41. No MAT for YOU

In today’s podcast I talk about something that affects about ten percent of workers in America: Substance use disorder. I’m not just talking about any worker, either, I’m talking about physicians who suffer from addiction.

Many organizations have employee assistance programs to help workers who need help with addiction. However, there’s disparity in treatment options available to the average worker compared to some professionals, specifically doctors.

In a 2009 study by the Mayo Clinic, reachers found that 50 percent of the physicians in the survey misused alcohol, while almost 36 percent abused opioids. These medical professionals are only human, susceptible to the same stressors the rest of us deal with each and every day. One would think the doctor would be better able to manage these stressors because he’s, well, a doctor, right?

Not exactly. According to the Mayo study, the nature of the physicians’ role and their elevated social status can have an isolating effect when they’re confronted with a disease like addiction. This is primarily due to the social stigma associated with the disease, but the disastrous impact it can have on their careers and future livelihood plays an important role, as well. And to make matters worse, should their drug use be discovered, physicians don’t have access to the same treatment options as the general population, specifically medication assisted treatment. Medication-assisted treatment (MAT), including opioid treatment programs (OTPs), combines behavioral therapy and medications to treat substance use disorders.

A physician who is discovered to have a substance use disorder is normally referred to a Physician Health Program (PHP), which work with state licensing boards. The PHP will develop a treatment plan that they’ll recommend to the board and the physician will be compelled to follow the plan to maintain or reinstate his license. Historically, the treatment plans developed favored abstinence-based programs such as inpatient rehab followed by alcoholics anonymous or narcotics anonymous. In most cases, medication assisted treatment is simply not an option. Why?

Since the FDA considers medication-assisted therapy “one of the major pillars of the federal response to the opioid epidemic in this country” why wouldn’t a treatment modality that is quickly becoming the gold-standard for opioid and alcohol use disorder, be offered to our physicians? Additionally, The Surgeon General recently reported that “medication-assisted treatment is effective in treating opioid use disorder, but is vastly underused.” It doesn’t make sense.

Is this a patient safety issue? Patients being treated with medicines like methadone, buprenorphine, and suboxone are able to care for their families, hold jobs, drive, or work machinery. Although there are likely some procedures that shouldn’t be undertaken by a physician while taking buprenorphine, for the general practitioner, this isn’t really an issue. So, what is it?

Very likely, it’s simply the stigma that surrounds addiction. We stereotype the addict as someone who can’t cope, has no self-control, and only has himself to blame for his situation–the physician is looked upon as an even bigger failure. Given this, the thought of treating an opioid addiction with an opioid seems counter-intuitive, but we train the immune system by introducing live viruses, don’t we? Why should medication assisted treatment seem so outrageous?

It’s time we start treating substance use disorder as the chronic brain disease it is and offer our caregivers the same access to care he is expected to provide to his patients. Diabetes is a chronic disease, but we don’t withhold a diabetics medication because he brought the disease on himself, do we?

Sources:

  1. Statement from FDA Commissioner Scott Gottlieb, M.D., on the agency’s continued efforts to promote the safe adoption of medication-assisted treatment for opioid addiction

  2. Facing Addiction in America: The Surgeon General’s Spotlight on Opioids

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