Why do so many doctors and nurses avoid treating patients with addiction?

0:00It's Consider This where every day we go deep on one big news story. Today, why do so many doctors and nurses avoid treating patients with addiction? One night in December 2023, Jean Descamp was unresponsive and taken to the emergency room. He was experiencing signs of an overdose, and when police arrived, they pleaded with hospital staff to let him stay. Why is he being released? We have no place to take him. Experts say interactions like this are common, where people experiencing signs of addiction are turned away from care by health care workers. We are othering the person with opioid use disorder or substance use disorder suddenly not our patient anymore.

0:43Beth Meyerson is an expert on addiction treatment at the University of Arizona College of Nursing. We're going to not see that patient as a person anymore. That dehumanization process, we just can't filter that out. Consider this. About a quarter of a million people die each year from alcohol and drug-related illness, and there are proven medical treatments for addiction. So why aren't doctors prescribing them more often?

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2:19It's Consider This from NPR. What would happen if doctors, nurses, and other health care workers failed to treat patients facing a common and often deadly illness? Well, that is happening right now to millions of people in the U.S. who struggle with alcohol and drug addiction. New federal data shows the vast majority of people with serious addictions still are not getting treatment. In part because most doctors refuse to offer medications proven to save lives. NPR's Brian Mann reports. On a cold December night in 2023, John Descamp was taken by ambulance to the emergency room at Providence Hospital in Milwaukee, Oregon, south of Portland.

3:05Descamp was 26 years old, homeless, emaciated, and experiencing what doctors believed was chronic street drug addiction, a leading cause of death for young Americans. The hospital's medical team cleaned him up and gave him Narcan, a medication that reverses opioid overdoses. But as he lay slumped and unresponsive, doctors and nurses called police and told them to remove Descamp, suggesting they drop him at a bus station. He's been evaluated medically. There's no medical problems for him. One of the hospital's medical team can be heard there on a body camera recording released by Milwaukee police.

3:37NPR hasn't been able to identify the speaker. He tells officers Descamp is faking the severity of his illness. And it's all behavioral. Yep, 100 % behavioral. Police used a wheelchair to roll Descamp's limp body into the dark hospital parking lot. In the cold, officers draped him with a blanket voicing concern about his safety. Do you at all feel comfortable with anything that's going on right now? No. A spokesman for Providence Milwaukee Hospital declined NPR's request for an interview about Descamp's case and didn't respond to detailed questions about his treatment. A statement issued to the media by the hospital after Descamp's death said, We fell short of our goal of providing safe, reliable, compassionate care to our patient.

4:19After interviews with more than a dozen doctors, researchers, and government officials, and a review of research and federal data, NPR found what happened that night in Oregon is part of a troubling national pattern. People with serious alcohol and drug addiction in the U.S. regularly go to doctors' offices, clinics, and hospitals, but are turned away after receiving insufficient or no treatment. Dr. Judy Chertok treats patients and teaches addiction medicine at the University of Pennsylvania. We would not allow, as a society, people with heart attacks to come to a hospital and not get appropriate treatment.

4:52This is as serious as that. Chertok and others have been working for years to bring addiction treatment into the medical mainstream. While overdose deaths have dropped in recent years. Alcohol and drug-related illnesses still kill a quarter million people in the U.S. every year. New federal data shows fewer than one in five people who need help get any medical treatment for their addiction. Much of what I do is scream back at that. Many who ultimately die from their illness have had significant contacts with health care and social services agencies in the few months leading up to their deaths.

5:30In the case of Jean Descamp on that winter night in Oregon, death came much faster. Hey, Gene. Hey, Gene. Boy, I don't know. I don't know. Look at his eyes. I don't know. While officers were transporting Descamp to another medical facility, hoping to get him help, he overdosed from drugs already in his system. An investigation later found hospital staff never gave Descamp a toxicology test and ignored officers warning he might die. This kind of outcome is rarely caught on camera, but federal data suggests similar devastating medical events for people with addiction are common. One study by the Centers for Disease Control and Prevention found two-thirds of fatal overdoses in 2024 involved people who had some kind of opportunity for intervention but didn't get help.

6:18Where it comes to substance use disorder, we've not decided as a country, this is an illness we actually can treat. Beth Meyerson is an expert on addiction care at the University of Arizona's College of Nursing. She says the problem isn't just in hospital emergency rooms. It's still common for most doctors and nurses to actively avoid treating patients with alcohol and drug-related illnesses. So if I'm at my own GP, my own general practitioner, and I suddenly clear that I'm addicted to an opioid, my doctor will likely send me somewhere else. Meyerson says for the most dangerous forms of addiction, alcohol and opioids, those doctors should be offering many of their patients medications available for decades that are low cost and relatively easy to prescribe.

7:02We have good tools. Methadone and buprenorphine are gold standard. And here's the best message. Here's the game changer. Access to treatment will reduce opioid overdose by 60 percent. In some studies, I saw 80 percent. In 2022, the federal government made it far easier for doctors to prescribe buprenorphine, a medication that reduces opioid cravings and withdrawal symptoms. But studies show most still don't. It's even more rare for clinicians to offer medications like naltrexone that reduce alcohol cravings. The obvious question is why. If addiction is common and deadly but also treatable, why don't more clinicians help?

7:41Chertok at the University of Pennsylvania says many of her fellow doctors view addiction patients with deep suspicion and even hostility. I have observed or heard people talk about someone with addiction in the health care setting in a way that is not tolerated for any other group. It's so jarring that that is accepted by so many. A report issued earlier this year by the American Medical Association identified stigma among health workers as a significant hurdle for patients needing treatment. That bias is so widespread, many doctors believe their patients will abuse addiction medications to get high, even though studies show misuse of buprenorphine is rare.

8:27Robert DeFord is with a group called Shatterproof that works to convince physicians to treat substance use disorders. So, persistent stigma, right? They don't want these people around them. They don't think that the drugs that we have that are FDA-approved medications are really going to actually help the patient. That is what I would say is a fatal flaw in our system. Most experts interviewed by NPR said there has been gradual improvement in addiction treatment. More doctors' offices, clinics, and ERs are adopting science-based treatment practices. But no one said the current level of care is acceptable.

9:01And we heard again and again that progress is being hindered by the fact that most medical and nursing schools still don't teach clinicians how to care for addiction patients as a core part of their practice. Meyerson at the University of Arizona says that has to change. We will have to have very clear laws, policies, and frankly, training practices and curriculum in medical schools, nursing schools, to really combat this. I know we can do this. But for now, there are few legal or professional consequences for providing insufficient care, even when addiction patients die. On the body camera recording after Jean Descamp's fatal overdose, police officers can be heard voicing sorrow and anger at his lack of treatment.

9:44That guy does not need to be dead right now. That guy does not need to be dead right now, the officer says. NPR reached out repeatedly to Oregon health officials and reviewed documents relating to this camp's case, but found no record that Providence Hospital or its staff faced any kind of disciplinary action. In a statement sent to NPR, hospital officials said they have improved staffing and strengthened procedures for caring for vulnerable patients. The statement also says hospitals shouldn't be held accountable for what happens to patients after they're discharged. Brian Mann, NPR News. This episode was produced by Liz Baker and Catherine Fink, with audio engineering by Ted Meebane.

10:24It was edited by Maureen Pau and Tinbeet Hermes. Our director is Elena Moore, and our interim executive producer is Courtney Dorning.

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