ANSWERING THE CALL TO MICHIGAN’S LACK OF ADDICTION SPECIALISTS

The number of opioid-related deaths in Michigan has hit an all-time high, requiring the resources of the state’s three major research universities and one of its largest health systems to tackle the problem.

Under a two-year, $1.5 million grant, Michigan State University, the University of Michigan, Wayne State University and Grand Rapids-based Spectrum Health will train more physicians as addiction medicine specialists by streamlining the certification process.

Currently, fewer than 200 physicians in Michigan are certified in addiction medicine or addiction psychiatry, and there’s only one specialist in the entire Upper Peninsula.

“That’s not enough to meet demand,” said Kelly Strutz, 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 more physicians.”

According to Cara Poland, a Spectrum Health Medical Group physician and certified addiction medicine specialist, most doctors receive fewer than five hours of addiction training in medical school.

“We are in an opioid epidemic, and by some national measures, Michigan is in the top 10,” Poland said, who also is an assistant professor at MSU. “We literally don’t have enough doctors equipped to deal with this epidemic.”

Poland and Strutz are leading the program called Michigan CARES, or Collaborative Addiction Resources and Education System, in cooperation with Edward Jouney, clinical instructor and program director for the U of M Addiction Psychiatry Fellowship Program, and Mark Greenwald, a professor who leads Wayne State’s Substance Abuse Research Division.

Certification in a medical specialty is typically achieved through a fellowship program. However, new specialties have a limited timeframe where physicians can gain more experience and fulfill certification requirements without a fellowship. This is known as a practice pathway.

Due to the urgency of Michigan’s problem, Poland and Strutz’s program will assist physicians in fulfilling the requirements through online courses, clinical experiences and leadership opportunities.

“This epidemic does not discriminate, and Michiganders from all walks of life have been affected in one way or another,” Jouney said. “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.”

Opioid misuse, which includes prescription painkillers, heroin, fentanyl and other synthetic drugs, was blamed for 49,000 deaths nationwide in 2017. This prompted 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.

“Due to recent policy changes that prescribers have followed, deaths related to prescription painkillers have shown a modest decrease,” Greenwald said. “Yet, despite this positive trend, deaths from heroin and synthetic opioids have risen. Cocaine and sedative use along with opioids also complicate the picture. Our training curriculum will be responsive to these changing tides.”

The team is currently recruiting four staff members to help run the program, and they also hope to enroll physicians in the coming weeks. While the motivation centers around opioids, physicians will receive skills to treat other forms of addiction, including methamphetamines, stimulants and alcohol.

“It’s not just about opioids,” Poland said, 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.”

The grant is supported by the U.S. Substance Abuse and Mental Health Services Administration through the Michigan Department of Health and Human Services opioid response fund.