Consequences Section

Weeks ago I posted a few new ideas—things like a memorial wall for victims of opioid dependence, and a ‘wall of shame’ for doctors who are known for reckless prescribing of opioids.  I mentioned these ideas over at SuboxForum as well.
I received good feedback from readers here, and from members there.  Sometimes the best feedback is the hardest to hear;  I’ll get excited about a certain plan of action, and like anyone, I don’t like it when someone rains on my parade.
One of my addiction docs from years ago was big on ‘sober thinking.’  Back then, it seemed as if anything I came up with that pushed the boundaries was in need of more ‘sober thinking.’  I wondered if ‘sober thinking’ was simply code for ‘I don’t want to say yes to your idea, and maybe that was the case in SOME instances.  But I now recognize a part of myself that acts quickly, impulsively, with great optimism, and with little regard for risks.  ‘Sober thinking’ is simply letting an idea sit in one’s mind for a few days or even weeks, and keeping a truly open mind to the comments that one receives about the idea.

Prison is a better consequence to heroin addiction
Beats Death--- Barely

I won’t spell out who wrote to me, but I’ll thank the people who did—who risked my ire by giving their honest opinions.  I mentioned a memorial page;  some people pointed out that a memorial on an addiction-related web page may add to the pain and shame felt by family members.  As for my ‘doctor wall of shame’, I was reminded that every story has two sides, and it may be more useful to simply provide referenced information that would allow readers to make up their minds without my own coloring of the facts.  I want to thank the people who wrote, and let them know that they made a difference—and the site will be better because of their efforts.
Instead of the earlier ideas, I added what I am calling the ‘consequences’ page.  The page will contain news stories identified to Google as having ‘drug overdose’ in their tags.  The information will be replaced every 24 hours or so.  I experimented with a couple different intervals and found that no day went by without a significant amount of news under that tag—a rather compelling statistic!
Click on ‘consequences’ to check it out, and let me know what you think!

Narcissism, Celebrity Rehab, and Another Overdose Death

On May 27th, 2011, actor Jeff Conaway died from complications of opioid dependence. His death has been attributed to several causes—sepsis, pneumonia, and aspiration among them— but there is little debate over the ultimate cause of his death at the age of 60 years, that being addiction to opioid pain medications.
Mr. Conaway reportedly struggled with chronic pain and addiction to pain medications for a number of years. His situation was particularly tragic—living with severe pain that was relieved by nothing save for a substance with the power to destroy him. Such situations are, unfortunately, not uncommon.
It is easy to take the position that Mr. Conaway should have avoided pain pills; that his addiction essentially disqualified him from even considering them. I will take that attitude myself from time to time, after a series of appointments with patients who are clearly worsening their situation by using opioids for pain that appears ‘tolerable.’ But about the time I start to become confident in my position, I always seem to develop a painful condition of my own—minor sciatica, plantar fasciitis, or lumbar strain, far less severe than the condition of the patients who I have decided should ‘tolerate’ their pain. Whenever that happens I realize, very quickly, something that I had forgotten– pain hurts! Funny how easy it is to ‘tolerate’ pain that is being experienced by someone else!
Most studies that follow patients with chronic pain over periods of years show that people are more ‘functional’ if they never use opioids for chronic pain. But there is considerable debate among the medical community over this issue, with each side finding little to appreciate in the other side’s position. Through my 25 years as a physician I’ve seen the pendulum swing back, and forth, and back again over the issue of opioid treatment for nonmalignant chronic pain. At present, science suggests that opioids are grossly overprescribed. But patients who are taking pain medications for severe pain have a hard time accepting the results of those studies.
There is also considerable confusion among people with addictive disorders about the proper treatment of addiction. I read that Mr. Conaway tried to recover from addiction using methods based in Scientology, as well as ‘traditional’ treatment methods. When he appeared on ‘Celebrity Rehab’, he had every reason to trust his treatment team, and to believe that the advice that he received was sound. But was he told that the success rate for the type of treatment offered in that silly, exploitative TV show is perhaps 5%—and that the presence of TV cameras probably made the success rate even lower?
And am I the only person who finds it bizarre that the doctor behind that TV show has a new book coming out about the harmful effects of narcissism on society– a book that he wrote after building his career off putting movie cameras in the treatment sessions of people who were dying from the end-stages of fatal disease?
I watched the same guy—the doctor writing about all those darn narcissists— do family ‘sex therapy’ on another TV show, offering 15 minutes of fame for teens who would talk about the most intimate details of their young lives, again providing one more step up the career ladder for the guy who is supposedly critical of narcissism.
Wow.
That same doc who is fuzzy on narcissism has made statements about buprenorphine that have done little to clarify the science of treating addiction. He was often on record on his celebrity show stating that buprenorphine should only be used short term, because otherwise people would become ‘dependent’ on it. Those comments surprised me, as I used to think that anyone with a TV show was at least up on the literature in his supposed field of expertise—and the literature has shown quite clearly, for several years now, that opioid addicts LIVE when they are on buprenorphine, and often DIE when they are not.
I can state without reservation that every patient I have treated with buprenorphine has remained alive while taking the medication—the vast majority of them feeling entirely normal, with no side effects save for constipation—which was a problem when they were using opioid agonists as well. I tell patients on buprenorphine that I’m sorry that they need medication, but they have a fatal illness after all—and that yes, they are dependent on buprenorphine—just as diabetics are ‘dependent’ on insulin.
We will never know for certain, but I strongly suspect that had Mr. Conaway received THAT recommendation—that he had a chronic illness, and that he deserved chronic treatment with a chronic medication—then I would have had to find a different topic for this blog post.
And that would have been fine with me.
Rest in Peace, Jeff Conaway.