There aren’t enough addiction doctors.
This is just one of the many problems that are keeping us as a society from treating addiction as well as we could be, but it’s something we shouldn’t ignore. We talk a lot about the regulatory side of it, but we can’t forget the personnel side. It isn’t just that regulations scare physicians away from addiction — it’s also that it is extremely difficult to have a practice that can take care of both addiction and non-addiction patients. Addiction patients are a special population with extreme and specific needs. They require much more tracking of medications than patients with other illnesses, and they can be much more “difficult” behaviorally, requiring more of a doctor’s time and energy. To have a practice where both addicted and non-addicted patients are treated quickly begins to look unfair to the non-addicted patients, who feel threatened and pushed aside by all the time the doctor needs to devote to managing the behavioral symptoms of addiction. So physicians often find themselves faced with a practical choice: to refuse to have anything to do with addiction, or to switch completely and focus all their energy on this patient population.
Unsurprisingly, few doctors who have built up a practice are willing to abandon it to jump into a brand-new, under-researched, under-funded field. (This isn’t helped by laws like the 100-patient limit, which make it difficult to earn a living from an addiction-only practice.) So we are left with a severe shortage of addiction doctors. This isn’t just an inconvenience, it’s a tragedy. It means that patients who want to get treated, who are desperate for treatment and ready to do whatever they need to do, patients who have tried all other treatment methods, are turned away — not because of anything about themselves, just because there isn’t room or time for them to be seen. Access to an addiction physician becomes a luxury commodity, in high demand, and that drives prices up, which closes the gates to even more people. Misinformation is a big reason people aren’t getting the addiction treatment they need, but a lack of physician availability is another.
I’m sure there is a regulatory fix for this — ways the government has to offer incentives to physicians who are trained in addiction, or encouraging them to move to underserved areas. Abolishing the 100-patient limit would be a fantastic start to opening up the field. By shutting down incentives and ability of physicians to move into addiction, harsh regulations can shut off the supply of treatment as they try to shut off the supply of illegal substances. But either way, the regulatory answer probably isn’t going to be the ultimate solution. Education, as always, is going to be my suggestion. If people can be made aware that medication management with a physician is treatment that works, if we can get demand for it going not only at the level of patients but at the level of hospitals, employee healthcare plans, and schools, then maybe we can attract enough doctors to the field to begin to meet that demand. As it is, proper addiction care is being hoarded, where proper care for heart disease and cancer is being distributed widely, as it should be. This is just one more way in which we need to bring addiction up to speed.