BATON ROUGE, LA (WAFB) - One of the first voices to raise awareness about the role the medical community played in driving the opioid epidemic belonged to psychiatrist Dr. Anna Lembke. Lembke, who is on staff at Stanford University School of Medicine, said even as doctors and physicians were trained to distribute opioids under the belief they were not addictive, the idea of addressing and treating addiction was nearly non-existent. Lembke says even as she began her own residency and practice, she had no interest in treating addiction. However, her patients brought that issue to her. She quickly realized substance abuse was a prevalent problem.
“I realized if I did not figure out how to help them with that problem, they were not going to get better,” said Lembke.
Lembke said she retrospectively began an education on addiction and began to see a clear connection between the prescribing practices of physicians and the growing opioid epidemic.
“The epicenter of the opioid epidemic really was in hospitals clinics, in clinics, in emergency rooms,” said Lembke.
In 2012 she began working on a book to highlight the responsibility the medical community shared for the issue, and how it could be changed. Her book, Drug Dealer MD – How Doctors Were Duped, Patients Got Hooked, and Why It’s So Hard to Stop, was released in 2016. In that time, Lembke has become one of the nation’s experts on addiction. It’s a mantel she said she received almost by default.
Lembke spoke about her book and other opioid issue during a free seminar hosted by the Baton Rouge Health District earlier this week.
Lembke said there’s a huge need for addiction treatment resources, including more specialists. However, she fears that stigma and finance may be huge hurdles to developing the needed work force. She said until the reimbursement to medical facilities for providing addiction services is similar to the reimbursement received for treating other diseases, it will be hard to convince doctors to invest their time in the field.
“When people go to medical school and choose their residency, part of their choice is going to be motivated by practicality,” said Lembke. “If you don’t see anybody above you working the field, you’re not going to get inspired; but, if you can’t make a living treating patients with addiction a lot of people aren’t going to go into it.”
Other hurdles and complications according to Lembke include changing the prescribing practices of opioids and working with patients who currently use opioids to adjust or change their treatment options to reduce potential harms. The later, Lembke admitted, will take a huge commitment from doctors.
Lembke’s clinic in California has developed a “deprescribing” system, to help chronic pain patients adjust or change their opioid regimens. That includes taking them off opioids completely or reducing the dosage to a safer level. Lembke said it takes time and compassion, but there is success.
Another big criticism of the current opioid epidemic is the reaction to the current issue. When compared to the “War on Drugs” approach to earlier illicit drug issues, which emphasized criminalization, there is now much more emphasis on treatment and looking at addiction as a disease instead of a choice. Lembke said it’s clear that the demographic of opioid users played a big role in the dramatic shift in national attitude.
“Racism is a big part of it. It’s fascinating when you tease apart the way that racism in our culture and in medicine has caused this epidemic to differentially affect different populations,” said Lembke.
Lembke pointed out that the rate of opioid addiction was slow to grow among minority populations because many physicians would view a minority patient as “drug seeking rather than needing treatment for pain,” so they were less likely to prescribe opioids. In a way, Lembke said, that act of implicit racism insulated minority populations from the opioid epidemic for a time. However, now that opioid addiction has gripped nearly all demographics, Lembke said minority patients still struggle to get access to better treatment.
Lembke hopes as more people view addiction as a treatable disease, there will be improved outcomes across the board.
“The silver lining for the opioid epidemic, if one can find a silver lining in such a tragedy, is that it’s finally forced the medical profession to wake up and say, hey this is a problem that we partly caused and that we can do something about,” said Lembke.