To the Editor:
In March 2019, the National Academies of Sciences, Engineering, and Medicine released a consensus committee report entitled Medications for Opioid Use Disorder Save Lives.1 The report found that “To stem the opioid crisis, it is critical for all FDA-approved options to be available for all people with opioid use disorder.” The 3 current approved medications (methadone, buprenorphine and naltrexone) are available in multiple formulations, including long-acting implants and injectables, and all except methadone are usually prescribed in a physician's office. The report found that a major barrier to medication use is “the lack of appropriate education and training among health care providers.”
The Accreditation Council for Graduate Medical Education (ACGME) plays an essential role in educating and training physicians. Currently, none of the ACGME's curriculum components require that physicians-in-training learn to treat opioid addiction. At present, fewer than 7% of American physicians have completed the necessary 8-hour DATA waiver training to allow them to prescribe buprenorphine for opioid use disorder, a medication associated with a 50% or greater reduction in the probability of overdose death.Reference Sordo, Barrio and Bravo2 An ACGME requirement for such training in the over 11,000 programs they accredit would dramatically improve the nation's capacity to address the opioid epidemic and begin to close enormous gaps in training with respect to addiction more generally.
In recent months, a group of medical students and faculty have asked the ACGME residency review committees to consider requiring training in addiction treatment for residents.Reference Sharfstein and Olsen3 None have agreed to date. A recent JAMA blog posting set out the case for ACGME leadership; the response has been a willingness to consider the question further.4 A bipartisan group of 31 members of the US Congress has also asked the ACGME to require that all physicians-in-training who care for patients with opioid use disorder learn to treat opioid addiction.5
We ask that the ACGME act promptly and establish a requirement that all residents and fellows who care for patients who use opioids, as well as their core faculty, receive specific training on the treatment of opioid use disorder. This is a defining moment for American medicine. It is our obligation to provide physicians with sufficient training to effectively treat patients with opioid use disorder.
We are writing to urge health care professionals to sign on to this letter at www.AddictionTrainingFor-Residents.org.
Signatories:
Josiah D. Rich, MD, MPH
Professor of Medicine and Epidemiology
Brown University
Eli Y. Adashi, MD, MS, CPE, FACOG
Professor of Medical Science Former Dean of Medicine and Biological Sciences
Brown University
Jia Ahmad, MPH
Medical Student Johns Hopkins School of Medicine
Daniel P. Alford, MD, MPH
Professor of Medicine Associate Dean, Continuing Medical Education
Boston University School of Medicine/Boston Medical Center
Scott A. Allen, MD, FACP
Professor Emeritus, Clinical Medicine University of California, Riverside Medical Director
The Access Clinic, Borrego Health
Frederick L. Altice, MD, MA
Professor of Medicine and Public Health
Yale University
Katrina Armstrong, MD
Physician-in-Chief, Department of Medicine
Massachusetts General Hospital
Monica Bharel, MD, MPH
Commissioner
Massachusetts Department of Public Health
John M. Carethers, MD, MACP
C. Richard Boland Distinguished University Professor
John G. Searle Professor and Chair, Department of Internal Medicine Professor, Human Genetics
University of Michigan
Chinazo Cunningham, MD, MS
Professor, Departments of General Internal Medicine, Family and Social Medicine, and Psychiatry and Behavioral Sciences
Associate Chief, Division of General Internal Medicine
Albert Einstein College of Medicine
Paul H. Earley, MD, DFASAM
President, The American Society of Addiction Medicine
Jack A. Elias, MD
Senior Vice President for Health Affairs
Dean of Medicine and Biological Sciences Frank L. Day Professor of Biology Professor of Medicine
Brown University
David Fiellin, MD
Professor of Medicine, Emergency Medicine, and Public Health
Professor of Investigative Medicine Director, Yale Program in Addiction Medicine
Director, Health Services and Research Core, Center for Interdisciplinary Research on AIDS Yale School of Public Health
Traci Green, PhD, MSc
Associate Professor, Emergency Medicine
Associate Director & Senior Scientist, Injury Prevention Research Center Boston University Medical Center, Emergency Medicine
Shelly F. Greenfield, MD, MPH
President, American Academy of Addiction Psychiatry Kristine M. Trustey Endowed Chair in Psychiatry
Chief Academic Officer, McLean Hospital Chief, Division of Women's Mental Health
Professor of Psychiatry, Harvard Medical School
Director, Clinical and Health Services Research and Education
Division of Alcohol and Drug Abuse McLean Hospital
Keith Humphreys, PhD
Esther Ting Memorial Professor of Psychiatry, Stanford University
Former Senior Policy Advisor, White House Office of National Drug Control Policy
Gerald T. Keusch, MD
Professor, Medicine and International Health
Associate Director, National Emerging Infectious Diseases Laboratories
Director, Collaborative Research Core Boston University
Alan I. Leshner, PhD
Former Director, National Institute on Drug Abuse
National Institutes of Health
David C. Lewis, MD
Professor Emeritus of Community Health and Medicine
Founder of the Center for Alcohol and Addiction Studies
Brown University
Wei Sum Li, MD
Chief Medical Resident Brown University, Warren Alpert Medical School
Joseph Loscalzo, MD, PhD
Senior Physician, Brigham and Women's Hospital
Head of the Department of Medicine at Brigham & Women's Hospital Harvard Medical School
Paula J. Lum, MD, MPH
Professor of Medicine Program Director, UCSF Primary Care Addiction Medicine Fellowship University of California, San Francisco San Francisco General Hospital
Yngvild Olsen, MD, MPH
Medical Director, Institutes for Behavior Resources, Inc.
