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America’s opioid addiction problem began, in my opinion, over 30 years ago in what many consider an unlikely place: America’s medical schools. Prolonged anxiety, grief, isolation, and financial worries stemming from COVID-19 have only exacerbated an already growing problem.

There’s been a dramatic surge in opioid-related deaths during the past six months. In fact, just this month, the American Medical Association issued a statement citing rising cases of opioid-related mortality in more than 40 states, urging those governors and legislatures to take swift action to help curb the deadly tide.

Lack of training leads to over-medication

In four years of medical school plus a five-year surgical residency, I had no formal instruction in substance use or addiction. In fact, it was mostly treated as an annoyance—doctors were tasked to “deal with the junkie in Room 208.”

I found this ironic, considering that as surgeons, we were frequently the cause of a patient’s pain—the result of a procedure to treat their primary affliction. Afterward, prescribing opioids for post-surgical pain was the standard operating procedure. Percocet, Vicodin, Oxycontin, and Dilaudid were all top of the list.

Pain was even viewed as a “5th vital sign.” It was seen as such a detriment to healing and survival that doctors were encouraged by specialty societies and medical boards to treat it aggressively for the overall recovery and well-being of the patient.

Unfortunately, physicians lacked training in the risks of opioid use. They also had limited understanding of how certain medications work (or don’t work) for acute injuries versus chronic conditions.

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This opened a flood gate of excess opioid prescriptions. This, in turn, resulted in the growing consumer demand for more powerful drugs, creating an entire class of addiction patients.

Reversing course while picking up the pieces

Now, of course, things are much different. We know the dangers of opioids. And, we’ve come light-years in drug research and alternative pain therapies to minimize the risk of addiction. But we now face the daunting task of undoing years of damage.

The good news is that we have made some progress, including

      • expanding treatment for opioid use
      • cracking down on excessive prescriptions
      • and even going after pharmaceutical manufacturers for preying on consumers

However, more than 90% of patients who need treatment for addiction still can’t get the help they need.

Societal attitudes and the stigma and shame associated with addiction play a large role in creating those hurdles, but one of the biggest obstacles lies within the treatment community itself.

Addiction medicine: a huge void in treatment

One of the largest hurdles in getting more treatment for more people is the lack of access to the right kind of care, specifically addiction medicine. Most people are familiar with the different types of clinical treatments known to be effective, including

      • group therapy,
      • individual counseling
      • behavior modification

But they may not be familiar with the medical specialty of addiction medicine which deals specifically with the physical aspects of drug addiction treatment.

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It encompasses a full range of medical needs, including detoxification, vital patient care, and medication therapies to treat co-occurring diagnoses that must be managed simultaneously, including but not limited to: 

      • depression
      • PTSD
      • bipolar disorder 

A myriad of treatments can help with these needs, including medications that can minimize the damage and discomfort of detox and prevent co-occurring issues from undermining clinical therapy. These therapies must dovetail perfectly within a comprehensive treatment program to ensure the best possible outcome and avoid unintended consequences.

Unfortunately, 98% of addiction treatment providers are untrained in addiction medicine. This creates a huge shortage of specialists that have the expertise that is desperately needed in order to effectively tackle the opioid addiction epidemic from a holistic approach.

A new addiction medicine fellowship aims to fill the gap

To address the addiction medicine shortage, River Oaks Treatment Center, an American Addiction Centers facility, has partnered with the Brandon Regional Hospital to launch a new Addiction Medicine Fellowship. HCA Healthcare/USF Morsani College of Medicine GME Programs is a sponsor of the program. 

Led by Brandon Regional’s Dr. Abbas Sina and River Oaks’ Dr. Michael Murphy, the fellowship aims to provide in-depth, hands-on experience for two clinicians in direct addiction medicine treatment.

Through this ambitious program, two medical fellows, myself included, will partake in clinical rotations at both Brandon Regional and the River Oaks Treatment Center. We will receive a full and intimate view of the entire addiction treatment process, including

      • inpatient detox
      • inpatient treatment
      • outpatient aftercare
      • ongoing patient support.

