Opioid summit experts: Treat addiction as a chronic disease


Over the past few years I've written a great deal about the epidemic of opioid addiction, and a whole lot about providing care for chronic disease. But it wasn't until I attended a unique event hosted by the Massachusetts Medical Society last week that I would have thought to raise both issues in the same sentence.

One of the panelists, Ruth Potee, M.D., a family physician at Greenfield Health Center, married the topics succinctly: "If you fire an addict from your practice, that's the same as kicking out a diabetic with a high A1C."

As a general family doctor, Potee considers it part of her job to treat the 10 percent of the population that suffers from addiction. "It's not a separate clinic issue," she said.

While acknowledging that most physicians receive little training in substance abuse or addiction, "a lot of us have the capacity to be equipped" to treat it, Potee, the chairwoman of Healthcare Solutions Opioids Taskforce of Franklin County, told her colleagues. She added, "If you don't have the capacity to treat, you have a responsibility to transition patients to someone who can."

Not all of the presenters at the MMS' Opioid Misuse and Addiction Summit were physicians; the panel also included healthcare leaders, law enforcement officials, substance abuse experts, pharmacists and patients. Keynote speaker U.S. Attorney General Loretta Lynch addressed the significance of these entities coming together. "Physicians see the true human cost" of this public health crisis, she said. "Far too many, for far too long, have only seen it through the lens of law enforcement."

No one group can address the problem alone, the experts agreed. In fact, Potee described how she works with probation officers and other officials directly. If a patient doesn't show up for a scheduled methadone treatment, for example, she will call his or her probation officer and say she needs to see the patient in her office immediately for a shot.

Otherwise, many of these patients would die, she said. "These are some of the sickest people among us. If he had cancer, he would have had wraparound care."

Thus, addressing the stigma of addiction was another powerful and recurring theme throughout the morning, as speaker after speaker reinforced the fact that addiction is a disease that can claim any victim, regardless of age, race or socioeconomic class. The average age of an opioid addict is 40, they noted, adding that most dependencies start with legitimate use of opioids for acute pain that continues just long enough to get hooked.

If not as aware of the risks as I happen to be through this job, one of those statistics could have been me. After a nasty wrist fracture and ensuing surgery, I can tell you that I took more of the painkillers I was prescribed than I expected to need. When I awoke at 4 a.m. after the nerve block wore off feeling like a house had fallen on my arm, there was no question that Motrin wasn't going to cut it. Thank goodness I filled that prescription I thought I was too tough to need, and had someone there to open the child-proof bottle I couldn't manage with one hand. And exponentially more thanks to the fact that my pain diminished quickly and was easily managed by ibuprofen within a couple of days.

I wasn't prescribed an excessive amount of pills, but I wasn't warned about them, by doctors or pharmacists, the way experts recommend either. Maybe you would have to be living under a rock to not know that Vicodin and oxycodone are dangerous, but it's really not hard to see how a problem could blossom in a person you'd hardly suspect.

The story of Tom Foye, a former Ludlow police detective and recovering addict, is a perfect and heartbreaking example. Now that the one-time contender for chief of police is out of jail and wearing an electronic bracelet, "good deeds" such as speaking publicly about opioid addiction, are all he has, he told us.

From one of the deepest perspectives in the room, Foye shared a frank synopsis of how stories like his occur and perpetuate. "They don't throw fundraisers for addiction," he said. "People don't go see a doctor because of the stigma. And if you do seek help, people [physicians] don't know what to do to help."

It's time to change that. - Deb (@PracticeMgt)