Skip to content
  • About
  • Contact
  • Contribute
  • Book
  • Careers
  • Podcast
  • Recommended
  • Speaking
  • All
  • Physician
  • Practice
  • Policy
  • Finance
  • Conditions
  • .edu
  • Patient
  • Meds
  • Tech
  • Social
  • Video
    • All
    • Physician
    • Practice
    • Policy
    • Finance
    • Conditions
    • .edu
    • Patient
    • Meds
    • Tech
    • Social
    • Video
    • About
    • Contact
    • Contribute
    • Book
    • Careers
    • Podcast
    • Recommended
    • Speaking

Why aren’t you treating opioid addiction?

Kathleen A. Hallinan, MD
Meds
May 11, 2019
102 Shares
Share
Tweet
Share

Our community had one of “those” providers — a midlevel who was the local pain person. If you had pain, go to her. She would write you for anything you could want and more. It’s unclear if she was unscrupulous or just inept. But last year, the DEA finally figured out what she was doing and yanked her license. There was nothing in the news. Nothing on the internet. We all knew it just by word of mouth from other providers and her patients. The tragedy for many of these patients was that not only did their primary care providers abandon them but even the local pain specialists abandoned them. No one would write for the doses of narcotics these people were on with the strategy to wean them down. No one would put them on Suboxone because no one wants to get their waiver. So they called me.

There are only a few of us in this community who have Suboxone waivers. We are a rural area that is not large enough to support a methadone clinic, so the only other medically assisted therapy that would keep these patients out of withdrawal would be Suboxone (buprenorphine/naltrexone). While shots of naltrexone alone are somewhat helpful to patients who need a deterrent from going back to opiates, those who are on high doses are facing a terribly rough road if they are not eased down with a substitute therapy. That is where buprenorphine comes in. It locks onto the opiate receptors and takes them out of withdrawal. It blunts their cravings.

These patients are often scared, to the point of being frantic. If the DEA wanted to create the perfect condition to create heroin addicts, they did a great job. Take a patient base on high dose oral prescription opioids and pull the plug on them with no plan and no providers willing to step in. Often these patients have coexisting mood disorders, depression, anxiety or bipolar disorders that have been left untreated.

Thankfully, I have been able to help several of these people wean down from unthinkable doses of opiates. One gentleman didn’t want to change over to Suboxone but just wanted me to take him down on his dose until he could get off the prescriptions. He started at over 500 mg of oxycontin and oxycodone a day and is now down to 10 mg three times a day.

Several other patients were brought in to the office in moderate withdrawal and started on Suboxone. We start these patients in the office by protocol. If patients have a lot of active opiate in their system and are not in withdrawal then giving them, Suboxone can precipitate withdrawal.

That being said, Suboxone is used by addicts in the community to keep from getting sick, and it has an extraordinarily good safety profile. The buprenorphine has a very high affinity for opiate receptors but reaches a plateau in its effect. Patients who are completely naive to it may have some euphoria with a first dose, but after that, they are not feeling “high” with steady dosing. It takes them from a state of withdrawal to feeling normal. Watching this transformation over the period of an hour in the office is an amazing thing to watch. These patients go from gray, fidgety, sniffling, nauseated wrecks to someone who looks fine in the span of an hour.

The tragedy here is that most primary care providers will not take the course and take the test (which any drug addict could pass) in order to write for this medication. Why? Because it is a difficult patient base to treat. These patients often lie, divert, relapse and misbehave in all sorts of ways that make the physician want to sit them down with Howard and Marion Cunningham (Happy Days reference) for some solid parental oversight. They need discipline, love, and guidance. And they need providers to not fall for their “my dog ate my films” stories.

Most providers seem paralyzed at the prospect of treating a patient that they can not trust. That being said, the patients I have who have been clean now for years, have gotten their children back, maintained a job, a home, and a car, and aren’t in jail or dead, and have been the most amazing patients I have ever known. They often have come from life situations that are ripe with stories of being beaten, abused and — at best — neglected. It takes a lot to come back from that. It takes a patient who sees that there might be a reason to hope that there is a way out of the hole. It takes a medical community who is willing to give them rungs to climb up.

