In the Spotlight. Read our monthly interviews with leaders in the pain management field
Physicians for Responsible Opioid Prescribing. An Interview with Andrew Kolodny, MD.
[Who elected Kolodny as a “leader” in the pain management field? What are his credentials in pain management?]
This was about ten years ago, and at the time our effort to reduce drug overdose deaths was focused on heroin. Although overdose deaths from opioid analgesics were already beginning to rise, we were unable to appreciate that a new epidemic was developing. To reduce overdoses we worked on expanding access to effective treatment, namely [mostly] buprenorphine.
[10 years ago, Kolodny began focusing on heroin abuse, and how have his efforts paid off? Considering his connections with Big Pharma, I’d say pretty well — for him.]
The task wasn’t easy because many physicians have negative views of people with addiction and are not interested in obtaining their buprenorphine certification.
[“Negative views” is quite an understatement, wouldn’t you say? In case Mr. Kolodny forgot, drug abuse and addiction are crimes in this country. As is suicide, by the way.]
According to the CDC, this new opioid epidemic is far worse than the heroin epidemic of the 1970s and the crack cocaine epidemic of the 1980s.
[Did the CDC actually say this? And what about the current heroin epidemic?]
For myself and many others in the fields of pain, addiction, public health, emergency medicine, toxicology, and the lay public, especially people who have lost loved ones to overdose deaths, we feel that sitting on the sidelines and watching the problem get worse is simply not an option.
[Kolodny is in the field of pain? When did this happen? Are “people who have lost loved ones to overdose deaths” also in fields of medicine?]
We mainly found each other through research publications. Several of our original members are quite prominent in their respective fields. Individuals like Jane Ballantyne MD, Len Paulozzi MD, MPH, Michael Von Korff ScD, Gary Franklin MD, MPH and Irfan Dhalla MD, MSc, are all well known for their work in this area.
[Good to know.]
What we all had in common was a concern that the epidemic was largely caused by aggressive opioid prescribing for chronic non-cancer pain and that this change in practice was not supported by strong evidence.
[Your “concern” is now public policy, thanks so much, Mr. Kolodny and crew. But this is a rather narrow focus on a rather large and complex problem. And when one doesn’t look for evidence, or is selective about which evidence to believe, one usually doesn’t find it.]
We believe that opioids are an important option in palliative care and for acute pain. Although we presume that there might be some patients with chronic non-cancer pain that can benefit from treatment with opioids, we strongly agree with the recent Institute of Medicine’s report’s statement that the effectiveness of opioids for chronic pain is “far from certain.”
Is anything really certain in medicine? I mean, there are many things that work which are “far from certain” (according to the medical industry), like medical cannabis. And just because something has been determined by one agency as “far from certain,” that doesn’t mean opioids should only be used for end-of-life care and acute pain.
You “presume that there might be some patients with…”? Aren’t presumptions (and concerns) also “far from certain”?
Mr. Kolodny, I assume (or presume) that you and your colleagues don’t suffer from chronic pain (but even if any of you do), so it must be really easy for you to determine what’s best for about 100 million chronic pain patients. (You elitist, egotistical, narrowly-focused, making-money-off-other’s-misery, know-it-all, handsomely-paid, alleged and pretend “expert.”)