[The following post by Dr. Peter Grinspoon has been shared with us by Harvard Health Publishing after originally appeared on their website in May of 2019.]
Going Public with Sobriety…
Alcoholism is hardly a rare disorder in the United States. According to recent studies, 12.7% of adult Americans currently suffer from alcohol use disorder, more commonly known as alcoholism; according to other studies, 29% will meet the criteria for an alcohol use disorder at some point during their adult lives.
If you add drugs to the mix, addiction (substance use disorder, including alcoholism) is even more common: it is estimated that in 2015, 20.8 million Americans met criteria for a substance use disorder within the prior year.
Given how common this problem is, one might think addiction would be readily accepted by our society, and that all one would have to do in order to get support is to admit one’s problem and ask for help. Right? Continue reading “Why Does This Doctor Talk about His Addiction? Because “Secrets Make You Sick””
By Sarah Bernstein, MD and Jessica Gray, MD
March 21, 2019
The opioid crisis and rise in overdose deaths in recent years has received a great deal of media attention. Though the media has helped to raise awareness, it has also contributed to stigmatization of individuals struggling with addiction. Pregnant and parenting women are among those who have been severely affected by the epidemic and perhaps most shamed by society for their use. Sadly, at a time when many women feel motivated to connect with the health care system and make healthy choices, women with addiction often avoid interacting with providers due to feelings of shame and mistrust. There are many misconceptions regarding the risks and benefits of medical treatment for women with substance use disorders as well as the treatment of neonatal withdrawal. We hope to dispel some of these myths and provide a better understanding of the evidence supporting the treatment of substance use disorders in the setting of pregnancy as well as neonatal withdrawal. Continue reading “Dispelling Common Myths about Opioid Use Disorder in Pregnancy”
by The HMS CME Online Team
NP and PA MAT Waiver Training
Through the Comprehensive Addiction and Recovery Act (CARA), nurse practitioners (NP) and physician assistants (PA) can become waivered to prescribe buprenorphine in the treatment of opioid use disorder (OUD) after completing 24 hours of specialized training.
We are pleased to announce that The Substance Abuse and Mental Health Services Administration (SAMHSA) has approved two of Harvard Medical School’s CME Online Opioid Use Disorder Education Program courses as fulfilling the 16-hour portion of the NP/PA 24-hour required training for waiver eligibility. These courses are: Continue reading “HMS Online CME Courses Approved for MAT Waiver Training”
By Sarah Wakeman, MD
September 18, 2018
In the face of a growing crisis of overdose deaths, predominantly driven by opioid-related fatalities, there has been a tremendous focus on decreasing the prescribing of opioid pain relievers. The reason for the drive to reduce prescribing is pretty simple; when we looked at the onset of the current crisis of opioid-related deaths, it was strongly correlated with rising rates of prescription opioids and treatment admissions for prescription opioid use disorder. As policy makers and clinicians looked at this correlation, a simplistic narrative emerged. If increased prescribing rates “caused” the overdose crisis, then reducing prescribing should curtail deaths. Unfortunately, as the saying goes, “For every complex problem there is an answer that is clear, simple and wrong.” As prescribing rates have decreased over the past five years, we have seen opioid-related deaths increase significantly. Continue reading “Making sense of opioid prescribing in the midst of the overdose crisis”
By Peter Grinspoon, MD
April 5, 2018
[Part three of a three-part series.]
As a profession, we can best navigate this complex thicket by returning to a basic, simple principle: the patient comes first.
As an undergraduate philosophy major, I learned that a moral system was flawed if a situation could present itself where a person could do no right. When it comes to providing pain medications, and treating chronic pain patients, doctors can feel as if their moral universe is broken. We are assailed on all sides. Bureaucrats try to restrict our prescribing and intimidate or harass us into not prescribing opiates. Patients rage at us when we can’t or don’t prescribe these medications. The end result can be a rupture in the thing that most of us value above all else: the doctor-patient bond. Continue reading “Doctors and Patients—Treating Chronic Pain As a Team”
By Peter Grinspoon, MD
March 8, 2018
[Part two of a three-part series.]
Why do so many healthcare providers find it difficult to treat chronic pain patients? I have not seen colleagues roll their eyes or audibly groan upon hearing that a patient that is new to their panel has diabetes or cancer, so what is it about a pain patient on opiates that fills so many with dread? Continue reading “The Harried Doctor & Chronic Pain Patients”
By Peter Grinspoon, M.D.
February 1, 2018
[Part 1 of a 3-part series.]
The commonly cited proverb, “The road to hell is paved with good intentions,” was coined in the twelfth century by a French abbot named Bernard of Clairvaux. In no case is this adage more apt than as applies to chronic pain patients, who have been cut off from their longstanding and stable supplies of opiates by physicians who have been convinced, cajoled, intimidated, mandated, and cowed into no longer prescribing high-dose opiates for chronic pain patients in response to the current opiate epidemic. Continue reading “The Orphaned Patient: Treating Chronic Pain with Opioids”