‘Wake up the doctors’ and teach them addictions

published on July 29, 2015 by Dr. Jan Klimas in Canadian Healthcare Network

“Wake up the doctors and educate the people,” Dr. Ernest Bishop, a clinical professor of medicine at New York Polyclinic Medical School, wrote in the American Journal of Public Health. “Medical, legislative and popular ideas are all in error.”

The article was titled “Narcotic drug addiction: A public health problem” and the year was 1919. Dr. Bishop argued that addiction is not a vice but a disease that requires treatment. However, there were few medications to treat it back then. He also noted “addiction is practically untaught in the school.”

Little did he know that it would take a century for things to start changing. Although we have effective medications now, they are underused because doctors don’t know about them.

Nor is the drug problem any less pressing than Dr. Bishop felt it to be nearly 100 years ago. According to Statistics Canada, in 2012 approximately 21.6% of Canadians (about six million people) met the criteria for having had a substance use disorder during their lifetime.

Furthermore, in the Canadian Journal of Addiction(September 2014), Dr. Peter Selby, chief of the addictions program at the Centre for Addiction and Mental Health (CAMH) in Toronto, and colleagues noted the prevalence of substance abuse in Canada is about 11%.

However, Dr. Selby and his coauthors went on to note that although Canadian family physicians cited it as the third most important area of competence for a newly practising family physician in a recent survey undergraduate training in addiction medicine in Canadian medical schools “is minimal to non-existent.”

Among residency programs, the researchers noted, only psychiatry requires any dedicated exposure to addiction care. As for fellowship programs, there are a few scattered programs for psychiatry residents; a fellowship for family medicine residents at St. Joseph’s Health Centre in Toronto; and only two programs accredited by the American Board of Addiction Medicine (out of 27 in North America), at CAMH and at Saint Paul’s Hospital in Vancouver.