A troubling study released last month on JAMA Network Open tracked drug overdose deaths backwards through the medical system to see where opportunities for treatment had been missed. They asked the patients’ primary care physicians why they didn’t recommend treatment sooner. The answers are quite revealing:

• 81.2% said it was due to the lack of institutional support
• 73.9% said they lacked the skills to treat substance use disorders
• 71.9% said they lacked the knowledge to treat substance use disorders

Out of 283 missed opportunities to recommend a patient enroll in an addiction treatment program — patients who later ended up dead from overdose — more than 70% of the primary care physicians said they lacked the knowledge and skills to intervene. That physicians can get through medical schools and residencies without learning how to assess and treat substance use disorders is alarming. I’m not the only one who sees this as a shocking deficiency of training and education.

Meet Dr. Cara Poland, a physician and researcher at Michigan State University’s College of Human Medicine. Dr. Poland is a passionate advocate for addiction education and the force behind MI CARES, an ambitious effort to unite seven medical schools in Michigan in the provision of physician-level training and certification in addiction medicine. Along with physicians, MI CARES offers programs and certification for physicians-in-training, resident physicians, RN and PN students, social work students, and social work practitioners.

MI CARES points out that physicians receive, on average, less than 10 hours of addiction treatment training in medical school. In an effort to expand the number of physicians able to prescribe controlled substances for addiction treatment, in 2023 Congress passed the Medication Access and Training Expansion (MATE) Act requiring DEA certification with only eight hours of MATE Act training. MI CARES provides MATE Act training, and so much more.

MI CARES provides the training and certification needed to become board-certified in Addiction Medicine. The collaborative effort of seven medical schools provides support for students every year in school and throughout their residencies. MI CARES works to expand medical school offerings in Addiction Medicine and Addiction Psychiatry, and to strengthen addiction education in social work programs.

At the center of this whirlwind of activity is Dr. Cara Poland. With a Master’s in Education along with her many medical credentials, Dr. Poland is uniquely qualified to lead this impressive educational effort. She has also been touched, personally, by the loss of a brother who suffered from alcohol use disorder before taking his own life. She shares her very difficult story in a TEDxMSU video released just last week.

Dr. Poland says:

Research has shown a marked stigma against training for substance use disorders. We hope that by educating students during medical school, we bring forth evidence based, anti-stigma treatment before negative attitudes can form in practice. Medical students are the future of the workforce. We want them to have as much judgment-free knowledge as possible to help combat the addiction crisis.

Dr. Poland specializes in working with pregnant women with substance use disorders. She sees that it is stigma that causes physicians to downplay the needs of their SUD patients, which causes insurance companies, pharmacists and medical professionals to look the other way rather than reaching out. This compassionate attitude is reflected in the mission statement of MI CARES:

MI CARES aims to reduce stigma around substance use disorder and treatment, knowing that education is a critical component of fighting the addiction crisis.

Written by Steve O’Keefe. First published August 6, 2024.

Sources:

“Physician Reluctance to Intervene in Addiction: A Systematic Review,” JAMA Network Open, July 17, 2024.

“Healing trauma through storytelling: Restoring justice in addiction medicine,” MSU Today, August 1, 2024.

Image Copyright: Elnur.