Pain & Addiction Course: Common Threads XIII Set its Focus on Physician Opioid Addiction, Rx Drug Abuse

Herbert Malinoff, M.D., FACP, FASAM

Herbert Malinoff, M.D., FACP, FASAM

When leaders planned Thursday’s day-long Pain & Addiction Course: Common Threads XIII — Healing the Healer, they ensured that presentations addressed the latest research on treatment strategies for physicians with opioid addiction and the profession’s response to the epidemic of prescription drug abuse. The course succeeded on both fronts in featuring leaders in these fields presenting the latest advances and insights on these important issues.

Speakers presented successful strategies for treating physicians with addictions, and participants learned much from this experience that could benefit all people who are addicted to opioids, says Herbert Malinoff, M.D., FACP, FASAM, Chair of the Pain & Addiction Course Planning Committee.

Edwin A. Salsitz, M.D., FASAM

Edwin A. Salsitz, M.D., FASAM

“The experts in the field reviewed how physicians with addictions are treated successfully, but the real issue is how to extrapolate that to others who aren’t physicians,” says Dr. Malinoff. “The treatment physicians can access can be a template or paradigm for treating all people with that illness. The problems are that our health care delivery system is not set up to deliver that kind of care to those who need it and, even if it were, there are not enough professionals to provide that kind of treatment.”

Dr. Malinoff says that he appreciates the location of the 2012 ASAM Medical-Scientific Conference in Atlanta because it is home to many government agencies, including the Centers for Disease Control and Prevention, and that many government officials attended the course. These are government thought leaders who could take information they learned and discuss important issues surrounding the delivery of care for addiction.

During the course, ASAM Board of Director-at-Large Paul H. Earley, M.D., FASAM, Earley Consultancy, LLC, Atlanta, presented the latest data on physician addiction and treatment, what is known about who has the disease, how they recover, and how licensure boards and physician health programs become involved with treatment decisions.

“Outcome studies of addicted physicians would naturally affect decisions on their treatment,” says Edwin A. Salsitz, M.D., FASAM, Co-Chair of the course.

Prescription drug abuse has received recent attention in the media, and Dr. Malinoff says that it truly is an epidemic.

“There is a lot of overdosing going on, and the epidemiology of this is depressing,” he says. “The problem is not just doctors writing too many prescriptions, it’s that the prescribed drugs are getting into the hands of college students, high school students, older people, and others.”

Dr. Salsitz notes that the focus of this portion of the course was led effectively by experts in the field.

“We had a distinguished group of speakers on this topic, led by Andrew J. Kolodny, M.D., the President of Physicians for Responsible Opioid Prescribing (PROP),” says Dr. Salsitz. “Almost all physicians prescribe these drugs, so how to do this properly is most important. The entire symposium on opioid prescriptions should lead to a more enlightened prescribing approach among attendees.”

Dr. Malinoff found the concluding panel discussion invigorating and observed that his fellow attendees found this portion of the program enlightening as well.

“I think the best part was the case discussions that took place,” he says. “One can hear how experts handled these cases, and the audience could interact with them and ask questions. It was very valuable.”

Pain and Addiction Course Addresses Physician Addiction Issues, Increase in Overdose Deaths

Leonard J. Paulozzi, M.D., M.P.H.

Leonard J. Paulozzi, M.D., M.P.H.

While it is bad news that physician addiction is disconcertingly real and dangerous, perhaps the good news is that recovering physicians are also more inclined to adhere to treatment than other patient populations. This was one of many issues addressed during Thursday’s Pain and Addiction Course: Common Threads XIII – Healing the Healer.

In its entirety, the Pain and Addiction Course featured leading experts in addiction medicine who outlined the scope of the impaired physician problem in the United States, reviewing the current data with regard to treating addicted physicians, and defining the epidemiology of the prescription opioid epidemic. The program also outlined the increase in overdose deaths related to increased opioid prescribing and dosage level, and offered up a Universal Precautions paradigm to guide opioid prescribing practices.

Doctors with Opioid Addiction
Paul H. Earley, M.D., FASAM, of Earley Consultancy, Atlanta, shared insights and perspective about his presentation, “Physician Health: Doctors with Opioid Addiction,” during an interview before the ASAM Annual Medical-Science Conference. He focuses on what is currently known regarding who has the disease, as well as defining what is known about how those with the disease recover, and a host of other topics.

“It is bad that these doctors are addicted, and it is bad that it is so easy for them to become so,” he says. “But it is also true that treatment is very good. The long-term prognosis is high — data shows 80 percent of doctors who went through treatment and were followed two to five years afterward were doing very well, with no relapse.”

Physicians do develop addictions as commonly as any other patient cohort, Dr. Earley noted. The difference is, he says, “doctors tend to become more addicted because of their often unfettered access to the drugs. It is that simple, they have a higher rate of opiate addiction because they can get the drugs easier.”

CDC Presents Epidemiology and Public Health Role
In another pre-Med-Sci Conference interview, speaker Leonard J. Paulozzi, M.D., M.P.H., shared insights about his scheduled topic of presentation, “Epidemiology of the Epidemic.” He is a Medical Epidemiologist in the Division of Unintentional Injury Prevention within the National Center for Injury Prevention and Control at the Centers for Disease Control and Prevention (CDC) in Atlanta, GA.

“This issue has been around for more than two decades, and awareness of the problem has grown over the last dozen or so years,” Dr. Paulozzi says. “Of course, the role of opioid analgesics in this problem has come into sharper focus in the last year or two. The problem has gone from being a local issue to one where overdose deaths have been steadily increasing nationally, with no resolution to the problem in sight.”

The increase in fatalities has not led to effective efforts to check the spread of the problem, he says. There are some encouraging signs in some states, “but we haven’t bent the curve down nationally yet, so we need to do more,” Dr. Paulozzi adds.

Dr. Paulozzi says there are a number of strategies that could prove efficacious in dealing with this trend. One is improving how opioids are tracked throughout the system.

“Doctors should be able to get data on their patients’ use of controlled substances incorporated into their daily workflow.  They should be able to access a list of all prescriptions given their patients and see whether the patients are visiting multiple providers and picking up prescriptions from multiple pharmacies.”

With that information, it is much easier to coordinate the care of patients and avoid extremely high doses and drug interactions. “It becomes easier to identify patients with high usage rates with regard to controlled drugs, particularly opioids,” Dr. Paulozzi says. “We would like to see more of a wide-scale attempt by state programs such as Medicaid to coordinate the care of patients in this way.”

In addition, state laws and regulations pertaining to access to scheduled drugs need to be in place to take action against illegal activity perpetrated by both prescribers and patients, Dr. Paulozzi says.

“We need to use these drugs much more carefully if we are to reduce their abuse,” he says. “And at the same time, we need to improve access to treatment for addicted patients.”