Addiction is an ancient phenomenon, but treating it within a complex, institutional medical system is a new problem. Doctors can be confounded by addiction and addicts’ behavior. Discussions about the opioid crisis have often pushed access to treatment as the ultimate answer. There has been less discussion, however, about the treatment providers themselves receive.

For decades, there have been calls to reform addiction education for medical professionals. William Russell, outlining findings from the Royal College of General Practitioners, summarizes the issue thus: “Drug addicts are unwelcome patients.” The reluctance to treat addicts doesn’t stem only from stigma. Practitioners cited the unique difficulties they encountered when treating addicts. Weaning someone from a chemical dependency is one thing. There is also the challenging behavior of addicts to contend with. Russell writes that drug addicts were described as “a nuisance…not polite…abusive to staff, and rang up in the middle of the night.”

Russell cited additional obstacles to treatment, including the theft of prescription forms, the practice of having drugs prescribed by more than one practitioner, claiming to need more medication than necessary, and a clever manipulation of the system. He quotes a physician: “…the addict would always turn up at a surgery at the last minute seeking help. He would rely on the general practitioner not being able to check out his story because the clinic he was attending would probably have closed down for the day and access to his records would be impossible.”

Such unsavory behaviors aren’t character flaws, but hallmarks of addiction. Doctors may find addicts hostile and uncooperative patients, when really, their difficult behavior is a manifestation of their illness. Russell highlights the need to adequately teach doctors about the less palatable effects of the condition.

Additionally, some of the major problems addicts face don’t fall under the purview of a medical professional. Russell writes of

addicts who remained problem free if maintained on adequate drugs, for whom maintenance clinics were the appropriate places, and others, genuinely motivated to stop, but unable to cope with the environmental and psychological pressures once they were drug free.

To support these patients, Russell highlights “the importance of bringing in other disciplines like social workers, youth workers and employment agencies.”

Medical professionals are often vilified for the inability to treat patients adequately (and sometimes even charged with causing the crisis itself.) But there’s a growing recognition of what the Royal College concluded in 1985—that as much as getting addicts into treatment was important, “in the end it all seemed to come down to improving the training of those coping with drug addicts.”