Pubdate: Mon, 20 Aug 2012
Source: Globe and Mail (Canada)
Copyright: 2012 The Globe and Mail Company
Contact:  http://www.theglobeandmail.com/
Details: http://www.mapinc.org/media/168
Author: Evan Wood

CANADA SHOULD TRAIN DOCTORS TO SPECIALIZE IN ADDICTION

As a Vancouver physician specializing in inner-city medicine, I'm 
regularly asked by friends and colleagues about what can be done to 
improve the situation in the city's notorious Downtown Eastside. As 
the poorest urban neighbourhood in Canada, the area suffers from a 
range of poverty-associated conditions, including a serious HIV 
epidemic that emerged among drug addicts in the 1990s.

A fundamental issue is the high rate of untreated drug and alcohol 
addiction. While complaints about underfunding of the 
addiction-treatment system have been regularly voiced, one of the 
basic reasons for the problem will come as a shock to many.

Unlike virtually all other medical disciplines, which graduate an 
annual wave of specialist physicians from fellowship programs based 
within Vancouver's university-affiliated hospitals, there is no 
fellowship training program in addiction medicine in the province.

The problem is typical of all Canadian provinces. In fact, although 
Ontario's leading Centre for Addiction and Mental Health does place 
some emphasis on physician education, a patient with an addiction who 
walks into Ottawa Hospital, for example, cannot be treated by an 
addiction medicine specialist because there is none on staff. As a 
result, despite the fact that recent advances in addiction research 
have helped identify effective new treatments, there are few skilled 
physicians to prescribe them. Dedicated and caring as they usually 
are, most Canadian physicians who consider themselves addiction 
medicine specialists assembled their knowledge about addiction 
treatment after completing their medical training.

 From a patient's perspective, imagine being rushed to the hospital 
emergency room clutching your chest in the throes of a heart attack 
and being seen by an extremely well-meaning physician - who has not 
actually been through a standardized cardiology training program.

A recent report from the U.S. National Center on Substance Abuse 
highlights the fact that most people with addictions in the United 
States do not get treatment from a physician at all. Rather, much as 
in Canada, U.S. addiction care is usually provided by unskilled 
laypersons. The report's harshest criticism is saved for the medical 
community, stating that "most medical professionals who should be 
providing addiction treatment are not sufficiently trained to 
diagnose or treat it."

There are, however, centres of excellence in addiction, and few rival 
the Boston Medical Center's Clinical Addiction Research and Education 
(CARE) Unit. What was really eye-opening from my visit to this 
program was the impact that a skilled addiction medicine work force 
can have in turning patients' lives around. In some instances, they 
are using medications not even available in Canada.

While Canada has benefited from the work of the Canadian Society of 
Addiction Medicine and its efforts to certify physicians who have 
received on-the-job experience treating drug and alcohol addiction, a 
potentially ground-shifting opportunity has emerged with the recent 
establishment of the American Board of Addiction Medicine. The board 
has created guidelines for the development of addiction medicine 
fellowship programs enabling Canadian medical schools to create 
programs that are eligible for full accreditation.

This development cannot go unnoticed, especially given that, 
according to the Canadian Centre on Substance Abuse, untreated 
substance abuse costs Canadians about $40-billion a year.

When Stephen Harper released his government's five-year National 
Anti-Drug Strategy in 2007, the Prime Minister stated: "If you're 
addicted to drugs, we'll help you, but if you deal drugs, we'll 
punish you." Since that time, a lot of attention has been placed on 
expensive criminal justice measures while helping addicts and their 
families has been given short shrift. The results have been predictable.

Last week, a study published in the American Journal on Addictions 
demonstrated how, despite the expensive policing measures enacted as 
part of the anti-drug strategy, illegal drugs remain free and easily 
available in Vancouver. In fact, evidence globally has demonstrated 
that funding police and prisons instead of addiction treatment has 
resulted in avoidable human misery and a large and growing criminal 
enterprise that exists because of this steady stream of untreated 
drug consumers.

The Downtown Eastside has received a lot of notoriety, but every 
community in Canada has been harmed by the problems of untreated 
addiction. With Canada's drug strategy currently set to be renewed 
for another five years, all Canadians would benefit if the new 
strategy placed some emphasis on the creation of addiction medicine 
training programs.
- ---
MAP posted-by: Jay Bergstrom