addicts and the medical systemI’ve presented my case that addiction should be considered a disease, according to the definition of that term. I suggested that reservations some people hold against considering addiction a disease have to do with expectations of will power.  I suggested that such reservations are not fair, since the lack of will power is one of the core symptoms of addiction.

I described an example of how the medical community treats those with the disease of addiction.  Finally, I asked a question: Where is the outrage by organized medicine over the large number of deaths from the current epidemic of opioid dependence?

By ‘organized medicine’ I am referring to the many professional societies that claim to speak for doctors in regard to public policy– the people who weigh in on health-care expenditures, health access, health insurance, and funding for medical research. I am also referring to doctors themselves, because the silence of policymakers largely reflects the lack of outrage among physicians.  Doesn’t anyone care?!

The sad truth is that those in the medical profession have abdicated their role in the treatment of opioid dependence.  Physicians want to be the final authority for treating diseases—just not THIS disease.

They assume that those other folks, those people who dress more casually and might be addicts themselves, are taking care of the addicts. Medical doctors don’t know much about what those people do with the addicts, and frankly don’t want to know. They are just happy to have someone to send those people to, after giving them larger and larger scripts for opioids and benzodiazepines, and worrying that they would never stop asking for more.  It is so nice to be able to say ‘I’m done with you!’ and send them away!

Typically, if a doctor sends a patient to a specialist, the specialist treats the patient and then sends the patient back to the referring physician, who continues treating that patient. In contrast, patients with addictions are sent off with the expectation that the patient will be taken care of by someone else, permanently. Thank goodness– no more early refills for medication. No more self-sabotage. Good riddance.

It would be one thing if patients did well after being sent away; physicians could be excused, perhaps, for dumping patients if the patients ended up the better for it.  But patients do not typically do well after being sent for treatment.  Many don’t even complete the treatment process. But once referred, doctors seem to think that they have done their job, regardless of the final outcome.

This attitude is unique for addiction. If doctors were sending women with breast cancer to facilities that charged $50,000 per month and had 5% success rates, the New England Journal of Medicine would feature editorials about ‘sham treatments!’

In the case of most diseases, there is a process for handing-off patients from one expert to another. There is the expectation that the next expert in line will treat the patient with the same care and compassion as the referring physician. The specialty hospital or clinic keeps the patient on their radar until handing the patient back to the referring physician. There is a general understanding that patients should not fall through the cracks.

If patients are somehow lacking in capacity— developmentally disabled or suffering from a psychiatric condition, for example— the hand-off is particularly careful, with social workers and nurses making phone calls to set up follow-up appointments. And when patients sent for specialized treatment do poorly, the specialist and referring physician have discussions about the next plan of action.

Doctors don’t seem to notice—or care—that addiction treatment centers that have different rules than the rules for patients with other diseases. If a person with hypertension has a setback—say a spike in blood pressure that causes a stroke– the specialist would be expected to transfer the patient to a higher level of care. Discharging a patient in an unstable state would be considered patient abandonment, and grounds for a lawsuit.  But If a patient with addiction has a set-back in the form of relapse, the person is likely discharged. In fact, if the patient runs out of money midway through treatment, the patient is discharged.  If the patient becomes belligerent because of withdrawal, you get it—the patient is discharged.

And in the case of addiction, discharged patients fall between the cracks and are quickly forgotten. Nobody looks for those patients, the ones who dropped out of treatment after one week, or who were kicked out for a ‘dirty’ urine. There is no process to find them, or to keep them safe. Their charts are archived in the back rooms of treatment centers, never opened—unless a patient happens to come up with another $50,000.

Sadly, if anyone was looking for these people, the most promising place to look is in the newspaper—in the obituary section.

Photo by GAFiretrucks, available under a Creative Commons attribution license.