The Yale School of Medicine Section of General Internal Medicine has established a new program — the Yale Program in Addiction Medicine. The multi-disciplinary clinical, educational, and research program will further enhance Yale’s portfolio of state-of-the-art addiction research and patient care, while increasing the pipeline of physicians trained in evidence-based strategies to tackle the opioid crisis and other addiction-related health issues.
The establishment of this new program comes at a critical time: Drug overdose deaths nearly tripled during 1999–2014, according to the Centers for Disease Control and Prevention. From 2014 to 2015, the death rate from synthetic opioids increased by 72.2%, and heroin death rates increased by 20.6%. Death rates rose across all demographic groups and regions, and in numerous states.
Yale School of Medicine (YSM) has been leading the field in addiction research and education for nearly three decades. It is one of the first medical institutions to establish an accredited fellowship program in addiction medicine, which began accepting trainees in 2015.
Additionally, YSM faculty members Dr. Patrick O’Connor and Dr. Gail D’Onofrio led the effort to make addiction medicine an official medical subspecialty in 2016. This landmark change will increase the number of physicians in a variety of primary care and other medical specialties, including psychiatry, to be trained and certified as specialists in addiction prevention and treatment.
“The combination of the remarkable accomplishments in addiction research at Yale related to expansion of addiction treatment into general medical settings, along with our growing portfolio of clinical and educational programs, makes this the right time to organize these activities in a manner that will support their further development and solidify Yale’s leadership role in this area,” said Dr. Patrick O’Connor, the Dan Adams and Amanda Adams Professor of General Medicine and chief of general internal medicine.
“The current opioid epidemic, along with the high prevalence of a variety of substance use disorders, demands innovative and creative approaches in prevention, treatment, and medical education,” he noted. “Yale is uniquely positioned to provide national leadership in this critical area.”
Based in Yale’s General Internal Medicine section, which now includes 12 faculty doing addiction-related work, the Yale Program in Addiction Medicine includes important collaborations with Yale School of Public Health and the Departments of Emergency Medicine and Psychiatry. It will be directed by Dr. David Fiellin, professor of medicine, emergency medicine, and public health.
“David is a leading internationally recognized expert in addiction medicine, whose research has spurred the development of innovative new approaches to addiction treatment and has greatly enhanced our knowledge of the clinical epidemiology of addiction,” said O’Connor. “This, in combination with his incredible clinical expertise and mentorship skills, make him an ideal choice for this appointment.”
The multi-disciplinary program will emphasize addiction research on critical topics, including improving the recognition of and access to treatment of substance use disorders in primary care, emergency departments, and hospitals; addressing the quality of addiction treatment; and technology-based prevention in youth. The program includes experts on the treatment of pain, HIV, and hepatitis C in patients with and without substance use disorders, as well as evaluating guidelines for prescribing commonly misused medications.
In addition to the Addiction Medicine Fellowship directed by Dr. Jeanette Tetrault, associate professor of medicine, the Addiction Medicine Program will work to advance trainee education at all levels, especially for health professional students as part of the ongoing curriculum redesign. Clinical components of the program, such as the existing Addiction Recovery Clinic and a proposed Addiction Medicine consult service at Yale New Haven Hospital, will provide comprehensive services to patients in need.
“Since the use of opioid, tobacco, alcohol, marijuana, and other substances is common in general medical settings, and often goes undetected and untreated, we need a medical system that does a better job of making sure and that all healthcare professionals implement effective prevention, screening, treatment, or referral practices, and treat addiction as they do other medical conditions,” Fiellin says.
“Yale General Internal Medicine has led the way in enhancing addiction care broadly in the health care system,” said O’Connor. “The Yale Program in Addiction Medicine represents a major step forward in furthering this critical goal.”