Addiction Medicine Training Research Articles

Educational Studies Examining Knowledge of Substance Use Disorders and Career Aspirations Among Medical Trainees in an Inner-City Hospital.

Gaps in addiction medicine training are a reason for poor substance use care in North America. Hospital addiction medicine consult services (AMCS) provide critical medical services, including screening and treatment of substance use disorders. Although these programs often feature an educational component for medical learners, the impact of AMCS teaching on objective knowledge and career aspirations in addiction medicine has not been well described. The authors report findings from two sequential studies conducted at a large academic hospital in Vancouver, Canada. The first study assessed the impact of an AMCS clinical rotation on medical trainee addiction medicine objective knowledge using an online survey of 6 true/false questions before and after the rotation. The second study examined the impact of an AMCS rotation on career aspirations using 4 seven-point Likert-type questions. One-sample t tests on mean differences (MD) with Benjamini-Hochberg adjustment for multiple comparisons were employed for statistical analyses. Between May 2017 and June 2018, knowledge scores were significantly higher postrotation (MD = 4.78, standard deviation [SD] = 19.5, P = 0.034) among 115 medical trainees. Between July 2018 and July 2019, aspirations to practice addiction medicine were significantly more favorable postrotation (MD = 3.48, SD = 3.15, P < 0.001) among 101 medical trainees. AMCS rotations appear to improve addiction medicine knowledge and aspirations to practice addiction medicine among medical trainees. Larger-scale evaluations and outcomes research on integrating substance use disorders teaching in these settings will help move the discipline forward.

Opioid Substitution Treatment in Germany: Physicians' View on the Effects of the 3rd Revision of the Narcotic Drugs Prescription Ordinance

ZusammenfassungZiel der Studie Die weltweit effektivste Behandlungsform der Opioidabhängigkeit ist die Substitutionsbehandlung mit Opioiden (Opioidsubstitutionstherapie – OST). Diese Therapieform ist auch in Deutschland etabliert. Jedoch bestehen Versorgungslücken, v. a. in ländlichen Gebieten und einzelnen Bundesländern, was auf eine abnehmende Anzahl substituierender ÄrztInnen zurückzuführen ist. Mit der 3. Verordnung zur Änderung der Betäubungsmittel-Verschreibungsverordnung (3. BtMVVÄndV) in 2017 wurden ärztlich-therapeutische Aufgaben der OST in die Richtlinienkompetenz der Bundesärztekammer überführt. Die umfassende Reform der Rahmenbedingungen der OST führt zu einer stärkeren Rechtssicherheit dieser Behandlungsform. Die vorliegende Studie zielt darauf ab, die Auswirkungen der 3. BtMVVÄndV aus der Behandelndenperspektive zu analysieren. Methode Ein Fragebogen zu individuellen Erfahrungen mit den Veränderungen durch die 3. BtMVVÄndV wurde zwischen August und Dezember 2019 an 2503 substituierende ÄrztInnen in Deutschland sowie an 563 nicht oder länger nicht mehr substituierende ÄrztInnen in Hamburg, Bayern, Nordrhein-Westfalen sowie Sachsen verschickt. Die Versendung erfolgte über die Bundesopiumstelle sowie die Kassenärztlichen Vereinigungen der ausgewählten Bundesländer. Die Auswertung differenziert zwischen substituierenden ÄrztInnen mit und ohne suchtmedizinische Weiterbildung sowie zwischen städtischen und ländlichen Kreisen. Ergebnisse Die Rücklaufquote substituierender ÄrztInnen lag bei 34,1%. Das Durchschnittsalter betrug 57,9 (± 8,7) Jahre und 64,5% waren männlich. Aus substitutionsärztlicher Sicht waren die relevantesten Änderungen der 3. BtMVVÄndV keine zeitliche Vorgabe für das Erreichen einer Opioidabstinenz (85,3%), die neue Bewertung und Behandlung des Konsums weiterer psychotroper Substanzen (71,0%), die Möglichkeit, die Take-Home-Verordnung auf 30 Tage auszudehnen (70,0%) sowie die größere Rechtssicherheit (66,2%). Die Ausweitung der Konsiliarbehandlung auf 10 PatientInnen erfuhr mit 14,8% wenig Zustimmung. 36,7% sah die Versorgung substituierter PatientInnen weder aktuell noch zukünftig gesichert. Schlussfolgerung Die Neuerungen durch die 3. BtMVVÄndV wurden positiv aufgenommen und hinsichtlich der erhöhten Rechtssicherheit und therapeutischen Freiheiten als relevant eingestuft. Informationsbedarf besteht in ländlichen Gebieten, bei substituierenden ÄrztInnen ohne suchtmedizinische Weiterbildung sowie bei ÄrztInnen, die in der Vergangenheit substituierten, es aktuell jedoch nicht mehr tun.

