The Brown Medical Association held a panel to discuss how to better train doctors and medical professionals to prevent opioid addiction and treat those suffering from the epidemic Thursday night at the Alpert Medical School.
Though the general focus is on the illicit overseas production of fetanyl, an opioid used in pain medication, doctors within the United States have contributed to the crisis by doling out 250 million opioid prescriptions a year, said Marc Siegel, associate professor of medicine at New York University Langone Medical Center and moderator of the panel. Twenty-five percent of patients who are prescribed opioids become addicted, he added.
The panel was comprised of four medical professionals who considered ways in which the medical community could reduce its prescriptions of opioids, especially through reframing the understanding of pain.
There has been a general reduction in the number of pills prescribed, said Jennifer Clarke, medical director of the R.I. Department of Corrections. “If you have a tooth removed, you won’t get 40 Vicodin,” she joked, adding that it is important to figure out the root cause of a condition rather than using an opioid as a cure-all solution.
There is also a movement toward not prescribing opioids in the first place, though each patient should be treated on a case-by-case basis, said Clinical Assistant Professor of Psychiatry and Human Behaviour Laura Levine.
“I don’t think there is any cause for people to pull it out and take all of their patients off of opioids,” she said. “I’ve had some pretty severe negative consequences from that happening.”
In addition to discussing ways to decrease the accessibility of opioids, panelists emphasized the importance of destigmatizing addiction. There are shifts in terminology within the medical landscape to avoid ostracizing those affected by addiction, Levine said. The word “abuse” is used less and less in this context, she said, adding that “we didn’t call an eating disorder ‘food abuse.’” In toxicology, the word ‘clean’ is used less frequently to describe a person not using drugs, as it may imply that those using drugs are ‘dirty,’ she added.
Geoff Capraro, assistant professor of emergency medicine, hopes that his NaloxBoxes will further help destigmatize opioid addiction by putting “these tools out there” for the public to intervene in overdose cases, as previously reported by The Herald.
The panel also highlighted the need for resources for those leaving prison. When people stay in a facility — while incarcerated or in treatment — their tolerance goes down, and they can die from what was previously a non-toxic dosage, Clarke said.
“This drug changes people’s brains,” she said. “They have all the intentions in the world of stopping, but once you get out and you’re exposed to the triggers that you weren’t exposed to in prison, … it’s all around.”
Overdose deaths in the state are decreasing, Clarke said, citing the effectiveness of Gov. Gina Raimondo’s Overdose Task Force on opioid addiction.
“I got the knowledge that we have some really great medical professionals working in the state of Rhode Island on this unbelievable, overwhelming epidemic,” said Laurie MacDougall, a founder of Resources Education and Support Together.
For its part, the University is a pioneer in the education of the pathophysiology of pain, said Paul George, associate professor of family medicine.
There is also an addiction fellow on campus and a course that focuses specificially on pain and addiction, Levine said.
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