BOSTON Often, people with drug or alcohol problems don’t get help until they end up in the emergency room or in their doctor’s office for another issue.
Many doctors are not trained in how to identify or treat addiction. But with new research into how it affects the brain, and with new drugs to treat it, more doctors are handling addiction as a medical problem and managing it like a chronic disease.
Addiction As A Chronic Disease
In a sparse exam room at Boston Medical Center, Dr. Christine Pace examined a patient and spoke with him about his kidney stones.
“Are you taking the Oxycodone right when you get the pain?” Pace asked her patient.
The patient, Paul B., does not want to be fully identified because he is recovering from heroin addiction.
“Tell me about how about the rest of your recovery program,” Pace said. “Are you doing counseling? Going to meetings?”
Asking patients whether they are attending 12-step meetings is not the norm in American medicine, but Pace just got out of medical school and is the very first resident at Boston Medical Center in a new sub-specialty called addiction medicine.
“This approach, being a medical patient and not being judged, it’s like I’m actually treated as if this is disease not a morality problem.”
“Medicine has been to slow to embrace what we’ve known for a long time, which is that addiction is a chronic disease,” Pace said. “We don’t in medical school or in residency, no matter what the specialty, get a whole lot of training… in diagnosis and treatment of addiction. I think as a result of that, physicians — like many people in this country — continue to stigmatize [addiction] and continue to not really see it as a disease.”
Doctors now have a better understanding of the biology of addiction and the changes that take place in the brain. That has led to more forms of treatment.
One of those treatments is a highly regulated drug called Suboxone. Paul B. has been using the drug for years.
“I’ve been in recovery for almost 10 years and I’m on Suboxone,” Paul B. said. “I was a former methadone patient, a former IV drug user. I’ve used heroin, OxyContin, Dilantin, medications like that. I’m really lucky to be alive because a lot of my friends aren’t alive.”
Even though there is more acceptance of treating addiction in mainstream medicine, he says there is still a lot of ignorance.
“A lot of doctors don’t want addicts in their waiting room,” Paul B. said, “they don’t even want to draw that clientele to their establishment. … This approach, being a medical patient and not being judged, it’s like I’m actually treated as if this is disease not a morality problem.”
Paul B. was one of the first patients to be given Suboxone at BMC when the medication was approved in 2003. Today, the hospital and its clinics use the drug to treat 500 patients with opioid addiction.
Colleen Labelle, an RN who runs the Suboxone program at BMC, says there’s a growing demand from doctors who need help in treating patients with addiction.
“You know, throwing their arms up not knowing what to do,” Labelle said. “‘This patient comes in and they’re on Percocet and OxyContin and Ativan and Xanax and what do I do with this person?’ And having no clue where to start and what questions to ask.”
So far, 20 medical residents are training in hospitals nationwide to become experts in this new field of addiction medicine — that number is expected to grow next year.
Doctors at Boston Medical Center hope that the training will eventually lead to an established medical specialty so more patients with addiction problems can find help in their own doctor’s office.