I’m a physician who specializes in addiction medicine, which means I’ve been busy lately. Busy treating some of the millions of Americans affected by the opioid crisis. Busy advocating for my colleagues in primary care to do the same.
In lectures and workshops, I ask them to start prescribing medications to help treat opioid addiction. I tell them patients are dying — and have died — because they are unable to find providers willing to help them. I remind them that drug overdose is now the leading cause of death for adults under 50 and that a medication called buprenorphine, which they have the power to prescribe, can cut that death rate by more than half.
This is a crisis, I tell them. We must act.
Not infrequently, my colleagues — smart, compassionate, dedicated doctors, nurses and physician assistants — refuse.
They tell me they bought the pharmaceutical company line once already, back when primary care providers were told to take care of patients’ pain and then given no resources other than opioids to do so.
They tell me they were taught that opioids weren’t addictive if prescribed to a patient in pain.
They describe how they were taught, as I was, that they needed to ask all their patients, every time, if they hurt, where they hurt and how much.
It turns out providers often weren’t helping those patients; we harmed them. Maybe even killed them. We helped start the opioid epidemic. So no, they tell me, they will not buy the promise of a magic pill again.
I want to shake them and scream, “This is not the same thing!” Opioids for chronic pain often have only moderate efficacy and carry significant risks; buprenorphine saves lives and helps decrease risk of HIV infection. I want them to stop arguing and just prescribe it.