Doctors should be better trained in addiction treatment, says study

Patients who have been prescribed opioids aren't likely to become addicted, a new study suggests.
Patients who have been prescribed opioids aren't likely to become addicted, a new study suggests. THE CANADIAN PRESS/AP/Toby Talbot

A study by the British Columbia Centre for Excellence in HIV/AIDS is calling for more doctors across Canada to be formally trained to diagnose and treat patients addicted to drugs.

Dr. Evan Wood, co-author of the study published in the current edition of the Journal of Addiction Medicine, said there’s a greater awareness that for many people, addiction is a chronic disease that must be treated with evidence-based medicine, the same as heart disease or any other condition.

“We’re just sort of learning and trying to unpack the mystery that some people will go into long-term recovery and never go back, whereas for other people it ends up being a fatal disease and they can never put it down. In many cases it’s because people haven’t accessed good treatment.”

Statistics from the BC Coroners Service show there were 371 drug overdose deaths between January and June of this year, about 60 per cent of which were tied to fentanyl, a powerful pain killer.

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Wood said the prevalence of addiction means treatment must be integrated in the primary care setting where family doctors are trained to help patients who may need further care from specially trained physicians.

There are about 25 addiction-care providers in British Columbia based on their accreditation with the American Board of Addiction Medicine, the study said. There is no formal system of accreditation in Canada.

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Wood, who is accredited through the American board, said one-year fellowship programs in addiction medicine are offered in Calgary, Montreal, Toronto and Vancouver.

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“British Columbia is ahead in that our addiction medicine training program is the largest in North America,” Wood said.

He said 13 doctors took part this year in the fellowship program at St. Paul’s Hospital in Vancouver, where addictions training is also offered to nurses and social workers who visit detox centres, recovery programs and primary-care clinics where drugs are prescribed as part of addiction care.

“We’re really trying to look at what are the structural reasons that addiction care has really behind in terms of what’s available for patients and families and really trying to address some of those structural barriers head on.”

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The need for specially trained health-care providers is even more dire in rural and remote areas, he said, adding opioid addiction needs to be treated in the primary-care setting in all areas because too many patients are ending up in emergency departments and leaving without referrals elsewhere for follow-up care.

Dr. Francine Lemire, executive director and CEO of the College of Family Physicians of Canada, said she supports the study’s recommendations to invest in addiction training at medical schools, along with continuing medical education for health professionals dealing with the issue.

“If we are serious about the extent and depth of this societal problem, early screening, diagnosis and treatment is key,” Lemire said in a statement.

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Lemire said the college will recognize physicians who acquire enhanced skills with a special certificate of competence and anticipated the process to be completed over the next 12 to 18 months.

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