Our voice matters. We can call on our medical schools to give us the training to provide the care our patients need. We can even ask our government leaders to do their part.


Here in Massachusetts, our state government and medical schools have partnered to establish medical education core competencies for substance use disorder prevention and management, and medical students have played a crucial role in accelerating and sustaining ongoing change. A coordinated student advocacy push across our four medical schools made it clear that we wanted more training, which supported collaboration between government officials, educators, and students to set up our own state-level pathway to buprenorphine certification through medical school curricula. And student collaboration with the American Society of Addiction Medicine helped catalyze the introduction of the new federal buprenorphine waiver legislation mentioned above.


A future in which every single medical student in the U.S. graduates qualified to treat opioid use disorder with buprenorphine is achievable—with your help. Stay tuned in the coming weeks, as AMSA shares materials you can use to lobby your medical schools, legislators, and government officials to make addiction treatment the medical core competency that it should be.


Siva Sundaram is a fourth-year MD candidate at Harvard Medical School and a member of the Massachusetts Student Coalition on Addiction. This article is adapted from an op-ed previously published by Student Coalition on Addiction members on WBUR’s CommonHealth blog.