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LEGISLATIVE
CHALLENGES

EXPANDING

FORCES

IN THE DRUG WAR

By Neal H. Gray, MD, BCMS Past President

P oliticians tell us that the war in Afghanistan is the USA’s

longest war, and not yet won. If you consider our ef-
fort on substance abuse and addiction as a war, that
started in 1784 with a pamphlet “Inquiry into the Ef-
fects of Ardent Spirits on the Human Mind and Body” by Dr.
Benjamin Rush. He was probably the first to claim that
the alcoholic could be restored to health through med-
ical treatment. After 224 years, we have not won this
war either.
The New York Times had a piece on September 10,
2018 by Jan Hoffman, “Most Doctors Are Ill Equipped
to Deal with the Opioid Epidemic. Few Medical Schools Teach
Addiction”. I agree. Looking back on my medical edu-
cation at the University of Missouri in the early 1960’s,
the curriculum included just one hour by the Depart-
ment of Psychiatry that was presented by a local man from
Alcoholics Anonymous that told his story. No faculty mem-
bers were involved. that is
Has medical education in addiction improved? Not much, but chronic, relaps-
some schools have at least begun. In 1991, The American Board of ing, progressive and
Medical Specialties approved a psychiatric fellowship in addiction. too often fatal. It is not a
Addiction Medicine, not psychiatry, began to be included in 2009 mental illness: it is a brain disease. They often can co-exist. Their
in the ABMS process and there are now 2,500 physicians who are care is difficult and demanding.
board certified in Addiction Medicine. Currently, out of 6,260 res- There are about a dozen Addiction Medicine physicians in San
idency slots across the country, only 52 are in Addiction Medicine. Antonio and I don’t think that any of them are active full time. I
The Center for Disease Control and Prevention states that am not aware of any facility in Bexar County that provides the
632,000 deaths from tobacco, alcohol, opioids and other drugs whole spectrum of care needed. We have very good places in
occur annually. It has been estimated that about a third of all pa- Hunt and Center Point, Texas to which we often refer patients.
tients in a county hospital are substance abusers or addicts. Taking Many of the affected physicians we see at BCMS are sent out of
care of addiction patients is a real challenge. The disease is a pri- state for initial treatment. Our Physician Health Committee then
mary brain disease of disrupted, but reversible, neurochemistry follows them in recovery and reentry to practice.

20 San Antonio Medicine • January 2019