Too many doctors worry about “those people” showing up in the waiting room. They don’t particularly want to be known as a resource for the addicted.

This article is by an addictionologist who is also a resident scholar at the conservative American Enterprise Institute:

The Myth of What’s Driving the Opioid Crisis

She argues that physicians have been unfairly blamed for the opioid epidemic and as a result have become overcautious in their use of opioids with pain patients.

I’m  not sure that qualifies as a myth. I can see her point about excessive caution: The docs I’ve encountered of late seem to range from unusually careful to downright paranoid about using opioids to treat pain. It’s a noble effort but our healthcare system has been dependent on opioids for as long as I can remember and it’s not a habit that can be replaced overnight. I figure physicians are overreacting to the frightening reality of an epidemic that shows few signs of slowing down, let alone coming to an end.

A decade or two ago those of us in the addiction field were still bombarded by advocates for more aggressive use of opioids, based on an estimated 100 million chronic pain patients” (nearly 1/3 of the American population? Should that have been a tip-off to… something?) Now the news is all about those mounting numbers of fatalities. If I were a prescriber, I sure wouldn’t want to be associated with that, in any respect.

So the challenge is clear: How do we provide necessary care for those who genuinely need opioid treatment, while protecting the rest of society from the obvious dangers of widespread opioid use? I hate to admit it, but the US healthcare system, as presently constituted, does not appear up to the task. Neither does the criminal justice system.

One point: in my experience, there’s a limited future in trying to attract the majority of private physicians to use of medications such as buprenorphine and naltrexone. Too many doctors worry about “those people” showing up in the waiting room. They don’t particularly want to be known as a resource for the addicted.

Sure, it’s stigma. But it’s one thing to criticize people for how they feel and quite another to change those feelings in any lasting way. That takes time we may not have.

If it were my call (and of course, it isn’t), instead of recruiting Everydoc, I’d focus on expanding the reach of specialty treatment programs– on ways to improve clinical care as well as ensure those programs are  operationally sound and financially sustainable, going into the future.


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