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Recommendation 3d: Health care policymakers and educators should make a major investment in addiction-related training of specialist and generalist health professionals.

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     Many addiction-focused curricula have been developed by educators, researchers, clinicians, and professional societies. But at the undergraduate, graduate, medical, and residency levels, such training is infrequently provided. Years of exhortation on this point have not had significant impact, so the Commission believes it is now time for such training to be required. Bodies responsible for the education of health professionals, most notably schools of medicine, nursing, and dentistry, as well as professional societies that provide continuing education and certify professional training programs (e.g., medical, dental, nursing, and psychological associations in the USA and Canada) should agree on minimum standards for substance use disorder-related instruction that must be met for accreditation across the curriculum. Much of the training can be directed at generalists and professionals focused on other disorders, for example training on how to manage alcohol use disorder in cardiology care, how to detect substance use disorders in family medicine clinics, how to concurrently treat substance use disorder in patients receiving psychotherapy for depression, how to detect and manage OUD in pain clinics, and how to respond to OUD presentations in the emergency department. 

     The USA does require additional addiction-focused continuing education for physicians who wish to prescribe buprenorphine for OUD to more than 30 patients, but the Commission prefers a broader approach. Specifically, education in managing addiction and on the risks of addiction to prescribed medication should be required before any health professional is granted a license to prescribe controlled substances. 

     Specialty training programs should also be significantly expanded to meet the enormous need for addiction treatment. Among specialties, psychiatry has historically done the most to treat addiction, but addiction medicine should not be regarded as only a psychiatric subspecialty. Indeed, one of the most positive developments of recent years is the 2015 recognition of addiction medicine as a medical specialty, paving the way for a diverse set of physicians to receive additional training in addiction medicine under the auspices of the U.S. Accreditation Council of Graduate Medical Education. Addiction medicine and addiction psychiatry fellowships provide advanced fellowship training to a diversity of specialists (family medicine, internal medicine, psychiatry, emergency medicine) to increase the work force targeting substance use disorders. Student loan repayment incentives should be expanded to encourage professionals to specialize in the addiction field.