Merging Addiction Treatment & Primary Care Medicine?

by Academy of Clinical Excellence on June 17, 2010

I had the recent privilege of being invited to a meeting with Dr. Thom McLellan, Deputy Director of the Office of National Drug Control Policy for the White House. No, the President was not present, but with two other physicians, I was part of an almost 90 minute discussion with Dr McLellan and one of his associates.

The discussion focused largely on the merging of addiction treatment with primary medical care. He already knew of our practice in which we incorporate buprenorphine treatment for opiate dependence in the primary care setting. We discussed ways of advocating substance abuse screening and brief intervention training for medical students, residents and practicing physicians. We also touched on board exams including questions related to addiction and ways to make addressing addiction in patients less of a barrier.

Probably, the most provocative discussion focused on changing the concept of addiction treatment. There is no area of medicine where a treatment for a medical condition can be viewed in the context of “punishment”. Yet, that is often the case as even drug courts, which in my view serve a terrific role, offer the alternatives of jail or treatment (pick your punishment?).

We then discussed the general topic of getting patients into treatment. In caring for patients, we also often say the patient has to hit rock bottom to accept treatment. Why do we allow that to happen? Shouldn’t we be motivating patients as soon as we know that substance abuse has been detrimental to their health? We don’t wait for a hypertensive patient to have a myocardial infarction before we try to intervene.
At the end of the meeting, Dr. McLellan, openly discussed his decision to leave his position this August after only one year. The Office of National Drug Control Policy for the White House has no separate powers, but rather interacts with many other government agencies. For someone very motivated to make change (pun intended), he found the setting frustrating and exasperating. He has been a lifelong advocate for individuals with addiction and his leaving is a loss for the medical field.
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