Residency Setting Association With Resident Substance Use Disorder Training: A CERA Secondary Data Analysis.

As the opioid crisis worsens across the United States, the factors that impact physician training in management of substance use disorders become more relevant. A thorough understanding of these factors is necessary for family medicine residency programs to inform their own residency curricula. The objective of our study was to identify factors that correlate with increased residency training in addiction medicine across a broad sample of family medicine residencies. We performed secondary analysis of a national family medicine residency program director survey conducted in 2015-2016 (CERA Survey PD-8). We obtained data from the Council of Academic Family Medicine Educational Research Alliance (CERA) Data Clearinghouse. We analyzed residency clinic site designation as a patient-centered medical home (PCMH), federally-qualified health center (FQHC), or both, for their correlation with faculty member possession of DEA-X buprenorphine waiver license, as well as required residency curriculum in addiction medicine. Residency programs situated in an FQHC were more likely to have faculty members who possessed DEA-X buprenorphine waiver licenses (P=.025). Residency clinics that were both a PCMH as well as an FQHC also correlated strongly (P=.001). Furthermore, residencies with faculty who possessed a DEA-X license were significantly more likely to have a required curriculum in addiction medicine (P=.002). Our quantitative secondary analysis of CERA survey data of family medicine residency program directors revealed that resident training in addiction medicine is strongly correlated with both residency clinic setting (FQHC or FQHC/PCMH) as well as residency faculty possession of DEA-X licenses.

Addiction Medicine Training Fellowships in North America: A Recent Assessment of Progress and Needs.

Although unhealthy substance use and addiction contribute to 1 in 4 deaths and are estimated to cost the US more than $740 billion annually, fewer than 12 hours of physician education over the 7 years of medical school and primary residency training specifically address alcohol and other drug-related issues. Addiction Medicine was formally recognized as a medical subspecialty in 2016 to address the need for physicians trained in prevention, treatment, and management of substance use. This study examines the characteristics of the Addiction Medicine fellowships in operation during this critical period in the subspecialty's development to identify needs and potential. This study is a cross-sectional survey of Addiction Medicine Fellowship Directors from 46 fellowships accredited as of 2017 (43 in the United States and 3 in Canada). The response rate was 100%. Directors estimated significant growth in available fellowship slots between 2016 to 2017 and 2017 to 2018 (F = 49.584, P < .001). The majority of Directors reported that demand for their graduates was high (79.5%). Fellow training in screening, brief intervention, and referral to treatment spanned many substances and age groups, although fewer programs focused on nicotine and on adolescent populations. Notably, most directors reported that graduates completed waiver training to prescribe buprenorphine-naloxone (77.5%) and gained clinical experience in an opioid treatment setting (89.1%). Funding was the #1 need among 56.8% of Directors. Despite significant growth in Addiction Medicine fellowships over the past 6 years, meeting future workforce demands for Addiction Medicine specialists depends on access to funding to support fellowships.

Models of Resident Physician Training in Opioid Use Disorders

Medications for addiction treatment (MAT) are the standard of care for treating opioid use disorder (OUD) and reducing overdose deaths, yet demand for MAT providers has outstripped supply in the USA. Public policy and graduate medical education (GME) leaders have called for increased focus on addiction medicine training for resident physicians to mitigate this provider gap. We sought to characterize the current state of OUD training at the GME level by reviewing published literature on GME educational interventions designed to enhance the care of patients with OUD. We identified 31 articles describing 29 unique interventions. The majority of these articles detailed specific, reproducible interventions with outcomes, and tended to focus on training resident physicians in behavioral approaches to treat OUD, rather than MAT. Fewer than half of interventions involved direct patient care. MAT training is under-represented within the current landscape of educational interventions, despite MAT being the standard of care for OUD.

