Oregon Health & Science University will receive a $2.3 million federal award to bolster its addiction medicine training program for physicians.
The five-year award marks the first time the federal government has funded workforce expansion efforts in the field of addiction medicine and substance use disorders.
The Health Services & Resources Administration approved awards to 44 centers across the country, but among all the states, Oregon stands out for its high rates of mental illness and substance abuse and low rates of access to treatment. In its 2020 report, Mental Health America ranked Oregon last in the prevalence of mental health, which includes substance use disorder. And in its latest published statistics, the U.S. Substance Abuse and Mental Health Services Administration rated Oregon 50th in access to treatment.
But recognition of the need for trained professionals -- something the OHSU program addresses -- is growing. A little more than a decade ago, addiction medicine was not a specialty. Now, physicians are incorporating addiction medicine into their family and internal medicine practices.
“It wasn’t considered part of medicine, and the big shift in the last 15 to 20 years has been gradual,” said Dr. Todd Korthuis, fellowship program director and medical professor at OHSU School of Medicine. “It’s now become a part of medicine and I think that goes a long way to decreasing stigma.”
The fellowship started at OHSU in 2014 as an early forerunner for addiction medicine. In 2015, the American Board of Medical Specialties recognized addiction medicine as a subspecialty, paving the way for providers to gain certification through accredited fellowships.
The Oregon Addiction Medicine Fellowship will receive $450,000 in federal funding annually for the next five years. The money covers salaries of fellows and a program coordinator and administrative costs. The funding will allow four fellows each year. That’s up from one in the past. The program trains physicians in rural areas where addiction rates tend to be high. They also serve in federally qualified health care centers, which treat low-income residents, and work with underserved populations like Native Americans and adolescents.
“The addiction medicine fellowship is one example of our longtime and expanding commitment to immerse and train physicians in communities across Oregon,” Dr. George Mejicano, senior associate dean for education in the OHSU School of Medicine, said in a statement.
The fellowship attracts physicians from a variety of backgrounds. The program’s first 12 fellows were five family physicians, five internists, one neurologist and one anesthesiologist. Some are recent graduates and others have been in the field for several years.
All the fellows will work in Oregon. The long-term goal is to bolster the workforce and patient access to addiction treatment in Oregon, including rural regions.
Eight of the 12 fellows stayed in Oregon after they finished the one-year clinical program. OHSU officials hope that pattern continues.
“Doctors tend to practice where they train, and if you’re never exposed to a training environment in a rural area, you’re unlikely to ever consider a job there,” Korthuis said.
When fellows finish, they’re qualified to work in or run a specialty addiction treatment center. OHSU officials also hope graduates will work in a variety of clinical settings such as family practices and hospitals.
“The fellowship’s main goal will be to train people who then take their addiction medicine skills and integrate them into diverse health care settings,” Korthuis said.
That work can unfold in different ways. Physicians can conduct drug and alcohol abuse screenings for patients. Primary care providers also can become certified to prescribe buprenorphine, one of three federally approved drugs to treat opioid addiction.
Access to treatment is often limited. A 2019 OHSU study found that pre-authorization requirements of Medicare insurance companies made access to buprenorphine more difficult than access to opioids. OHSU researchers found that access to buprenorphine without restrictions plummeted from 89% in 2007 to 35% in 2018. Meanwhile, nearly all plans allowed opioid prescriptions without restrictions.
You can reach Ben Botkin at [email protected] or via Twitter @BenBotkin1.
