NOVA Documentary Explains Addiction Causes And Treatments

A dangerous cocktail of biology and medicine. That's how opioid addiction is described in a documentary that debuts on Nova tomorrow night. With drug overdose the leading cause of death in the U.S. for those under 50 years old. The documentary examines what causes addiction and how it can be treated powerful painkilling drugs like fentanyl and Oxycontin often start as prescribed medicine and can end up leaving patients with life threatening addiction. Joining me is Dr. Anna Lemcke. She's chief of the Stanford addiction medicine dual diagnosis clinic. She's the author of Drug Dealer M.D. How doctors were duped patients got hooked and why it's so hard to stop. And she appears in the Nova documentary Dr. Lemcke welcome to the program. Oh thank you for having me. We've heard about the terrible problem opioid addiction is in some states back East and in the Midwest. How does California compared to the rest of the country. Right. So California is actually doing pretty well compared to the rest of the country. There were about five deaths per 100000 persons in California in 2017 versus 13 deaths per 100000 persons as a kind of national average. So overall we're doing well we're also doing better than other parts of the country in terms of opioid prescribing and of course opioid prescribing has been one of the major factors contributing to opioid overdue overuse and subsequent addiction. So for example in 2016 the U.S. average for opioid prescribed prescriptions was 66. OK prescriptions per 100 persons. And the California state average was 45 opioid prescriptions per 100 persons that still a lot of opioid prescriptions. But again California's doing pretty well. I will though add as a caveat that there are counties in California that continue to have very high rates of death. And that also correlates with the same counties where there tends to be a lot of opioid prescribing. So it does vary quite a big county to county. Dr. Lemcke in the Nova documentary we hear the story of Casey who got addicted to opioids as a teen. Can you tell us about Casey why did she first start taking opioids. So my patient Casey first started on opioids because as a teen she had this inexplicable leg pain and because the doctors couldn't figure out what it was they admitted her to the hospital to do a very lengthy medical workup and to treat her pain while she was in the hospital. She was given really copious amounts of opioids on a daily basis. She was hospitalized for several months and during that time she received opioids daily to the point when she was ultimately discharged and it was determined that she didn't really have any significant serious medical condition. They actually gave her a serious medical condition which was that they made her opioid dependent. And that's that's really how it happened. She participated in the health care system and she threw that participation got addicted to opioids. The other thing that's I think important to be aware of is that as a teenager you know her brain is developing and is particularly susceptible to the kinds of changes that opioids can render in the brain such that she was because of her use of potentially even more susceptible to becoming addicted with that Dr. caused exposure. She complained of terrible pain not connected with the surgery that she underwent and it was finally discovered she was hurting from opioid withdrawal. Why wasn't that picked up sooner. Well it's a very insidious process whereby initially opioids help with pain but then as people become dependent on the body and the pain threshold changes such that when they're withdrawing they have enhanced pain which is not the pain of any underlying medical condition. But his opioid withdrawal mediated pain and you know for a long time in medicine we weren't really aware of the fact that patients could actually experience more pain when taking opioids long term that's something that we've just learned over time experientially after seeing many many patients on high dose opioids for long periods of time who actually have worsened pain which we believe is actually caused by the opioids. It's something called opioid induced hyper algaes you know when the hospital found out she was addicted. They told her not to come back. How often does that happen. Yeah that's a real tragedy. And I just find absolutely heartbreaking that that we're turning these people away even when we the medical profession are responsible for getting them addicted in the first place. That happens because doctors aren't well trained in how to treat addiction. The disease of addiction is highly stigmatized. There's no infrastructure in the House of medicine to provide this treatment. Insurance companies for the most part don't willingly pay for it. So we created you know several generations of opioid addicted persons. And then when we realized they were addicted we just sort of sent them away and it's a real tragedy. You know it's the tragedy of this epidemic. What are the alternatives to opioids to reduce pain. Well a very influential study just came out showing that if you take opioid naïve patients with chronic pain and you give them opioids for a year versus give them Tylenol or ibuprofen what you find is that the opioids work no better than Tylenol and no better than ibuprofen which is really important news because people have the impression that opioids are so much more effective for pain than these non opioid medications. But in fact it's not true. Furthermore that people in the opioid group after a year had many more side effects than the people in the Tylenol and ibuprofen group. Having said that there are also lots of other remedies or interventions for various sorts of chronic pain. There are all kinds of non medication remedies like physical therapy trigger point massage chiropractic acupuncture psychotherapy all kinds of mind body practices. There are also other interventions that pain specialists can use. They use Lleida cane infusions they use electrical stimulation devices and this is a growing area of research trying to find non opioid remedies to help people with chronic pain. Because I want to emphasize that living with chronic pain is horrible and we're not doing enough for patients with pain. But the important take home here is that opioids are not the answer because they don't work because they can make pain worse and because they can lead to addiction and death. I've been speaking with Dr. Anna Lemcke she's chief of the Stanford addiction medicine dual diagnosis clinic the addiction documentary on Nova will air tomorrow night on PBS TV at 9 Dr. Lemcke. Thank you. Oh thank you for having me.