Hospital-Based Addiction Medicine Healthcare Providers: High Demand, Short Supply.

: Substance use disorders account for a significant burden of disease and place an enormous strain on the health care system in the United States and beyond. Despite death tolls climbing, a myriad of evidence-based medications exist to effectively treat many substance use disorders including nicotine, alcohol, and opioid use disorders. To date, hospitals have largely been overlooked as a setting ripe for the delivery of specialized addiction care. This occurs despite a high lifetime prevalence of a substance use disorder (50%) occurring among hospitalized individuals. A potential barrier to this is the lack of addiction medicine training that currently exists in undergraduate and graduate medical education. Consequently, a paucity of existing physicians report feeling competent to adequately screen for, diagnose or treat substance use disorders. Given the prevalence, cost and potentially lethal consequences of substance use disorders, a critical need exists to improve its identification and evidence-based management in hospital settings.

Development and Evaluation of the Online Addiction Medicine Certificate: Free Novel Program in a Canadian Setting.

BackgroundDespite the enormous bur­den of disease attributable to drug and alcohol addiction, there remain major challenges in implementing evi­dence-based addiction care and treatment modalities. This is partly because of a persistent lack of accessible, specialized training in addiction medicine. In response, a new online certificate in addiction medicine has been established in Vancouver, Canada, free of charge to participants globally.ObjectiveThe objective of this study was to evaluate and examine changes in knowledge acquisition among health care professionals before and after the completion of an online certificate in addiction medicine.MethodsLearners enrolled in a 17-module certificate program and completed pre- and postknowledge tests using online multiple-choice questionnaires. Knowledge acquisition was then evaluated using a repeated measures t test of mean test scores before and after the online course. Following the certificate completion, a subset of learners completed the online course evaluation form.ResultsOf the total 6985 participants who registered for the online course between May 15, 2017 and February 22, 2018, 3466 (49.62%) completed the online pretest questionnaire. A total of 1010 participants completed the full course, achieving the required 70% scores. TThe participants self-reported working in a broad range of health-related fields, including nursing (n=371), medicine (n=92), counseling or social work (n=69), community health (n=44), and pharmacy (n=34). The median graduation year was 2010 (n=363, interquartile range 2002-2015). Knowledge of the addiction medicine increased significantly postcertificate (mean difference 28.21; 95% CI 27.32 to 29.10; P<.001). Physicians scored significantly higher on the pretest than any other health discipline, whereas the greatest improvement in scores was seen in the counseling professions and community outreach.ConclusionsThis free, online, open-access certificate in addiction medicine appeared to improve knowledge of learners from a variety of disciplines and backgrounds. Scaling up low threshold learning opportunities may further advance addiction medicine training, thereby helping to narrow the evidence-to-practice gap.

In-hospital training in addiction medicine: A mixed-methods study of health care provider benefits and differences

Background: Hospital-based clinical addiction medicine training can improve knowledge of clinical care for substance-using populations. However, application of structured, self-assessment tools to evaluate differences in knowledge gained by learners who participate in such training has not yet been addressed. Methods: Participants (n = 142) of an elective with the hospital-based Addiction Medicine Consult Team (AMCT) in Vancouver, Canada, responded to an online self-evaluation survey before and immediately after the structured elective. Areas covered included substance use screening, history taking, signs and symptoms examination, withdrawal treatment, relapse prevention, nicotine use disorders, opioid use disorders, safe prescribing, and the biology of substance use disorders. A purposefully selected sample of 18 trainees were invited to participate in qualitative interviews that elicited feedback on the rotation. Results: Of 168 invited trainees, 142 (84.5%) completed both pre- and post-rotation self-assessments between May 2015 and May 2017. Follow-up participants included medical students, residents, addiction medicine fellows, and family physicians in practice. Self-assessed knowledge of addiction medicine increased significantly post-rotation (mean difference in scores = 11.87 out of the maximum possible 63 points, standard deviation = 17.00; P < .0001). Medical students were found to have the most significant improvement in addiction knowledge (estimated mean difference = 4.43, 95% confidence interval = 0.76, 8.09; P = .018). Illustrative quotes describe the dynamics involved in the learning process among trainees. Conclusions: Completion of a hospital-based clinical elective was associated with improved knowledge of addiction medicine. Medical students appear to benefit more from the addiction elective with a hospital-based AMCT than other types of learners.