Kathleen A. Hallinan is an internal medicine physician.

Image credit: Shutterstock.com

Prev

Want to create a review course? Here’s how this physician did it.

May 11, 2019 Kevin 0
…
Next

Protecting women from maternal mortality

May 12, 2019 Kevin 0
…

Tagged as: Pain Management, Psychiatry

Post navigation

< Previous Post
Want to create a review course? Here’s how this physician did it.
Next Post >
Protecting women from maternal mortality

Related Posts

  • A physician’s addiction to social media

    Amanda Xi, MD
  • The dangers of opioid addiction in the medical industry

    Anonymous
  • The other opioid epidemic that we ignore

    Hans Duvefelt, MD
  • The opioid crisis: Doctors cannot lose hope

    Linda Girgis, MD
  • Treating the patient’s body is not synonymous with treating the patient

    Steven Zhang, MD
  • Treating mental illness will not stop mass shootings

    M. Bennet Broner, PhD

More in Meds

  • The deadly consequences of a shortage: The Pluvicto crisis leaves metastatic prostate cancer patients in limbo

    Matt Drewes
  • The real story of Xylazine contamination in street fentanyl and how we can manage it

    Julie Craig, MD
  • The cannabis education gap: Why patients are left in the dark

    Timothy Byars
  • Are doctors ready to discuss psychedelic therapies with patients?

    Thaís Salles Araujo, MD
  • The rise and dark side of fungi: Exploring health benefits and pathogenic threats

    Sandra Vamos, EdD and Deanna Lernihan, MPH
  • Advocacy and collaboration lead to major patient safety benefits on sterile pharmaceutical compounding: a review of USP’s revisions to Chapter <797>

    Elizabeth Rebello, MD
  • Most Popular

  • Past Week

    • A patient’s perspective on the diminishing relationship between doctors and patients

      Michele Luckenbaugh | Conditions
    • How chronic illness and disability are portrayed in media and the importance of daily choices for improved quality of life

      Juliet Morgan and Meghan Jobson | Physician
    • The hidden factor in physician burnout: How the climate crisis is contributing to the erosion of well-being

      Elizabeth Cerceo, MD | Physician
    • Why affirmative action is crucial for health equity and social justice in medicine

      Katrina Gipson, MD, MPH | Policy
    • The power of coaching for physicians: transforming thoughts, changing lives

      Kim Downey, PT | Conditions
    • Unlocking the secrets of cancer conferences: an end-of-life counselor’s journey among pharmaceutical giants

      Althea Halchuck, EJD | Conditions
  • Past 6 Months

    • “Is your surgeon really skilled? The hidden threat to public safety in medicine.

      Gene Uzawa Dorio, MD | Physician
    • It’s time to replace the 0 to 10 pain intensity scale with a better measure

      Mark Sullivan, MD and Jane Ballantyne, MD | Conditions
    • Breaking point: the 5 reasons American doctors are dreaming of walking away from medicine

      Amol Shrikhande, MD | Physician
    • Unveiling the hidden damage: the secretive world of medical boards

      Alan Lindemann, MD | Physician
    • Revolutionize your practice: the value-based care model that reduces physician burnout

      Chandravadan Patel, MD | Physician
    • Breaking the cycle of racism in health care: a call for anti-racist action

      Tomi Mitchell, MD | Policy
  • Recent Posts

    • The unjust reality of racial disparities in pediatric kidney transplants

      Lien Morcate | Conditions
    • The pros and cons of taking a gap year during medical school

      Med School Insiders | Education, Sponsored
    • A family physician’s journey on the OIG list and the struggle to return to practice [PODCAST]

      The Podcast by KevinMD | Podcast
    • Heartwarming stories of cancer patients teaching us about life and the human spirit

      Johnathan Yao, MD, MPH | Physician
    • We need a new Hippocratic Oath that puts patient autonomy first

      Jeffrey A. Singer, MD | Physician
    • The meaning of death in medicine: the role of compassionate care in end-of-life patient care

      Ton La, Jr., MD, JD | Physician

Subscribe to KevinMD and never miss a story!

