Major Mass. hospitals pledge to train doctors in addiction care
A new consortium of 12 Boston and Cambridge hospitals has pledged to educate their physicians about opioid addiction and to improve support for employees struggling with substance use problems.
The hospitals’ commitments were announced Tuesday, simultaneously with the results of a new survey showing that many health-care providers in Massachusetts feel ill-prepared to care for people suffering from addiction and harbor misconceptions about the illness and its treatment. Many respondents said that opioid addiction is not treatable, that treating addicted patients isn’t satisfying, and that such patients take away time and resources from other patients.
“It’s important that all the hospitals came together acknowledging that we can and we should do better,” said Michael Botticelli, executive director of Boston Medical Center’s Grayken Center for Addiction, which helped organize the consortium.
The members of the consortium — all the major hospitals in Boston and Cambridge — promised to provide, over the next year, a mandatory one-hour training for hospital-based physicians and to “strongly encourage” training for affiliated doctors not based at the hospital.
The hospitals said they would increase the number of clinicians who are trained to prescribe buprenorphine, a key medication used to treat opioid addiction — but the group stopped short of requiring the buprenorphine training.
The hospitals also promised that each would adopt at least three of 10 measures to help employees with substance use issues, such as creating a substance use disorder “employee support policy” or holding a public event “where people can tell their stories.”
Dr. Peter D. Friedmann, president of the Massachusetts Society of Addiction Medicine, said in an e-mail that the hospital’s commitments represent “a small step in the right direction, but [are] not likely adequate to address limited access to [opioid addiction] treatment.”
He faulted the group for failing to require all prescribing clinicians to complete training to prescribe buprenorphine. Federal law requires doctors to take an eight-hour training course before they can prescribe the drug, a process that few have the time or desire to undergo.
But Botticelli and others pointed out that certain hospitals, although not all, are requiring residents in certain specialties to undergo the buprenorphine training.
“Everyone acknowledges that we have a long way to go,” Botticelli said. “I think, however, this is an important first step.”
He pointed to the survey’s finding that less than half of emergency medicine, internal medicine, and family medicine physicians believe that opioid addiction is treatable.
In light of such misinformation, even an hour’s training in the basic facts of addiction can make a difference, he said.
“The one-hour training is only one of many steps,” Dr. Joji Suzuki, director of the Division of Addiction Psychiatry at the Brigham, said in an e-mail, “but having the hospital CEO make this public commitment is an important part of changing the culture by sending the message that the hospitals will take responsibility and ownership for treating OUD [opioid use disorder].”
Leaders of two unions that represent hospital workers applauded the plans to better address addiction among employees.
“Employers historically have not been very sensitive to this problem,” said Carol Mallia, associate director of the Massachusetts Nurses Association, which represents nurses in seven of consortium hospitals.
Nurses, she said, live in fear of losing their licenses if discovered to have an issue with substance use. Many employees’ health insurance plans require them to receive care at the institutions that employ them, putting nurses in the uncomfortable position of seeking treatment where they work. But if nurses feel safe, they can get help before they become impaired, Mallia said.
Filaine Deronnette, vice president of health systems for the District 1199 of the Service Employees International Union, was also enthusiastic about the move. SEIU represents workers in five of the hospitals in the group.
“For far too long the focus has been on penalizing workers,” Deronnette said. “This is a welcome shift to a more supportive role.”
The hospital consortium first met in February, organized by Dr. Betsy Nabel, president of the Brigham and Kate Walsh, president of Boston Medical Center, with urging from RIZE, a foundation working to end the opioid epidemic in Massachusetts, and the Grayken Center.
The consortium comprises all hospitals in Boston and Cambridge, excluding specialty hospitals, and may be expanded to other regions as it continues its work.
The survey was completed after the hospital group started meeting, and the results created the impetus to announce the hospitals’ commitments, said Julie Burns, RIZE president and CEO.
Conducted from December 2018 to January 2019 by Shatterproof, a national advocacy group concerned with addiction, and funded by RIZE and the GE Foundation, the survey questioned 264 health professionals, primarily doctors working in emergency medicine, primary care, and obstetrics-gynecology but also including others.
Among the key findings:
■ Only one in four providers had received training on addiction during their medical education.
■ Only one in 10 emergency medicine physicians found it satisfying to care for patients addicted to opioids.
■ Two in five members of those specialties feel that treating patients with opioid addiction takes time and resources away from other patients.
■ Providers who have been working for more than 20 years are more likely to prefer not to work with patients who have opioid addiction.
■ One in four emergency medicine, family medicine, and internal medicine doctors believe treating opioid addiction will attract undesirable patients to their practice.
Maegan Kenney, a 34-year-old who lives in Cambridge and has been in recovery from opioid addiction for seven years, provided a stark picture of why doctors’ attitudes matter.
Speaking on the conference call announcing the survey results, she described a humiliating encounter with an emergency room physician who could not believe the words of “a drug addict.” Then Kenney told of a doctor who ultimately guided her to recovery. The second doctor, she said, “saw me sick and suffering but was able to conceptualize the hope and healing that is in me today.”