Excellent reliability and validity of the Addiction Medicine Training Need Assessment Scale across four countries

BackgroundAddiction is a context specific but common and devastating condition. Though several evidence-based treatments are available, many of them remain under-utilized, among others due to the lack of adequate training in addiction medicine (AM). AM Training needs may differ across countries because of difference in discipline and level of prior AM training or contextual factors like epidemiology and availability of treatment. For appropriate testing of training needs, reliability and validity are key issues. The aim of this study was to evaluate the psychometric properties of the AM-TNA Scale: an instrument specifically designed to develop the competence-based curriculum of the Indonesian AM course. MethodsIn a cross-sectional study in Indonesia, Ireland, Lithuania and the Netherlands the AM-TNA was distributed among a convenience sample of health professionals working in addiction care in The Netherlands, Lithuania, Indonesia and General Practitioners in-training in Ireland. 428 respondents completed the AM-TNA scale. To assess the factor structure, we used explorative factor analysis. Reliability was tested using Cronbach's Alpha, ANOVA determined the discriminative validity. ResultsValidity: factor analysis revealed a two-factor structure: One on providing direct patient treatment and care (Factor 1: clinical) and one factor on facilitating/supporting direct patient treatment and care (Factor 2: non-clinical) AM competencies and a cumulative 76% explained variance. Reliability: Factor 1 α = 0.983 and Factor 2: α = 0.956, while overall reliability was (α = 0.986). The AM-TNA was able to differentiate training needs across groups of AM professionals on all 30 addiction medicine competencies (P = .001). ConclusionsIn our study the AM-TNA scale had a strong two-factor structure and proofed to be a reliable and valid instrument. The next step should be the testing external validity, strengthening discriminant validity and assessing the re-test effect and measuring changes over time.

Patients With Substance Use Disorders Leaving Against Medical Advice: Strategies for Improvement.

: In this issue of the Journal of Addiction Medicine, 2 studies fill an important gap in knowledge by examining predictors of leaving against medical advice from inpatient withdrawal management settings. The studies identify important risk factors for leaving against medical advice and highlight important areas for inpatient withdrawal management. These include the use of substance specific standardized protocols and initiation of opioid agonist treatment instead of opioid detoxification given harms associated with opioid withdrawal. Further need for increased training in addiction medicine for primary care physicians, and use of inpatient addiction medicine consult services as part of early intervention for substance withdrawal are also discussed.

Training in office-based opioid treatment with buprenorphine in US residency programs: A national survey of residency program directors

ABSTRACTBackground: The prevalence of opioid use disorder (OUD) has increased sharply. Office-based opioid treatment with buprenorphine (OBOT) is effective but often underutilized because of physicians' lack of experience prescribing this therapy. Little is known about US residency training programs' provision of OBOT and addiction medicine training. Methods: The authors conducted a survey of residency program directors (RPDs) at all US residency programs in internal medicine, family medicine, and psychiatry to assess the frequency with which their residents provide care for OUD, presence and features of curricula in OBOT and addiction medicine, RPDs' beliefs about OBOT, and potential barriers to providing OBOT training. Results: The response rate was 49.5% (476 of 962). Although 76.9% of RPDs reported that residents frequently manage patients with OUD, only 23.5% reported that their program dedicates 12 or more hours of curricular time to addiction medicine, 35.9% reported that their program encourages/requires training in OBOT, and 22.6% reported that their program encourages/requires obtaining a Drug Enforcement Administration (DEA) waiver to prescribe buprenorphine. Most RPDs believe that OBOT is an important treatment option for OUD (88.1%) and that increased residency training in OBOT would improve access to OBOT (73.7%). The authors also found that programs whose RPD had favorable views of OBOT were more likely to provide OBOT and addiction medicine training. Psychiatry programs were most likely to provide OBOT training and their RPDs most likely to have beliefs about OBOT that were positive. Commonly cited barriers to implementing OBOT training include a lack of waivered preceptors (76.9%), competing curricular priorities (64.1%), and a lack of support (social work and counseling) services (54.0%). Conclusions: Internal medicine, family medicine, and psychiatry residents often care for patients with OUD, and most RPDs believe that increased residency training in OBOT would increase access to this treatment. Yet, only a minority of programs offer training in OBOT.

