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By Will Stone, KJZZ, NPR, Kaiser Health News
The US The Surgeon General's office estimates that more than 20 million people have a substance disorder. Meanwhile, the country's drug overdose crisis shows no signs of slowing.
However, there are not enough physicians specializing in the treatment of addiction – doctors with comprehensive clinical education who are certified in addiction medicine.  The opioid epidemic made this medical deficit painfully visible. And there are drug-service centers across the country to create scholarships for aspiring physicians who want to treat the substance disorder with the same precision and science as other diseases.
These more than 60 members of these scholarship programs offer physicians one or two years postgraduate education in clinics and hospitals where they learn evidence-based approaches to treating addiction.
Such programs paint a new, talented generation of idealist physicians – idealists like Dr. Ing. Hillary Tamar.
Driven to Connect with Patients in Need
Tamar, now in the second year of a family medical residency in Phoenix, did not think about addiction medicine when she began her first medical studies in Chicago.
"As a medical student, you're honest about your ER rotation, people call a patient a 'pain specialist' and it's bad," Tamar said, "and that's all you do about it."
But in their fourth During the school year, she was randomly assigned to a rotation in a rehabilitation facility in southern Arizona.
"I was able to get in touch with people One way I could not connect with another specialty," recalls the 28-year-old.
Working with patients there changed the understanding of addiction for addiction, she said, showing her the potential for physicians to change lives.
"They can spend all their time tracking the acquisition of a substance, to brothers, sisters, daughters [and] and fathers who make breakfast for their children again, "she said." It's really powerful. "
When Tamar finishes her residence, she plans a scholarship She sees addiction medicine, such as primary care, as a way to build lasting relationships with patients – and a way to focus on more than one diagnosis.
"I love seeing addicted patients on my schedule, even when they're & # 39; Re pregnant and on meth, "she said. "More room to do good – it's exciting."
Build a Program and You Will Come
Doctors with Tamar enthusiasm are urgently needed Anna Lembke, medical director of addiction medicine at Stanford University School of Medicine, a longtime researcher in the field.
"Ten years ago," said Lembke, "I could not find a medical student or resident interested in addiction medicine if I looked under a rock. They just were not there.
But Lembke sees a change in the emerging generation of doctors because they are interested in social justice.
"I now have medical students and residents knocking on my door and sending e-mails to me, all of them wanting Learn more about addiction, "said Lembke.
Historically the path to addiction medicine was through psychiatry. This model began to change in 2015 when the American Board of Medical Specialties – recognized as the gold standard in medical certification in the US – recognized addiction as a true sub-specialty and opened training to physicians in other medical settings.
Until then, Lembke said, there had been no way to approve addiction grants through the nationally recognized Accreditation Council for Medical Graduate Education. This made it difficult to recruit young talents – and to secure the funding of their scholarships.
Last year, ACGME began accreditation for the first series of addiction medicine scholarship programs.
"We have an enormous gap between the need and the doctors available to provide this treatment," Lembke said.
"At least the medical community has begun to awaken, not just to fulfill its role in triggering this opioid Epidemic, but also the possibilities that are needed to solve the problem. ", She said.
The foundation of the foundation
Luke Peterson ended his Family Medicine Family Practice in Phoenix in 2016, Arizona did not have any addiction medicine grants.
So he moved to Seattle to complete a year-long scholarship at the Swedish Cherry Hill Family Medicine Residency. There he learned, among other things, how pregnant women should be treated, who have recovered from drug use.
"I really had to do a scholarship if I wanted to make a difference and be able to get others to do the same thing," said Peterson, who further helped found an addiction medicine scholarship program in Arizona. His program is based in Phoenix at the University of Arizona Medical School and its teaching hospital, operated by Banner Health and the Phoenix VA.
Arizona's two addiction grants received ACGME accreditation last year – an admission stamp that made the programs desirable choices for aspiring physicians, Peterson said.
Not every physician who intends to treat the substance disorder needs a scholarship, he said. His goal is actually to integrate addiction medicine into the primary care.
However, a specialist can serve as a referral center and resource center for local physicians.
For example, doctors may learn from a specialist such as Peterson, such as drug-based treatment such as buprenorphine.
Public health officials are pushing for more doctors to be trained on evidence-based treatments such as buprenorphine, which has been shown to reduce the risk of death in people recovering from an opioid overdose
"If we educate physicians more and support, they will feel better when they are looking for and treated, "Peterson said.
Peterson's own path to addiction started during a rotation with a family doctor in rural Illinois.
"At moments that are uncomfortable for most doctors – maybe a patient comes to ask for painkillers, and you see the negative side effects – he is not afraid of this situation," Peterson said. "He addressed it directly."
It was a formative experience for Peterson – one that other young doctors should have. And he acknowledges the urgency.
"In 20 or 30 years," said Peterson, "these medical students will look back at my current generation of doctors, and we will be judged on how we respond to this epidemic." As he and his colleagues now look back, how Doctors dealt with the HIV epidemic.
One of the first steps in stopping the epidemic is that there are enough local physicians who know how
Many of today's medical students, such as Michelle Peterson (no relation to Luke), say they also feel the calling ,
She is in her freshman year at the University of Arizona College of Medicine and became interested after working in an outpatient treatment center in addiction.
She said she was already learning addiction in her lessons, hearing from doctors on the field, and seeing other classmates equally engaged.
"It's definitely not just me," she said. "There are a lot of people who are really interested in addiction."
It's a trend they and their mentors want to continue.
This story is part of a partnership that includes KJZZ, NPR and Kaiser Health News. [19659051WillStoneKJZZNPRKaiserHealthNews