Doctors who deal every day with the opioid crisis are in an unusual position — while this crisis grew, in part, from an overabundance of painkillers prescribed by physicians, doctors are also the people into whose hands addicts fall when they overdose or seek treatment.
Doctors who gathered to discuss the crisis at a forum at Stony Brook Southampton’s Parrish Memorial Hall on Feb. 8 shared many stories of their frustrations with medical treatment practices and with insurance companies that do little to help patients find alternative methods of controlling pain.
The forum was organized by the Southampton Town Opioid Addiction Task Force’s Medical/Treatment subcommittee.
Stony Brook Southampton Hospital Director of Medical Education Shawn Cannon opened up the session by telling the crowd about a 24-year-old patient of his who had been sober for six months when something triggered him to start using again, and his mother found him dead in the shower on New Year’s Day with a needle in his arm.
“I don’t know one person who, somewhere in their relationships, hasn’t lost someone to opiates,” he said. “Addiction, it’s time to come out of the closet. We have to change the attitude of ‘not in my backyard.’ It is in your backyard. People are dying.”
Dr. Cannon, who oversees about 50 medical students and residents at the hospital, said he’d hosted an orientation for the students earlier that afternoon and, as at every orientation, he’d asked for a show of hands of students who’d had some training in addiction medicine. Only one person raised their hand, and they’d only gone to a one-day symposium on the subject. Many of those students and residents were again in the audience for the evening forum.
“Don’t look to us for answers. We don’t have them,” he said of the medical community. “We need resources. We need political will….. We need to do disruptive innovation.”
Dr. Cannon said it costs about $800 per night to put an addict in the Suffolk County Jail in Riverside, when that money would be better used to get them into treatment.
He added that doctors are “still taught that patients are supposed to leave with no pain,” adding that psychotherapy, acupuncture and yoga, which have all proven effective in pain management, are often not covered by insurance companies, while painkillers are covered.
“We have two political parties, but they’re really the same party — The Business Party,” he said. “Big pharma is controlling this industry. They’re letting this get into your medicine cabinet and into your children’s bodies.”
“Our president did say this is a national epidemic, but gave us no money. Zero,” he added.
He added that most insurance companies are covering about five to seven days of inpatient addiction treatment — perhaps long enough for detox, but not for recovery.
“No one in this room has more insurance than a 28-day stay,” he said.
Dr. Daniel Van Arsdale, who serves as the Administrative Director of Medical Education at Stony Brook Southampton Hospital, said the 86-acre campus of Stony Brook Southampton College, now owned by New York State, is underutilized and “full of buildings that are empty and vacant” that could be used for treatment and recovery housing.
Dr. Van Arsdale said there’s much debate within the medical profession about whether to demand abstinence of addicts or to offer drug-based treatments, or even to allow ‘shooting galleries,’ where addicts have access to clean needles in a safe, hygienic environment.
“That one crazy, stupid, ugly idea may be the one that saves peoples’ lives,” he said.
He added that, while many alternative strategies for dealing with pain are offered by the private sector and are out of financial reach for many addicts, the Westhampton Primary Care Center has two physicians who perform acupuncture and is beginning to offer more treatments that center around the biopsychosocial model of addiction.
Riverhead Town Justice Allen Smith participates in the East End Regional Intervention Court, a drug treatment court that serves all five East End towns.
“Drug courts work,” he said. “Non-violent offenders should consider the East End drug court.”
Dr. Allen Fein, who has a family medicine practice in Southampton, is certified to treat patients with opioid use disorder, using an injection of the extended-release opioid dependance drug Vivitrol, which blocks opioid receptors in the brain.
“Any doctor can use a Vivitrol injection every 28 days, combined with therapies,” he said. “Office treatment isn’t for everyone, though. Many people need inpatient care.”
Dr. Fein said the certification is an eight to nine-hour online course, which is offered for free in many areas.
“You get your certificate in two days, and you’re on board. It’s not rocket science,” he said. “This is crazy. You don’t need a waiver to treat unstable diabetes, and that is so much harder. Every doctor here should leave Southampton Hospital with that waiver.”
Dr. Fein said there is still stigma attached to treating addicts. He pointed out that he had recommended one patient who came to him specifically for drug treatment go back to his primary care doctor and ask his own doctor to continue the Vivitrol treatment. The patient said his doctor flat out told him that “I don’t treat drunks.”
One young man in the audience said he used to be one of Dr. Fein’s drug treatment patients, but didn’t understand why he needed to pay cash to be treated.
“It’s just a money cow,” he said. “If it costs $800 a day to incarcerate me for behaviors I exhibit when I use. Why not use that for the recovery I need.”
Dr. Fein said he doesn’t take every insurance plan, but he does take many plans. He said the city of Buffalo has set up a process by which they can provide three days of medication in an emergency room, giving patients follow-up appointments in the community for monthly Vivitrol maintenance.
But, on the East End, he said, few medical providers offer those services.
“The Hudson River Health Care Clinic does not treat any opioid disorder,” he said. “That would ideally be the go-to place.
Dr. Cannon said Vivitrol costs $1,800 per dose.
“I myself spend five days with a good insurance company and get nothing,” he said. “Most people, even in this community, cannot spend $2,000 every 28 days. I think we should put people in the hospital, but if we did, we’d be bankrupt in 90 days. The system is not supporting this endeavor.”
Dr. Cannon said there needs to be a public groundswell, like the ones around breast cancer in the 1970s and AIDS in the 1980s, of public pressure for changes in addiction treatment.
“We had kiss-ins and die-ins. People paid attention and people watched,” he said. “No one yet has marched hugely on Albany. Where is the quilt of people who have died of this horrible disease? The people have to have the voice.”
Southampton Town’s Opioid Addiction Task Force’s next event will be a second youth forum on March 23 from 5:30 to 7:30 p.m. at the Greek Orthodox Church of the Hamptons. They are asking youth who participated in the prior forum in January bring a friend to the March 23 forum.
The Task Force is then planning to hold a second public forum on April 11 at Southampton High School. The group is also planning to hold a community vigil at Good Ground Park in Hampton Bays on May 12 from 6 to 8 p.m. The Task Force is expected to present a report with recommendations to the Southampton Town Board in June.