The Opioid Epidemic as a Watershed Moment for Physician Training in Addiction Medicine.

The Opioid Epidemic as a Watershed Moment for Physician Training in Addiction Medicine.

Surveys of substance use disorders education in US pharmacy programs.

Introduction:Substance use disorders (SUDs) are a significant US health problem affecting roughly 20 million Americans, but there continues to be limited access to SUD treatment and inadequate addiction medicine training. Therefore, it is important to understand how SUD education is being delivered to US health professionals, including pharmacists.Methods:A recent survey of US pharmacy programs' neuropsychiatry curricula was evaluated to identify any progress made toward increasing SUD education since the last national survey in 2004 and determine any remaining gaps between what is currently being taught and American Association of Colleges of Pharmacy (AACP) curricular guidelines for SUD education updated in 2010. A survey of psychiatric pharmacists, regarding what they thought should be taught, was also evaluated and compared with the 2010 AACP curricular guidelines.Results:Our survey of US pharmacy programs demonstrated that 94% of programs reported teaching SUD content in 2014-15, which has increased from 81% reported in a survey study from 2004. There was also an increase for average hours of SUD didactic instruction, which increased from 2.2 hours in 2004 to 2.7 hours in 2015. The majority of members (84%) recommended at least 2 hours of SUD instruction, and 27% recommended teaching ≥4 hours.Discussion:There was an overall increase in SUD instruction, but the average hours taught still falls short of 2010 AACP curricular guideline recommendation suggesting ≥4 hours. Furthermore, a majority of the psychiatric pharmacists we surveyed did not agree with the AACP curricular guideline recommendation because only 27% of members recommended ≥4 hours of SUD instruction, and the average hours recommended was only 2.7 hours.

Barriers and facilitators to implementing addiction medicine fellowships: a qualitative study with fellows, medical students, residents and preceptors

BackgroundAlthough progress in science has driven advances in addiction medicine, this subject has not been adequately taught to medical trainees and physicians. As a result, there has been poor integration of evidence-based practices in addiction medicine into physician training which has impeded addiction treatment and care. Recently, a number of training initiatives have emerged internationally, including the addiction medicine fellowships in Vancouver, Canada. This study was undertaken to examine barriers and facilitators of implementing addiction medicine fellowships.MethodsWe interviewed trainees and faculty from clinical and research training programmes in addiction medicine at St Paul’s Hospital in Vancouver, Canada (N = 26) about barriers and facilitators to implementation of physician training in addiction medicine. We included medical students, residents, fellows and supervising physicians from a variety of specialities. We analysed interview transcripts thematically by using NVivo software.ResultsWe identified six domains relating to training implementation: (1) organisational, (2) structural, (3) teacher, (4) learner, (5) patient and (6) community related variables either hindered or fostered addiction medicine education, depending on context. Human resources, variety of rotations, peer support and mentoring fostered implementation of addiction training. Money, time and space limitations hindered implementation. Participant accounts underscored how faculty and staff facilitated the implementation of both the clinical and the research training.ConclusionsImplementation of addiction medicine fellowships appears feasible, although a number of barriers exist. Research into factors within the local/practice environment that shape delivery of education to ensure consistent and quality education scale-up is a priority.

Addiction Research Training Programs: Four Case Studies and Recommendations for Evaluation.

