One of the barriers for health care providers responding to the opioid crisis in Michigan is a shortage of doctors trained in addiction medicine.
A July report by Ann Arbor-based research firm Altarum that examined Michigan’s behavioral health system reported that just one-fifth of the estimated 638,000 people in the state with substance abuse disorder received treatment. People with opioid use disorder account for about one-third of those unmet needs, according to Altarum.
The demand contrasts with the 200 addictive medicine specialists practicing in Michigan, far less than what’s needed to address the opioid crisis. As well, none of those specialists are in the Upper Peninsula.
“We literally don’t have enough doctors equipped to deal with this epidemic,” said Dr. Cara Poland, a physician with the Spectrum Health Medical Group who is board certified in addiction medicine. “I think that’s definitely contributed to the devastation of the epidemic.”
To address the shortage, Michigan State University, the University of Michigan and Wayne State University joined with Grand Rapids-based Spectrum Health to train and certify more physicians in addiction medicine. Michigan CARES — short for Collaborative Addiction Resources and Education System — offers a streamlined, alternative process that uses online curriculum, clinical experience, and technical support for physicians applying to take the board exam to earn certification.
In a typical year, some 40 percent to 60 percent of submitted exam applications get returned by the American Board of Addiction Medicine, a subspecialty of the American Board of Preventive Medicine, because they are not filled out properly or lack the level of detail required, Poland said.
Backed by a $1.5 million, two-year state grant, Michigan CARES launched in January and has since helped three physicians achieve certification in addiction medicine. Another 43 physicians in Michigan are presently enrolled in Michigan. Three physicians located in other states also are in the program.
According to Poland, the Michigan CARES program continues to attract interest from new doctors.
“Just about every week we have a few more that are registering,” Poland said.
Poland co-leads Michigan CARES with Kelly Strutz, an epidemiologist and assistant professor at MSU’s College of Human Medicine. They collaborate with Edward Jouney, a clinical instructor and program director for the UM Addiction Psychiatry Fellowship Program, and Mark Greenwald, a professor who leads Wayne State’s Substance Abuse Research Division.
While the primary driving force behind Michigan CARES has been the opioid crisis, physicians receiving the training to become board certified in addiction medicine are taught to treat other addictions, including methamphetamines, stimulants and alcohol.
The online training program has no limit for how many physicians can enroll, Strutz added.
“We really don’t have a ceiling. We’re happy to have more,” she said. “We’re excited to have 49 and more is even better.”
Organizers of Michigan CARES are already talking to counterparts elsewhere about the potential to expand or replicate the program nationally, said Poland, who’s also an assistant professor at the MSU College of Human Medicine.
The U.S. now has about 4,000 physicians certified in addiction medicine and needs another 7,000 in the next few years to address the present need, Poland said.
“This is absolutely the beginning of what we hope to do much broader,” said Poland, who sees part of the shortage resulting from addiction medicine’s lack of a lengthy history as a medical specialty.
“We’re kind of in this period of history where we have a bona fide need and addiction doesn’t have that long-standing history of being recognized as a specialty in the way cardiology, pulmonology or internal medicine (have been),” she said.
The grant funding for Michigan CARES comes from the U.S. Substance Abuse and Mental Health Services Administration through the Michigan Department of Health and Human Services.