Pubdate: Wed, 12 May 2004
Source: Chicago Sun-Times (IL)
Copyright: 2004 The Sun-Times Co.
Author:  Andrea G. Barthwell
Bookmark: (Barthwell, Dr. Andrea)


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 

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."

- --

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.
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