Vice President of the American Society of Addiction Medicine
Michael S. Parmaceck, MD
Frank Wister Thomas Professor of Medicine
Chair, Department of Medicine Raymond and Ruth Perelman School of Medicine
University of Pennsylvania
Richard Saitz, MD, MPH
Chair, Department of Community Health Sciences (CHS) Professor of Community Health Sciences & Medicine
Boston University School of Public Health
Boston Medical Center
Jeffrey H. Samet, MD, MA, MPH
Chief, General Internal Medicine John Noble Professor in General Internal Medicine & Professor of Public Health
Boston University Schools of Medicine & Public Health
Boston Medical Center
Dean Schillinger, MD
UCSF Professor of Medicine Chief, UCSF Division of General Internal Medicine
San Francisco General Hospital and Trauma Center
Joshua M. Sharfstein, MD
Vice Dean for Public Health Practice and Community Engagement and Professor of Practice in Health Policy and Management
Johns Hopkins Bloomberg School of Public Health
Emma Simmons, MD, MPH
Salma Haider Endowed Chair Professor of Family Medicine Senior Associate Dean of Student Affairs
University of California Riverside School of Medicine
Jacqueline Tulsky, MD
Professor of Medicine, Emeritus UCSF HIV, ID and Global Medicine at ZSFG Clinician's Consultation Center – Substance use Warmline
Allan Tunkel, MD, PhD
Associate Dean for Medical Education Brown University, Warren Alpert Medical School
Sten H. Vermund, MD, PhD
Dean and Anna M.R. Lauder Professor of Public Health Yale School of Public Health Professor of Pediatrics Yale School of Medicine
Bob Wachter, MD
Professor and Chair Department of Medicine, UCSF
Sarah E. Wakeman, MD
Medical Director, Massachusetts General Hospital Substance Use Disorder Initiative
Program Director, Massachusetts General Hospital Addiction Medicine Fellowship Assistant Professor of Medicine, Harvard Medical School
Chief Medical Officer, RIZE Massachusetts
Alexander Walley, MD, MSc
Associate Professor of Medicine Director, Grayken Addiction Medicine Fellowship, Clinical Addiction Research and Education Unit
Boston Medical Center/Boston University School of Medicine
Alysse G. Wurcel, MD, MS
Assistant Professor, Division of Geographic Medicine and Infectious Diseases, Department of Medicine, Tufts Medical Center
October 8, 2019
To the Editor:
To address the opioid epidemic in the US, the ACGME is taking a leadership role to create sustainable solutions for the appropriate use of pain medication and the recognition and treatment of patients with addiction. The medical profession must work together to provide the resources and training necessary for physicians caring for patients to most effectively treat Opioid Use Disorder.
As of July 2019, the ACGME requires that all residency and fellowship programs “provide instruction and experience in pain management if applicable for the specialty including recognition of the signs of addiction.” As this is a core requirement, all specialty and subspecialty programs must provide, and all residents and fellows will receive this training. The ACGME is also providing resources to the graduate medical education community for this training on opioid use and treatment, which can be found here.
It is imperative that the medical community collaborate to address this issue. The ACGME is organizing a Congress of Medical Education Stakeholders in April 2020 to discuss the optimal curriculum for the education and training of residents and fellows on issues related to the treatment of addiction and management of pain. These stakeholders will include specialty societies, their certifying boards, program directors of ACGME-accredited programs, and the ACGME Review Committees, as well as representatives of the continuum of medical education. While the ACGME provides an educational framework for residency and fellowship programs, the curricula are the purview of the individual programs and their Sponsoring Institutions, and the relevant specialty societies and certifying boards. It will take a coordinated effort by all of these groups to effectively define the education and training needs for the entire medical community. The ACGME is taking the leadership role of convening and coordinating these efforts.
The ACGME is also financially supporting, a member of the steering committee, and co-chairing the National Academy of Medicine's Action Collaborative on Countering the US Opioid Epidemic Education and Training Work Group. This group is also working towards a coordinated approach for the continuum of health professional education that addresses acute and chronic pain management and substance use disorders. This continuum, which includes non-physician providers, begins in medical school for physicians, is developed during residency and fellowship training, and is enhanced throughout a physician's career.
Measures to provide resources and training to today's practicing physicians will have the most immediate impact on this epidemic. The ACGME strongly supports the removal of barriers to the use of these resources by all practicing physicians through changes in regulatory and payment policies. Currently, there is proposed legislation in the US Congress to improve access to these lifesaving therapies, which would allow physicians and other clinicians to immediately incorporate them into their practice.
The ACGME looks forward to continuing to work with the extended medical community to equip physicians with the full range of solutions needed to confront this epidemic.”
Sincerely,
Thomas J. Nasca, M.D., MACP President and CEO ACGME