Get free updates delivered free to your inbox.


Find jobs at
Careers by KevinMD.com

Search thousands of physician, PA, NP, and CRNA jobs now.

Learn more

View 5 Comments >

Founded in 2004 by Kevin Pho, MD, KevinMD.com is the web’s leading platform where physicians, advanced practitioners, nurses, medical students, and patients share their insight and tell their stories.

Social

  • Like on Facebook
  • Follow on Twitter
  • Connect on Linkedin
  • Subscribe on Youtube
  • Instagram

CME Spotlights

From MedPage Today

Latest News

  • Catching the Optimal Amount of Z's May Be Protective Against Long COVID
  • Treating Early Hospitalization Blood Pressure Deemed a No-No for Patient Safety
  • Addressing Burnout in an Invisible Part of the Health Workforce
  • Family-Oriented Sedation Protocol Helps Kids With ASD Manage Routine Healthcare
  • Bariatric Surgery in Kids With Obesity Becoming More Common

Meeting Coverage

  • New Model Aims to Study Intestinal Fibrosis in Crohn's Disease
  • Hypertension Tied to Worse Survival After Surgery for Upper Tract Urothelial Cancers
  • The Role of Amyloid PET in the Management of Alzheimer's Disease
  • New Inflammation Inhibitor Proves Effective and Safe for Dry Eye Disease
  • No Access to Routine Healthcare Biggest Barrier to HPV Vaccination
  • Most Popular

  • Past Week

    • A patient’s perspective on the diminishing relationship between doctors and patients

      Michele Luckenbaugh | Conditions
    • How chronic illness and disability are portrayed in media and the importance of daily choices for improved quality of life

      Juliet Morgan and Meghan Jobson | Physician
    • The hidden factor in physician burnout: How the climate crisis is contributing to the erosion of well-being

      Elizabeth Cerceo, MD | Physician
    • Why affirmative action is crucial for health equity and social justice in medicine

      Katrina Gipson, MD, MPH | Policy
    • The power of coaching for physicians: transforming thoughts, changing lives

      Kim Downey, PT | Conditions
    • Unlocking the secrets of cancer conferences: an end-of-life counselor’s journey among pharmaceutical giants

      Althea Halchuck, EJD | Conditions
  • Past 6 Months

    • “Is your surgeon really skilled? The hidden threat to public safety in medicine.

      Gene Uzawa Dorio, MD | Physician
    • It’s time to replace the 0 to 10 pain intensity scale with a better measure

      Mark Sullivan, MD and Jane Ballantyne, MD | Conditions
    • Breaking point: the 5 reasons American doctors are dreaming of walking away from medicine

      Amol Shrikhande, MD | Physician
    • Unveiling the hidden damage: the secretive world of medical boards

      Alan Lindemann, MD | Physician
    • Revolutionize your practice: the value-based care model that reduces physician burnout

      Chandravadan Patel, MD | Physician
    • Breaking the cycle of racism in health care: a call for anti-racist action

      Tomi Mitchell, MD | Policy
  • Recent Posts

    • The unjust reality of racial disparities in pediatric kidney transplants

      Lien Morcate | Conditions
    • The pros and cons of taking a gap year during medical school

      Med School Insiders | Education, Sponsored
    • A family physician’s journey on the OIG list and the struggle to return to practice [PODCAST]

      The Podcast by KevinMD | Podcast
    • Heartwarming stories of cancer patients teaching us about life and the human spirit

      Johnathan Yao, MD, MPH | Physician
    • We need a new Hippocratic Oath that puts patient autonomy first

      Jeffrey A. Singer, MD | Physician
    • The meaning of death in medicine: the role of compassionate care in end-of-life patient care

      Ton La, Jr., MD, JD | Physician

MedPage Today Professional

An Everyday Health Property Medpage Today
  • Terms of Use | Disclaimer
  • Privacy Policy
  • DMCA Policy
All Content © KevinMD, LLC
Site by Outthink Group

Why aren’t you treating opioid addiction?
5 comments

Comments are moderated before they are published. Please read the comment policy.

Loading Comments...