Canada should train doctors to specialize in addiction

published on August 20, 2012 by Dr. Evan Wood in The Globe and Mail

The following op-ed was written by Dr. Evan Wood.

As a Vancouver physician specializing in inner-city medicine, I’m regularly asked by friends and colleagues about what can be done to improve the situation in the city’s notorious Downtown Eastside. As the poorest urban neighbourhood in Canada, the area suffers from a range of poverty-associated conditions, including a serious HIV epidemic that emerged among drug addicts in the 1990s.

A fundamental issue is the high rate of untreated drug and alcohol addiction. While complaints about underfunding of the addiction-treatment system have been regularly voiced, one of the basic reasons for the problem will come as a shock to many.

Unlike virtually all other medical disciplines, which graduate an annual wave of specialist physicians from fellowship programs based within Vancouver’s university-affiliated hospitals, there is no fellowship training program in addiction medicine in the province.

The problem is typical of all Canadian provinces. In fact, although Ontario’s leading Centre for Addiction and Mental Health does place some emphasis on physician education, a patient with an addiction who walks into Ottawa Hospital, for example, cannot be treated by an addiction medicine specialist because there is none on staff. As a result, despite the fact that recent advances in addiction research have helped identify effective new treatments, there are few skilled physicians to prescribe them. Dedicated and caring as they usually are, most Canadian physicians who consider themselves addiction medicine specialists assembled their knowledge about addiction treatment after completing their medical training.

From a patient’s perspective, imagine being rushed to the hospital emergency room clutching your chest in the throes of a heart attack and being seen by an extremely well-meaning physician – who has not actually been through a standardized cardiology training program.

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