A leading addiction medicine expert says doctors are still prescribing too many opioids, and that those in the medical community should taper down doses and create “deprescribing clinics.”
Anna Lembke, a psychiatrist at the Stanford University School of Medicine, said that in Louisiana, 91 opioid prescriptions are written per 100 people, which is above the 2016 national average of 66 prescriptions per 100 people. She emphasized, though, that communities nationwide are grappling with the crisis and said doctors are under too much pressure to please patients rather than to practice medicine in the best way.
“Patients need to be able to walk into any emergency room, maternity ward, doctor’s office, and say, ‘I have addiction, can you help me?’ and get the care they need,” said Lembke, who penned the book “Drug Dealer, MD: How Doctors Were Duped, Patients Got Hooked, and Why It’s So Hard to Stop.”
Six hours after Kemper Roach was born, it grew clear something was wrong.
Speaking before a crowd of more than 100 Thursday at Pennington Biomedical Research Center, Lembke said she advocates decreasing opioid doses for patients who are in pain and not necessarily addicted. But, she said, health care providers often make the mistake of cutting doses too quickly. She explained that the resurgence of pain when someone starts taking lower opioid dosages is linked to the withdrawal that a patient feels because they crave the drug.
And she encouraged doctors to slowly taper down the drugs.
She also focused on the way perceptions of pain have changed over time. While medical attitudes used to be akin to the idea that “what doesn’t kill you makes you stronger,” the cultural narrative today is that any form of pain is dangerous, Lembke said.
She said, though, that doctors need to encourage patients to find other ways to manage their pain without necessarily taking medicine for it.
“We have to create life worth living for people, we have to think of creative ways to promote human flourishing so that the opioid is not the best option for them,” Lembke said.
Ava’s blonde hair sticks straight up in the air after she whizzes down her favorite slide at the playground.
After Lembke’s discussion, which was sponsored by the Baton Rouge Health District, she joined a question-and-answer panel with six other members of Baton Rouge’s health care community who represented hospitals, research centers and insurance providers.
One issue was whether Baton Rouge health care providers are set up to link people into medication-assisted treatment that helps addicts temper their desire for drugs like heroin by using Suboxone and Subutex instead. Lembke described herself as a proponent of those sorts of treatments, calling them “an absolute lifesaver for those who are severely addicted.”
But Amy Giarrusso, who represented Our Lady of the Lake Regional Medical Center on the panel, said they struggle to connect people from inpatient treatment to medication-assisted treatment once they leave the hospital.
“We don’t have that bridge,” Giarrusso said.
For pregnant women in Louisiana with opioid addictions, shame and stigma can be overwhelming.
Jan Kasofsky, executive director of Capital Area Human Services, said she hopes her agency can help to be part of that link. And John Spain, executive vice president of the Baton Rouge Area Foundation, encouraged the health care providers to support a longtime BRAF priority of building a mental health center and crisis stabilization center. Baton Rouge voters will weigh a property tax on Dec. 8 for that measure.