ANOTHER PIPE DREAM? –

March 10, 2023 – “Cheryl!” Both you and the patient are shocked by the harsh tone of your voice. There’s a pause where you both look down to the floor before you begin again, in a softer tone, “I see that in the last month, you’ve had four prescriptions filled from different emergency departments.”

“Doc, I had to! I ran out early again, and I was going to.”

“Cheryl, I’ve heard the excuses before. You have to go to rehab. At the rate you’re going, you’re going to die from this disease.”

“But I needed the insulin pens, doc. My sugars have been out of control. You said that my A1c was 12 last time. If you would just write me for a few pens, I know I can do it this time.”

“Cheryl, you have to go to diabetic rehab today.”

The idea of a primary care physician sending their patient to a quasi-medical facility for treatment of their type 2 diabetes seems absurd to us. No one would seriously suggest that a person with diabetes is better served by an inpatient stay in a poorly regulated, for-profit facility rather than their PCP’s office. But when it comes to substance use disorder, such treatment is sadly the norm.

There are few specialties of medicine more stigmatized than addiction medicine. Both patients and the physicians who attend to them are viewed with suspicion. To borrow a phrase from grade school, if I may, addiction medicine has “cooties.” Physicians turn away from patients with substance use disorder lest they be contaminated with these “cooties” in the eyes of their peers and society.

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