By Jorge Sigler
Opioid addiction is categorized as an epidemic by the American Society of Addiction Medicine (A.S.A.M.)1 and the CDC.2 The numbers are such that most of us are directly affected or know somebody in our inner circle dealing with the disease. In 2015 the CDC estimated that “91 Americans die every day from an opioid overdose,”2 a number that adds up to 2,730 people a month and 33,215 a year.
But, what is addiction? The A.S.A.M. defines it as “a primary, chronic disease of brain reward, motivation, memory and related circuitry . . .,”3 and the American Psychiatric Association defines it as “a complex condition, a brain disease that is manifested by compulsive substance use despite harmful consequence . . . .”4 Two words hold great importance in addiction, “brain” and “disease,” making addiction a health problem; as such, addiction should be treated by medical doctors and regulated by the Department of Health. In the state of Florida, providers of addiction treatment are licensed by the Department of Children and Families (D.C.F.), previously the Department of Social Services, a state agency responsible for protecting children and helping troubled families. A health problem, especially one of such magnitude, being treated by a social agency can be both a flawed and a dangerous strategy, potentially endangering tens of thousands of people.
As of October 2016, D.C.F. had a total of 1,546 current licenses for substance use treatment issued to a total of 757 care providers[I] in the state of Florida. Out of those 757 providers only 60% had a medical director on staff registered with D.C.F., leaving 308 providers who do not have a doctor treating this brain illness. As alarming as that number is, it only represents the tip of a much deeper iceberg.
The Medical field consists of 30 branches of study with more than 120 specialties and subspecialties,5 all requiring intensive as well as extensive years of training. An individual who has a heart condition should see a cardiologist; equally, a person with a tumor should seek the care of an oncologist. Deductive reasoning would lead us to correctly assume that a person with a brain disease should be treated by a doctor specialized in the brain, a psychiatrist. However, that is not the reality in Florida, where only 144, less than 20%, of the providers licensed to provide substance use treatment have a psychiatrist as their medical director; ophthalmology, urology and gastroenterology are among the specialties of some of the medical directors of treatment providers.
Based on the previous information, one could honestly ask, “Is an ophthalmologist qualified to treat brain diseases?” However, that may not be the actual problem, since that ophthalmologist may not be seeing the patients at all. The requirements for substance use treatment stipulated by D.C.F have major loopholes that allow providers to give care with a doctor barely supervising care or, in some instances, not requiring a doctor to oversee care at all. Even though 449 of the 757 providers have a medical director, the total number of doctors registered as medical directors under D.C.F. is 313. This difference answers to the following:
- 252 of the doctors are registered as medical directors of 1 provider.
- 32 of the doctors are registered as medical directors of 2 providers.
- 13 of the doctors are registered as medical directors of 3 providers.
- 8 of the doctors are registered as medical directors of 4 providers.
- 8 of the doctors are registered as medical directors of 5 to 9 providers.
At this point it becomes clear that there are several flaws in the way in which substance use treatment providers are being licensed. D.C.F. regulations and requirements for licensing do not reflect the A.S.A.M. standards of care for the addiction specialist physician.6 Ultimately, D.C.F. is neither prepared nor qualified to regulate substance use treatment; and this is simply because D.C.F. is a social agency and not a health agency, and addiction is a health problem.
In the end, only one question remains: “are federal and state agencies and institutions part of the problem?” Even though the Florida case may not definitively answer that question, it does bring to light several flaws and concerns. More research and studies may be needed to understand and correct these flaws; what is undeniable is that the Florida case is a clear health crisis based on poor state and federal policies regarding mental health. Within the Humane Party of America this situation is being closely examined to target the problem at its root cause, State and Federal level legislation. However, the Humane Party is not the only beacon of hope as this problem is becoming more apparent to many within the mental health field. Dr. Robert Moran, M.D., a triple board certified addiction psychiatrist and medical director of Family Center for Recovery in Florida, called for a review of these problems by some of his colleagues during the annual meeting of the Florida Psychiatric Society. Dr. Moran highlighted the Florida case as a major healthcare crisis and ethical concern and called for action to address and rectify these problems immediately. He is correct, the current situation calls for immediate action. Every day we continue down this path, 91 Americans die from an opioid overdose.
- American Society of Addiction Medicine. Opioid Addiction 2016 Facts & Figures. (2016). Retrieved from:
- Understanding the Epidemic, Center for Disease Control and Prevention. Drug overdose deaths in the United States continue to increase in 2015. (2015). Retrieved from:
- American Society of Addiction Medicine Quality and Practice, Definition of Addiction. Retrieved from:
- American Psychiatric Association, What is Addiction? Retrieved from:
- Careers in Medicine AAMC, Specialties and subspecialties list. Retrieved from:
- The ASAM Standards of Care. (2014, February 17). Retrieved from: http://www.asam.org/docs/default-source/practice-support/quality-improvement/standards-of-care-final-design-document.pdf
[I] Each level of care requires a different license with different requirements, one provider can have several licenses depending on the levels of care they provide.