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Fix Event Spreads New Hope on Opioids

Presenters from Physicians for Responsible Opioid Prescribing and CASAColumbia engage doctors on the drug epidemic of our time.

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Dr. Andrew Tatarsky, Dr. Andrew Kolodny and
Susan Foster

By Ben Feuerherd

02/26/13

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Addiction to prescribed opioids has become an epidemic in the US, as The Fix has frequently reported. Who’s to blame? It’s the addicts who “doctor shop” and misuse their prescriptions, right? Not quite—after all, if you're a doctor shopper, you're probably addicted already. The doctors who prescribe drugs like Oxycontin to chronic pain patients, and the pharma companies that falsely billed such drugs as “non-addictive” for chronic use, have had large parts to play.

In an effort to spread awareness of the problem and the possible solutions, The Fix sponsored a lunch presentation for physicians at the Yale Club in New York last Saturday, co-hosted by the National Center on Substance Abuse at Columbia University (CASAColumbia) and Physicians for Responsible Opioid Prescribing (PROP). “There is no objective national effort...[to address the epidemic]...this leads us to conclude it’s up to the medical professionals,” said Susan Foster, CASAColumbia’s director of policy and research analysis, during her opening talk on the prevalence of the problem.  

Leading psychiatrist Dr. Andrew Kolodny, chief of psychiatry at Maimonides Medical Center in New York and president of PROP, then gave a riveting presentation on the root causes of America's opioid epidemic, and the vital need for change in prescribing practices. Every US state has seen an alarming rise since the late '90s in fatal opioid overdoses, Kolodny showed us, and most who die were introduced to the drugs by a prescription. With doctors having to rely on self-reported information about patients' pain levels, we've actually arrived, said Kolodny, at the point of "de facto legalization of heroin." But most doctors haven't been prescribing opioids for chronic pain maliciously, he stressed; the drugs' manufacturers successfully presented them as "non-addictive" for such use, and doctors began prescribing them out of compassion. Now we know better.

In the final talk, Fix contributor Dr. Andrew Tatarsky, director of the Center for Integrative Psychotherapy for Substance Misuse, founder of the Center for Optimal Living and a founding member of the Division on Addiction of New York State Psychological Association, stressed the importance of the doctor-patient relationship in dealing with the problem, and the value of a holistic approach. And he urged the audience of primary care physicians to address the stigma associated with addiction. Various stereotypes about addicts can contribute to over-prescribing, he said, but "Everyone is vulnerable to substance misuse." Tatarsky also noted various possible alternative treatments for chronic pain, including relaxation techniques, yoga, exercise and diet. 

The event—in which Dr. Richard Juman, the former president of the New York State Psychological Association and the coordinator of The Fix's Professional Voices strand, played a major role—was designed to “engage primary care physicians to address addiction,” as Susan Foster summarized. It appeared to be working: The doctors stayed on long after the end to ask follow-up questions on how they should apply what they'd learned about opioid addiction to their practice. Attending GPs like Dr. Vincent Esposity and Dr. Jeff Trilling, for example, told us that the chance to meet "like-minded people" within their community was valuable to them, "because the resources just aren’t there.”  

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