: The presence of structured addiction research training programs helps to ensure that the scientific workforce includes well-trained, diverse scientists necessary to reduce the negative impact of alcohol, drug, and tobacco use disorders. Although the field has made significant progress in the development of standards for clinical training in addiction medicine, there remains significant room for improvement in the training of addiction researchers, and also opportunities to synergize across addiction research training programs. The purpose of this commentary is to describe 4 National Institutes of Health (NIH)-sponsored addiction research training programs, highlight critical components, and provide recommendations for more comprehensive and effective program evaluation. Moving forward, evaluation of addiction research training programs would be enhanced by the use of conceptual models to inform process and outcome evaluations, the application of innovative methods to ensure long-term data collection, the improvement of mentorship evaluation measures, and the integration of training methods from other fields of study. We encourage NIH and others in the field to be proactive in establishing core metrics for evaluation across programs. Furthermore, centralized tracking of NIH-funded addiction research trainees, analysis of aggregate data across programs, and innovative methods to effectively disseminate program materials and processes are recommended.

P098: Addiction medicine training in Canadian emergency medicine residency programs: a needs assessment survey

Introduction: Emergency department visits related to substance use are becoming more serious and increasingly costly in Canada. Emergency physicians must be able to effectively screen, manage, refer, and advocate for these complex patients. This study sought to describe the current state of addiction medicine training in Canadian emergency medicine (EM) residency programs and to assess the need for a formal curriculum. Methods: All Royal College and College of Family Physicians EM Program Directors (PDs) were asked to participate in a ten-question needs assessment survey on addiction medicine training for residents. Questions were developed through consensus after reviewing the relevant literature and conducting a formal pilot survey with staff physicians experienced in survey methodology. Responses were collected securely using the Research Electronic Data Capture (REDCap) database. Results: 19 out of 31 (62%) eligible PDs completed the survey. The importance of addiction medicine training received a median score of 69.5 (IQR=74.0) on a scale of 1-100. Most programs devoted two hours or less per year of formalized teaching on individual topics (such as opioids, alcohol, harm reduction) over the past two academic years. The two most common teaching modalities used were didactic lectures (15/19, 78.9%) and case-based tutorials (12/19, 63.2%). Case-based tutorials were identified as the most effective teaching method (12/19, 63.2%). Topics highlighted as most important to include in a curriculum were: screening for substance use disorders and referral for further treatment (14/19, 73.7%), social determinants of health (14/19, 73.7%), alcohol, opioid, and stimulant intoxication and/or withdrawal (14/19, 73.7% each), and management of patients on opioid agonist therapy (14/19, 73.7%). The most commonly perceived barriers to implementing such a curriculum were insufficient curriculum time (10/19, 52.6%) and lack of qualified teaching staff (7/19, 36.8%). Conclusion: This needs assessment provides an understanding of the current state of addiction medicine training for EM residents in Canada. A case-based addiction medicine workshop is currently being developed to address identified curriculum gaps. Integrating this curriculum longitudinally into a time-constrained academic schedule is an important next step.

Two birds with one stone: experiences of combining clinical and research training in addiction medicine

BackgroundDespite a large evidence-base upon which to base clinical practice, most health systems have not combined the training of healthcare providers in addiction medicine and research. As such, addiction care is often lacking, or not based on evidence or best practices. We undertook a qualitative study to assess the experiences of physicians who completed a clinician-scientist training programme in addiction medicine within a hospital setting.MethodsWe interviewed physicians from the St. Paul’s Hospital Goldcorp Addiction Medicine Fellowship and learners from the hospital’s academic Addiction Medicine Consult Team in Vancouver, Canada (N = 26). They included psychiatrists, internal medicine and family medicine physicians, faculty, mentors, medical students and residents. All received both addiction medicine and research training. Drawing on Kirkpatrick’s model of evaluating training programmes, we analysed the interviews thematically using qualitative data analysis software (Nvivo 10).ResultsWe identified five themes relating to learning experience that were influential: (i) attitude, (ii) knowledge, (iii) skill, (iv) behaviour and (v) patient outcome. The presence of a supportive learning environment, flexibility in time lines, highly structured rotations, and clear guidance regarding development of research products facilitated clinician-scientist training. Competing priorities, including clinical and family responsibilities, hindered training.ConclusionsCombined training in addiction medicine and research is feasible and acceptable for current doctors and physicians in training. However, there are important barriers to overcome and improved understanding of the experience of addiction physicians in the clinician-scientist track is required to improve curricula and research productivity.