As part of the one-year program, the fellows will gain experience in managing co-occurring conditions as part of a high-volume comprehensive care center,. This will allow them to follow patients’ progress throughout the addiction treatment journey.

The program also includes a unique introduction to addiction treatment within pediatric populations. It will include taking care of neonates born to addicted mothers and going through withdrawal.  

Vexing challenges demand unique solutions

Addiction has truly become one of the most vexing medical conditions of our time. It’s the only disease in which even getting patients to accept that they have the problem that needs treatment is a formidable challenge.

There’s no denying colon cancer or a coronary artery blockage—almost no one refuses surgery to fix those. But, with an estimated 10.3 million people misusing opioids a year, and overdoses up nearly 20% since the COVID-19 pandemic began, it clearly remains a public health crisis of epic proportions.

With the right kind of treatment and resources in place—which includes a much-needed expansion in the number of qualified addiction medicine providers—we can close this critical gap in medical care and get more Americans the help they need to overcome opioid use disorder.

Here is the link to learn more about the addiction medicine fellowship at River Oaks and Brandon Regional Hospital.


[Editors note: We have not received compensation for publishing this article. But we have included links to commercial entities because they add to the strength of the story.]

Forrest Arthur, M.D.

Dr. Forrest Arthur a General Surgery Specialist in St Petersburg, FL has over 32 years of experience in the medical field. He is currently enrolled in the Fellowship program at River Oaks, an American Addiction Centers facility.

Dr. Arthur received his Bachelor’s Degree from Northwestern University, followed by his Doctor of Medicine Degree from the University of Illinois at Chicago. Following this, he completed his training in General and Trauma Surgery at Wayne State University.

Dr. Arthur had a successful practice for the next 15 years in general, vascular and trauma surgery in St. Petersburg. In addition, he practiced and functioned as the Chairman of the Department of Surgery at a major metropolitan hospital.

Having experienced opioid addiction himself, he learned first-hand what successful recovery involves. Prompted by this experience, Dr. Arthur changed careers in order to help others deal with this deadly affliction. And during his administrative work in addiction, he worked for 9 years with addicted healthcare professionals and became known as an authority in this area.

His current employment enables him to be one of a fairly small group of physicians in this country with a Board Certification in Addiction Medicine. This includes chronic pain and pain management, treatment of substance toxicity and detoxification, as well as any co-occurring mental illness. Additionally, Dr. Arthur has expertise in the clinical areas of addiction treatment such as cognitive behavioral therapy and other approaches to therapy.

He currently belongs to the American Society of Addiction Medicine (ASAM).

Before his medical career, Dr. Arthur was an Olympic caliber equestrian in the arena of hunters and jumpers, rode professionally, and tried out for the 1984 Olympics.

2 COMMENTS

  1. I completely agree, the scope of the addiction crisis in this country includes many substances other than opioids, they just happen more popular in the lay press at this point. Interesting you should mention Adderall, this is becoming a very significant problem in the healthcare industry. It is now common for students (medical, pharmacy, nursing) to receive this medication, as it is being grossly overprescribed, then leading to stimulant-dependent healthcare providers. All of these issues are equally important and need to be addressed.

  2. Wholly agree with the content…adding that it isn’t only opioids. There are millions of addicts who present with methamphetamine use disorders connected to the overprescribing of Adderall and other pharmaceutical stimulants by both psychiatrists and MD’s. Additionally, a high percentage of each of these two are co-occurring with each other, and/or with another substance like alcohol or cannabis. Almost all have a trauma, sexual, and/or mental health crisis component. The focus on opioids is a hot trend in both the media and medical journals, but the whole scope of addiction medicine encompasses a much wider range of substances and issues…opioids and stimulants being most prominent in equal amounts. Both opioids and stimulants kill via overdose, but all of these are trauma related.

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