Dr. Peter Friedmann, Baystate Health's chief research officer and a nationally-recognized addiction medicine expert, appeared on last night's Medical Rounds - a collaboration between Baystate Health and Western Mass News. The weekly Medical Rounds is broadcast in the 5:30 p.m. portion of the Tuesday night news and focuses on family health and wellness and breakthrough technology. Each session is followed by an interactive live chat. Last night's session focused on opioid addiction, which has become a public health crisis throughout the country and right here in Western Massachusetts.
Q: What has led to opioid overdoses becoming such a serious public health issue in this country?
A: What we are seeing is the result of a confluence of factors that created the perfect storm. Beginning in the 1990s, there was a dramatic increase in the rates of opioid prescribing, primarily as a result of national organizations encouraging more awareness and treatment of non-cancer pain. Physicians listened. They did so largely because the risks of addiction in people with pain issues were greatly underestimated as the result of very limited evidence in the medical literature. At the same time, we saw pharmaceutical companies marketing new potent formulations of opioids that were being sold as having lower abuse potential. Of course, that didn’t come to pass. Finally, we saw the arrival of heroin in smaller markets like ours in Springfield and in the suburbs. This created the perfect storm for individuals to get initiated on opioids and develop a tolerance. Once someone develops a tolerance, they find they need more and more. However, their doctor may decide that they have an abuse problem and stop their prescription altogether, or these individuals may find that they need more than their doctor is giving them and turn to the streets to feed their addiction. As we’ve seen in recent years with the increasing amounts of heroin laced with fentanyl and other analogs of it – which are 100 times more potent than the heroin itself – when people turn to the streets it is often with fatal results.
Q: While we may have misunderstood how addictive these drugs are, we still need to treat people in pain. How can we do that going forward?
A: I believe the recognition that these are tools with both risks and benefits is really important for us as a society and for the medical profession to be aware of, and that has been an important first step. There are increasingly more guidelines in terms of how we can prescribe opioids more safely, doing more urine monitoring, doing more pill counts and seeing patients back more often in the office. In general, we need physicians to be more skilled in managing pain and addiction, and having those difficult conversations with patients that say, ”I know you have pain, but now you also have another condition which is addiction and we need to address that.” Also, physicians need resources in the community to do better in terms of pain management and addiction treatment.
Q: Do you foresee an end anytime soon to the opioid crisis, and what is being done to address this problem from both a national and local standpoint?
A: It has taken a little over two decades for us to get where we are and it certainly will not happen overnight. There are many steps that can be taken – we need to do more
to increase access to effective medication treatment of opioid use disorders, so people who have addiction can have easy access when they realize it is no longer just a pain issue, but also addiction. Physicians need to have a larger role in managing this condition. We also need to do more in terms of awareness of the risks and benefits around these medications and giving physicians license to be able to say, “Maybe we need to go in a different direction.”
Q: What about your own research into addiction, and how does it fit into your new role as Baystate’s first Chief Research Officer?
A: My research focuses on how we can have an effective system of care that recognizes addiction’s chronic relapsing nature. Recently, for example, I published a study in the New England Journal of Medicine that showed that an injectable, month-long form of naltrexone reduced opioid use in addicted former prisoners. Medicine and corrections will have to work together to find solutions to the opioid crisis, and I intend to use my research and my position to expand effective collaborations between Baystate and our regional criminal justice colleagues.
For more information, you can make an appointment to talk with a Baystate Health doctor by calling 1-800-377-4325.