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PAINSCAN LITERATURE REVIEW
Issue 1, Volume 4
Addiction Medicine and Relapse Prevention
8 Articles in this Series
Introduction
The Krebs SPACE Trial
Association of opioid prescriptions from dental clinicians for US adolescents and young adults with subsequent opioid and abuse
The influence of anxiety sensitivity on opioid use disorder treatment outcomes.
Draft Report on Pain Management Best Practices: Updates, Gaps, Inconsistencies, and Recommendations
The Addiction Patient
What the SUPPORT Act Means for Providers
Inside the NCASA Report: Ending the Opioid Crisis
The role of opioid prescription in incident opioid abuse and dependence among individuals which chronic non-cancer pain

The Addiction Patient

An Overview and Call to Action
2019;Commentary:

Addiction-treatment expert and anesthesiologist Frank A. Kunkel, MD, provides a look at preconceptions around individuals living with opioid use disorder and offers a step forward.

As a university trained anesthesiologist who has practiced medicine for 35 years, including pain management for nearly 30 of those years, it was not unexpected that I became interested in addiction medicine. So just over a decade ago, I earned board certification from the American Society of Addiction Medicine (ASAM) and opened an office-based addiction treatment center, commonly called an OBOT in the industry, that focused on the use of suboxone (buprenorphine and naloxone) for those suffering from opioid use disorder (OUD).

With participating insurance plans, this practice has grown to have between 700 and 800 new patient consults per month, 35 offices, and more than 100 part-time physicians. As its Chief Medical Officer, I feel incredibly compelled to remain abreast of current and historical events relating to opioids, both in the pain management and addiction arenas. Below are a few reflections on current issues faced in both of these specialized fields.  Obviously, these represent just one clinician's overall views.

First, there is a role for opioids in the treatment of pain, but these medications must be prescribed wisely and judiciously. Unfortunately, some prescribers have failed to prescribe appropriately in many cases, inviting the wrath of regulatory agencies and indeed the general public in recent years. By not policing ourselves, this was inevitable. Overzealous marketing of opioid medications has played a role as well, as has the non-standardized way death and overdose rates are reported in the United States (eg, the US does not uniformly conduct toxicology tests on all who die).

Sadly, the path forward is neither simple nor clear. But there is one response that I believe will make a significant difference—that is, to truly care for the addiction patient. Just as we offer compassion to any individual who is sick or faced with a chronic disease—through no fault of their own, we must care for those with OUD. The typical addiction patient is not a person of self-abuse. In 15 years, I have yet to meet a patient who says, “My goal today is to get addicted to opioids.”  Unfortunately, these individuals only seem to gain importance and get help when they are a brother, sister, son, or daughter. Let’s change how we see the addiction patient and how we care for them.  We have physicians, APPs, and many others in medicine in place already.

Addiction care should include, at a minimum:

  • programs to help eliminate bias and stigma toward the addiction patient
  • proper insurance coverage; the idea that addiction treatment may only be paid via cash is nonsensical
  • a stark realization that we must help those who want help, just as if they had cancer or heart disease.

Toward these goals, pharmaceutical companies, laboratories, health plans, and medical societies must work together to achieve whatever it takes to address opioid addiction as if it were a contagious, national crisis.  The pieces to get control of the opioid epidemic are in place; it is time to quit talking and attack this incredible problem.

...

Throughout this PainScan on Addiction Medicine & Relapse Prevention, recently published papers will be reviewed in the coming months in an effort to push forward this goal.

 
Next Article:
What the SUPPORT Act Means for Providers
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