Boston Medical Center receives $3.7 million grant to expand fellowship programs in addiction

Boston Medical Center's Grayken Center for Addiction has received a five-year, $3.7 million grant from the Health Resources and Services Administration to expand its fellowship programs in addiction medicine and addiction psychiatry. Effective July 1, this grant supports the training of 48 fellows to specialize in addiction medicine or addiction psychiatry, who will then provide evidence-based, high-quality prevention and treatment services for people with substance use disorders who are vulnerable to health inequities.

The data continues to show that providing access to evidence-based, high quality substance use disorder treatment improves health outcomes. However, according to a 2017 report from the United States Agency for Healthcare Research and Quality, limited qualified workforce capacity, including limited access to addiction specialists, was a major barrier to the provision of preventive services and substance use disorder treatment. And the most recent data from the Centers for Disease Control and Prevention shows that the need for treatment is as great as ever. Nearly 72,000 individuals across the United States died of a drug overdose in 2019 - a record number. And, according to the National Institutes of Health, approximately half of the individuals who have a mental illness will also experience a substance use disorder during their lifetime.

Given what we know about the number of people with substance use disorder and mental illness, we need to have more leaders trained in addiction medicine and addiction psychiatry to provide evidence-based, accessible care, develop innovative programs and conduct research that will meet the challenges of the addiction crisis."

Alexander Walley, MD, MSc, program director for the grant, director of the Grayken addiction medicine fellowship program at BMC and associate professor of medicine at Boston University School of Medicine (BUSM)

The funding will allow for enhanced collaborations between BMC's nationally-recognized addiction medicine and addiction psychiatry fellowships, its safety-net academic medical center and three federally qualified health centers to treat vulnerable patients with substance use disorders: Boston Healthcare for the Homeless, Codman Square Health Center in Dorchester, and South Boston Community Health Center.

A 2017 report from the National Survey on Drug Use and Health found that only 40 percent of those with a substance use disorder and/or a mental illness received medical treatment during the previous year. This information demonstrates that there are barriers to patients being able to access treatment.

"This training program expansion will help further address access to mental health care, where patients with substance use disorder and co-occurring mental health disorder often face health disparities and stigma. These same patients often prefer to be seen in community-based health settings," said Michael Dawes, MD, associate program director and vice chair of addiction psychiatry at BMC and BUSM. "This grant will produce addiction psychiatrists and addiction medicine providers trained to work collaboratively in these primary care settings to address barriers and improve access for this vulnerable population."

BMC was among the first academic medical centers to sponsor fellowship programs in both addiction psychiatry (1997) and addiction medicine (2011). These subspecialties were created, recognized, and accredited to meet the need for physician leaders to treat patients and develop health systems that would prevent and treat substance use disorders and their health consequences. This grant will allow the BMC addiction fellowships to expand the number of specialist leaders who can integrate into community health centers that serve vulnerable populations.

"BMC has a strong record of treating people with complex mental health problems and our history of training physicians in addiction psychiatry and addiction medicine is well established. However, our programs have been primarily institution based," said John Renner, MD, director of the addiction psychiatry fellowship at BMC. "Building on this record of achievement, the grant permits us to add a focus on community-based health care and will help BMC develop physicians who are leaders in the delivery of addiction services in those settings where early intervention will have the greatest impact."

Fellows will receive training in: population-based research; public health practice focused on health inequities in urban, impoverished, and minority populations; and medical education, including patient care and clinical preventive medicine. This grant will also support an implementation and evaluation analysis, which can be used to make changes to the program as well as provide the evidence necessary to lead to system-level changes to prevent disease and improve health across diverse populations.