WAR ON DRUG ADDICTION NEEDS DOCTORS ON FRONT LINE

In recent months, newspaper headlines across the country have alerted Americans to an emerging problem threatening health: prescription drug abuse.  Here in Chicago, emergency room mentions for prescription drugs have risen by 56 percent from 2000 to 2002, above the national average.

As the number of people using these drugs non-medically increases, physicians have begun to educate themselves and their peers about the dangers.

But even more basic than prescription drug abuse is the issue of physician detection of potential misuse of prescription medication and addiction.

Unless you count television dramas and news reports, physicians in training often receive little exposure to this topic.

This must change.

Recent surveys indicate that physicians often lack knowledge, skill and comfort with their role in discussing drug use with the patient.

Many physicians were trained at a time when the knowledge on drug addiction was little known.

Today, science has clearly demonstrated that addiction is a fundamental yet treatable disease of the brain.

Equipped with that knowledge, we can all do better in addressing this serious problem.

When knowledgeable and confident about drug abuse issues, physicians play a crucial role in educating their patients ( often kids ) about drug use.  Ninety-five percent of psychiatry residency programs offer some education in addiction.

By contrast, a recent survey indicated that less than half of U.S.  pediatric training programs require instruction in addiction treatment; less than one-third offered electives in the area.

The time has come for providing medical education to physicians in training at all levels.

With more than 19 million regular drug users in this country, the entire medical field must be ready to confront this disease.  Primary care physicians, for example, play a vital role in conducting brief interventions for patients who use drugs regularly but are not yet dependent on them.  Brief interventions by primary care physicians have already been shown to be effective in reducing alcohol use by heavy drinkers.  They have also long been used in the successful fight against cigarette use.  Forty years ago, interventions with alcohol and cigarette users were unheard of.  As we learned more about those drugs' health dangers, knowledge was translated into changes in curriculum, which has in turn made Americans healthier.

The power of health messages communicated by physicians can now be applied to help reduce substance abuse.

For example, in training, medical students and residents see a number of patients with addictive diseases.

Often we write, "Patient is a 39-year-old white female alcoholic.  .  ." as if the diagnosis were a relevant descriptor, with the same value as religion or occupation.  Descriptors help us understand more about a patient, but they confer no responsibility on the part of the physician to communicate life-saving advice.  If the condition were diabetes, physicians would be responsible for drawing a blood level and managing the disease.

Unfortunately, most of the time today the same standards do not apply when it comes to substance abuse.

We in the federal government recognize our role in this effort.

Our anti-drug budget offers $22 million to expand screening, brief interventions, referral and treatment.

But the government is not the only entity that has a part to play.  Encouragingly, foundations are beginning to sponsor medical training programs, and the American Medical Association advocates for their physicians to conduct alcohol screening procedures.  These are all positive steps.

But we must all do more to realize a day when patients expect a discussion of their drug use in the doctor's office, just as they would a cholesterol or heart problem.

This expectation can only be met once physicians are knowledgeable, skillful and comfortable in confronting addiction.

At a time when the science and our experience dealing with drug addiction clearly show how this disease can have a devastating impact on society and the individual, we can no longer afford to allow widespread physician education on drug addiction remain a distant dream.

It is time for all of us -- the medical community, advocacy groups, universities and government -- to work together, disseminate knowledge on this topic, and thus change the dynamic of the doctor-patient relationship in dealing with this disease.

To ensure a healthier tomorrow, physicians should acquire this knowledge from their time in medical school, rather than from watching "Law and Order" or "ER."

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Dr.  Andrea Barthwell is deputy director of Demand Reduction at the White House Office of National Drug Control Policy and past president of the American Society of Addiction Medicine.  She speaks today in Chicago at the annual meeting of the Society of General Internal Medicine.