Answering the call to Michigan's lack of addiction specialists
February 11, 2019 - Updated December 5, 2019
The number of opioid-related deaths in Michigan has reached epidemic proportions, requiring the resources of three of the state’s major universities and one of its largest health systems to tackle it.
Under a $1.5 million grant, Michigan State University, Wayne State University and Grand Rapids-based Spectrum Health are collaborating to train more physicians as certified addiction medicine specialists. Currently, fewer than 200 physicians in Michigan are certified in addiction medicine or addiction psychiatry.
“That’s not enough to meet demand,” said Kelly Strutz, PhD, an epidemiologist and assistant professor in the MSU College of Human Medicine. “The goal is for us to be able to reach the entire state and train physicians all over the state.”
Currently, only one physician in the Upper Peninsula is certified as an addiction medicine specialist, said Cara Poland, MD, a Spectrum Health Medical Group physician and assistant professor in the MSU College of Human Medicine.
Poland and Strutz are leading the program called Michigan CARES (Collaborative Addiction Resources and Education System) in cooperation with Professor Mark Greenwald, PhD, who heads Wayne State University’s Substance Abuse Research Division.
The addiction medicine specialty was formally recognized in 2016 as the opioid epidemic was increasing nationally. The usual route to certification in a medical specialty is through a fellowship program. New specialties, however, have a limited amount of time to use a “practice pathway” toward certification without a fellowship. Due to the urgency of the problem, Poland and Strutz’s new program will assist physicians in fulfilling the practice pathway requirements through online courses, clinical experiences, and leadership opportunities.
Importantly, “Our expert interdisciplinary team will ensure that training content and principles of treatment are based on state-of-the-art scientific knowledge. This will prepare professionals on this practice pathway to deliver evidence-based health care throughout Michigan,” Greenwald said.
In the U.S., opioid misuse was blamed for 49,000 deaths in 2017, prompting the U.S. Centers for Disease Control and Prevention to lower the country’s average life expectancy. Michigan recorded nearly 2,000 opioid-related deaths in 2017, according to the Michigan Department of Health and Human Services.
Opioids include prescription painkillers, heroin, fentanyl and other synthetic drugs. “Due to recent policy changes that prescribers have followed, opioid-related deaths due to prescription painkillers have shown a modest decrease. Yet, despite this positive trend, deaths from heroin and synthetic opioids have risen. Cocaine and sedative use along with opioids also complicates the picture. Our training curriculum will be responsive to these changing tides,” Greenwald added.
“We are in a current opioid epidemic, and by some measures Michigan is in the top 10,” said Poland, who is certified as an addiction medicine specialist. “We literally don’t have enough doctors equipped to deal with this epidemic.”
Most doctors receive fewer than five hours of addiction training in medical school, not nearly enough, Poland said.
The program to train more addiction specialists grew out of a meeting of the state’s seven medical school deans in January 2018. Norman Beauchamp, Jr., MD, dean of the MSU College of Human Medicine, offered MSU as the program’s clearinghouse and asked Poland to help create it.
The two-year grant is from the U.S. Substance Abuse and Mental Health Services Administration through the Michigan Department of Health and Human Services opioid response fund. MSU is the grant recipient, although all three universities and Spectrum Health are creating and will oversee the program.
“This isn’t a problem any one of us can or should try to solve on our own,” Poland said. “I’m thankful we were given this opportunity.”
She is recruiting four staff members to help run the program, and she hopes to begin enrolling physicians in the coming weeks.
The program includes two parts:
- Technical assistance to facilitate completion of the practice pathway;
- A curriculum for physicians that can be adapted for inter-professional teams.
While the impetus is the opioid crisis, the program will give physicians the skills to treat other forms of addiction, including to methamphetamines, stimulants and alcohol.
“It’s not just about opioids,” said Poland, whose brother died six years ago due to alcohol use disorder. “It can hit anyone. It doesn’t matter who you are or where you are.”
“This epidemic does not discriminate, and Michiganders from all walks of life have been affected in one way or another,” added Jouney. “Michigan is a state of phenomenal resources, and when presented with a challenge, the health care professionals in this state will rise to the occasion.”
Physicians interested in becoming board certified in addiction medicine may contact Cara Poland at Cara.Poland@spectrumhealth.org.