Doctors remain uncertain about drug education


Almost a decade after the start of the opioid epidemic and in the shadow of the COVID-19 pandemic, U.S. doctors appear to remain uncertain about how to identify and treat patients with blood disorders. drug addiction, according to a new survey.

Quest Diagnostics recently released its latest health trends report, Drug Misuse in America 2021: Physician Perspectives and Diagnostic Insights on the Drug Crisis and COVID-19, produced by the Harris Poll, which reveals the concerns and fears of doctors regarding the recognition of dependence and the effects of the pandemic on drug users.

Pills on a prescription pad

Responses from doctors show a troubling but unsurprisingly lack of understanding of opioid use disorder, addiction specialists say.

“Most doctors cannot recognize the early signs of drug abuse by their patient,” said Dr. Roberto Soria, chief medical officer of Crossroads Center, a methadone clinic in Corryville. “But not just during the pandemic.”

The survey, for which Quest Diagnostics partnered with the nonprofit Partnership to End Addiction in New York City, included the following key findings:

  • Almost 80% of doctors are concerned that patients will turn to illicit fentanyl if they cannot get a prescription drug.
  • Nearly 70% of physicians fear they may have missed signs of drug abuse or misuse in one or more of their patients during the pandemic.
  • Three in four think telehealth limits the ability to detect drug abuse.
  • 78% say they want more information on how to monitor prescription drug addiction.

“Despite the availability of effective screening, intervention and treatment options for opioid abuse and opioid use disorder, healthcare professionals continue to feel ill-equipped to manage this. huge growing problem in their clinical practices, “said Linda Richter, PhD, vice president of prevention research and analysis at The Partnership to End Substance Abuse.

The survey results come as the United States faces a record number of overdose deaths. Last month, the Centers for Disease Control and Prevention released a provisional tally of 100,306 drug overdose deaths between May 2020 and April 2021. The new record follows a previous record of 93,000 overdose deaths in 2020, indicating that the pandemic has exacerbated the epidemic.

Overdose deaths in the United States hit new highs; Biden administration announces strategy to reduce toll

The Quest investigation also follows reports from the U.S. Drug Enforcement Administration of a staggering increase in illicit fentanyl, including squeezed pills that are prescription opioid look-alikes. Fentanyl is a potent synthetic opioid that has been identified as the leading overdose killer.

Fentanyl and heroin in pill form for sale on the street

The research, says Quest, “reveals that physicians need comprehensive resources to identify risks, combat drug abuse, and care for suffering patients.”

Doctors don’t understand drug addiction, prescribing

“They need to know how to manage patient pain more safely, how to speak confidently and compassionately with patients about the risks of opioid abuse, Richter said,” and how to intervene early with those at risk to prevent abuse of prescription opioids lead to a problem with illicit opioids, including fentanyl. “

Soria said the investigation reveals a clear lack of understanding of substance use disorders. For example, he said, “If a patient gets fentanyl because he didn’t get an Rx, he had a problem initially. And this is being addressed by better training of physicians to identify patients at risk of developing or exhibiting addictive behaviors.

Pain relievers are poured out of a prescription bottle.

Dr Mina “Mike” Kalfas, an addiction specialist at Journey Recovery in northern Kentucky, said the doctors’ fears were not surprising. The message for the past 10 to 15 years has been to limit opioid prescribing, he said, but many doctors have adopted blanket non-prescribing as a result.

“The general response was not (to learn) how to prescribe safely,” Kalfas said. “It was, ‘I’m just not going to prescribe at all.'”

Kalfas said alternative methods – from prescribed ibuprofen to physical therapy – should be the first line of pain treatment. But he added: “There should be a monitoring process and a prescribing capacity for people in extraordinary circumstances and in terrible pain.” And doctors should understand that, as well as if someone is addicted to pain relievers.

Prescription form cut with tampon lying on the table

A question-answer tool can help physicians assess addiction

The survey indicates insecurity about the use of telehealth, a practice that has skyrocketed during the pandemic, to identify people at risk for substance use. Doctors in the Cincinnati area agreed it wasn’t a perfect system, but say a consultation over the phone or the Internet can still set off red flags.

“In person, I could notice their arms. I could notice their behavior, notice them fidgeting,” Kalfas said, but added that there are oral assessments of opioid abuse that are available to everyone. doctors and can help identify patients at risk.

A widely used assessment comes from the American Society of Addiction Medicine. It is a continuum of questions that uses “research quality questions … The Organization of Substance Abuse Specialists says the tool allows both clinicians and non-clinicians to assess patients with addiction, substance-related and concurrent issues through structured computer-guided interviews.

Dr. Kevin Hartman, a primary care provider with Mercy Health Physicians in Cincinnati and chief medical officer of the Bon Secours Mercy Health group of physicians, had this response to the telehealth dilemma: “In my opinion, this reflects learning. how to effectively deliver care through a new modality rather than a limitation inherent in telehealth. “

How were the signs of addiction missed during the pandemic?

People who use drugs themselves have said that the novel coronavirus pandemic has harmed their mental health, “including by exacerbating the use of alcohol or drugs … over the past year,” shows the 2020 National Survey on Drug Use and Health, released in October.

Hartman said that at the start of the pandemic all eyes were on the impact of COVID-19 itself.

“As a primary care provider, worrying about missed signs of drug abuse or substance use disorders reminds me of what all physicians learn in medical school: we shouldn’t make assumptions about our patients, and it’s important to ask openly. finished questions without being judgmental, ”Hartman said.

Clients at the Crossroads Clinic in Corryville wait at marked 6-foot intervals for methadone medication during the COVID-19 pandemic in April 2020. A security card with a medical mask is located at the exit.

Medical students have more education, but more needs to be done

The call for more training on substance use disorders for medical students has not gone unnoticed.

“There have been more attempts to improve medical education around substance use disorders,” said Richter, “but… it’s still not enough in terms of reach and reach. “

Kalfas has seen a greater interest among students in pursuing a specialist course in drug addiction, he said, but also an increased awareness that any doctor should be able to recognize the signs of drug addiction and refer patients to appropriate care.

Despite this, addiction specialists said it was clear that doctors needed more help in their own practice.

“My best recommendation,” said Soria, “is to educate, to educate.”

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