It’s hard to figure out which group of people in the forefront of the opioid epidemic disgust Dr. Richard D. Blondell the most.
The drug companies that enriched themselves developing painkillers and sending out legions of sales reps to flood doctors' offices with the narcotics?
Outlier “writer” doctors who only take cash to see patients, charge more than the going rate for office visits, and tailor prescriptions to the desires of their addicted patients?
Health insurers – including Medicaid and Medicare – that pay for these drugs, and pass on the cost to policyholders and taxpayers, although they have the ability to track and crack down on abuse?
Or politicians who lack the will to create a long-term nationwide strategy to address the opioid crisis?
“The bulk of addiction is now created by the health care system,” said Blondell, professor of family medicine and vice chairman of addiction medicine at the University at Buffalo’s Jacobs School of Medicine and Biomedical Sciences. “This is an artificial epidemic. It’s the unintended consequences of aggressive pain management.
“Americans constitute 4 percent of the people on the planet. We consume 80 percent of the opioid painkillers.”
Blondell, who grew up in the Finger Lakes region, holds a bachelor’s degree in biology from SUNY Geneseo and a medical degree in family practice from the University of Rochester. He became interested in addiction medicine in the early 1990s while working in Louisville, Ky., after he sent two doctors for treatment while head of a residency program. He came to UB in 2003 to do clinical research and treat patients.
“My two big areas of research are people who have been prescribed into addiction – they have some kind of a pain issue and they end up hooked on prescription drugs – and women who are pregnant or who have small children and have an addiction,” he said.
Blondell practices at Erie County Medical Center, Horizon Health Services and the UBMD Addiction Medicine Ambulatory Care Center in Amherst. Over the years, his Amherst office has come to look more and more like a pediatrician’s office, with children’s books, toy trucks and stuffed animals in the waiting room for the toddlers whose moms come in for treatment.
Blondell will give a free talk on the opioid epidemic at 7 p.m. Wednesday at St. Pius X Catholic Church, 1700 North French Road, Getzville. All are welcome.
Q. What will you talk about at St. Pius X Parish?
The opioid problem, some basics, treatment, measuring success and how prevention is the answer, as well as five things you can to do prevent addiction among your children: Learn about your family history and risk of addiction; limit the use of painkillers; use medications only under supervision; dispose of unused medication; get educated about the science of alcoholism and drug addiction.
Q. How is your Amherst office practice organized?
It’s a 50-50 split, men and women. My youngest patient is 16. My oldest is 89. Most of my patients have an opioid problem, usually a prescription drug problem. I treat some people with a straight-up alcohol problem. About one-third of my patients have a coexisting chronic pain disorder. We end up doing some primary care, too. We have about 600 people altogether. We have about 40 or 50 women in the women’s program. … We’re trying to integrate basic medical education, health education and risk reduction right into the care that they get in a doctor’s office. Support meetings enhance the doctor visits. We think if people understand their addiction better, understand what we’re doing and are armed with a little more knowledge, we’ll help improve their outcomes.
Q. What is it about the new and expectant moms that fascinates you in terms of treatment?
It’s a big problem with women involved in not great relationships. They face a lot of stigma and doctors in treatment programs who deal with addiction don’t know what to do with the pregnancy, and OBs who deal with the pregnancies don’t know what to do with addictions. A lot of times, these women are kind of shuffled around. Nobody wants them. I’ll take ‘em.
Q. What have you found to be most effective in terms of treatment?
The standard educational message that we have given doctors is that if you treat someone for pain and they get hooked on the drugs and are doing cocaine, then fire ’em. That often converts a legal drug problem into an illegal drug problem, because then they’re going to go out and find heroin. What we tell medical students is to continue to treat their pain, but also begin to treat their addiction. This has to be done in a way that’s not rude or condescending. It has to be done with some sort of compassion. You have to deal with the shame and the stigma that they feel in order to help them accept your recommendations.
Q. How do you do that?
There’s a standard way, FRAMES: Feedback, Responsibility, Action, Menu of options, Empathy and Support. A conversation might go something like this: Feedback: “I’m concerned about what these painkillers are doing to you. We’ve been giving you more and more of these, but your pain has been getting worse, and it doesn’t seem to be helping you function. In fact, some of your family members have been concerned about you, as well.” Responsibility: “Only you can decide whether to accept my advice about what to do here.” Action: “I want to change the pain medication you’re on into something that might work better and have fewer side effects, but I’m also going to want you to get some counseling to deal with other issues.” Menu of options: “Other things that we could do is get you involved in an inpatient drug rehab program. We could hook you up with methadone maintenance.” I’m going to list some other alternatives. “Here’s my Plan A for you, but I’ve got Plans B and C here that are options.” Empathy: “I know this is a difficult conversation, and emotionally charged issue. We’re here to help you. We’re not going to abandon you.” Support: “You can do this. We can do something that’s going to result in better pain control with fewer negative impacts on your family life and your job.”
Q. Is there any research you’re conducting or have just completed?
We just got something published, a qualitative study to the women's reactions to our groups and what they felt they needed. When women are referred to addiction treatment programs, the counselors say, “This is what you do,” or “Here’s what you need.” We decided to ask the women, “What do you think you need?” It turns out they have a lot of questions about the maintenance medications (like Suboxone), how they work and how they affect their baby. What’s going to happen if they have a C-section and need something for pain? What do they do when they take the baby home? They have a lot of health-related questions. We have an “Ask the Doctor” session set up every two months.
Q. The opioid crisis sounds as if it has become like whack-a-mole. How do we solve it?
Everybody’s to blame, and there’s enough blame for everybody: the doctors, the health care companies, the drug companies, the politicians, the patients. Everybody owns a piece of this problem. What’s hard for people to do is accept their little piece of the problem and fix it. It’s easier to say, “I do this, but the big problem is really over there.”
Q. In the final analysis, doesn’t this all roll downhill to the patient?
We can’t treat our way out of this problem, not when the health care system is creating drug addicts faster than our little office can treat them. The answer always lies upstream – in prevention.
Q. What would going upstream look like? Have we started the process at all?
When a kid comes in for a wisdom tooth extraction, they don’t need to go home with 30 pills of Lortabs and three refills. We can stop that tomorrow. When we were kids, we didn’t get any narcotics. Tough. ... Unless you’ve got some pretty damned serious pain, you don’t get drugs. And if you’ve got chronic pain, we know that these drugs don’t work most of the time, so we can stop doing this stuff.
The health insurance companies know who the big prescribers are. They don’t have to wait for the DEA to arrest them. They’ve got the data. They know who these outliers are. They could put the screws to these doctors. And they know which patients are filling boatloads of drugs. They pay for this stuff and they’ve got the data. They could identify these patients early.
And we’ve got to rein in the drug companies. They can’t keep promoting this stuff. They can’t keep approving these new addictive drugs because somebody gets their palm greased.
And the politicians can start sucking this up and say, “We know this is hard but we’re going to work across the aisle, come together and pass some logical legislation that’s going to help.” Instead, we get some crackpot out in Missouri who thinks this is too much government oversight, that we don’t need these databases (to track narcotic painkilling prescriptions). We got one politician out in that state who said, “If they die of a drug overdose we’re just removing them from the gene pool.”
A legislator said this. What kind of bull---- is that? It makes a good soundbite, and appeals to certain constituency, but they’ve got to stop this stuff when people are dying.
Twitter: @BNrefresh, @ScottBScanlon