A Needs Assessment of the Number of Comprehensive Addiction Care Physicians Required in a Canadian Setting.

Medical professionals adequately trained to prevent and treat substance use disorders are in short supply in most areas of the world. Whereas physician training in addiction medicine can improve patient and public health outcomes, the coverage estimates have not been established. We estimated the extent of the need for medical professionals skilled in addiction medicine in a Canadian setting. We used Monte-Carlo simulations to generate medians and 95% credibility intervals for the burden of alcohol and drug use harms, including morbidity and mortality, in British Columbia, by geographic health region. We obtained prevalence estimates for the models from the Medical Services Plan billing, the Discharge Abstract Database data, and the government surveillance data. We calculated a provider availability index (PAI), a ratio of the size of the labor force per 1000 affected individuals, for each geographic health region, using the number of American Board of Addiction Medicine certified physicians in each area. Depending on the data source used for population estimates, the availability of specialized addiction care providers varied across geographic health regions. For drug-related harms, we found the highest PAI of 23.72 certified physicians per 1000 affected individuals, when using the Medical Services Plan and Discharge Abstract Database data. Drawing on the surveillance data, the drug-related PAI dropped to 0.46. The alcohol-related PAI ranged between 0.10 and 86.96 providers, depending on data source used for population estimates. Our conservative estimates highlight the need to invest in healthcare provider training and to develop innovative approaches for more rural health regions.

Attitudes towards substance use and substance use disorders among medical students in Israel

Background: Negative attitudes towards substance use and Substance Use Disorders (SUDs) are among the commonly cited barriers to screening and treating these disorders by physicians. These negative attitudes have also been reported in medical students. The aim of this study was to examine attitudes of medical students in Israel towards nicotine, alcohol and drug use and SUDs based on their stage of training and personal experience. Methods: A sample of 329 medical students responded to the Attitudes Towards Substance Use questionnaire, which includes 50 questions regarding substance use and SUDs, as well as specific questions focusing on nicotine, alcohol, cannabis and heroin use. Results: Students at the clinical phase of their training had higher rates of moralism and lower rates of self-reported competency in treating SUDs compared to those in the pre-clinical phase of training. Personal experience with nicotine or alcohol use, as well as having a friend who suffers from addiction, were associated with lower rates of moralism. Across substances, the lowest ratings of treatment efficacy and of self-reported competence, were directed towards alcohol dependence. Conclusions: Medical education programs should include training in addiction medicine throughout all phases of medical school. This may have a significant role in future physicians’ attitudes towards individuals with substance use and SUDs, and eventually in the treatment these patients receive.

LO033: Attitudes of emergency physicians towards homeless and substance using patients

Introduction: Patients who are homeless and/or using substances rely heavily on emergency departments (ED) for medical care, and present with complex medical and social needs. Negative physician attitudes towards this population undermine the therapeutic relationship, compromising the quality of medical care provided. The objective of this study was to determine the attitudes of emergency physicians towards homeless and substance-using patients. Methods: Using a Modified Total Design approach, we conducted a cross-sectional survey of emergency physicians at five different healthcare locations in Calgary, Alberta, Canada. Attitudes were assessed using two validated measures, the Health Care Providers Attitudes Towards the Homeless Inventory (HPATHI), and the Short Understanding of Substance Use Scale (SUSS). Surveys were self-administered by respondents between March and December 2013. Results: A total of 117 physicians completed the survey (response rate 48%). 28% of respondents resented the amount of time it takes to see homeless patients, and 32% believed caring for homeless patients was not financially viable; 57% felt overwhelmed by the complexity of problems that homeless people have. Physicians with extra training in addiction medicine or health care for the homeless had more positive attitudes than physicians with no extra training; physician attitudes worsened over time towards both populations. Conclusion: Physicians feel overwhelmed when caring for patients who are homeless and/or substance using and negative attitudes worsened over time. Extra training in addiction medicine or healthcare for the homeless is associated with more positive attitudes. Possible strategies to improve attitudes should include a multifaceted approach addressing individual physician knowledge deficits, as well as expanded access to resources in the ED and community, designed to deal with the complex needs of these populations.