Who's to blame for America's opioid crisis? Is it possible to point the finger at one culprit and say, "Guilty as charged?" Stanford psychiatrist and addiction researcher Anna Lembke, MD, doesn't think so: She views the opioid epidemic in the United States as multi-factorial. In this 1:2:1 podcast about her book, Drug Dealer, MD, she told me:
You've got the biology of dependence or addiction to opioids driving it. You also have financial incentives for people to stay sick through Social Security disability insurance compensation. You've got doctors who are incredibly incentivized in many ways to continue to prescribe. I really feel like the opioid epidemic is the canary in the coal mine with regards to our health-care system. We have some serious infrastructure issues that we need to reform.
I asked Lembke about the problems that patients were confronting when they came to her for help. "What weren't the problems?" she responded. "They had problems at work, problems in their personal relationships. They had legal problems. They had serious health issues. Really, it touches all aspects of life."
Lembke told me that she wrote the book "for family members, and friends of people who have become addicted to prescription drugs, particularly opioids." She also had in mind physicians: "Anybody who was going to be prescribing who might not know very much about addiction or about this epidemic so that they could be better informed to stop the kinds of behaviors that are contributing to the problem."
So are physicians who prescribe opioids the problem, as the title of her book implies? Lembke's not willing to be as harsh. "I think there's been so much emphasis on primary care docs having to solve this problem... It's totally unfair unless they are given the time and resources to do it." Addiction is, she said "socioeconomically complicated... multi-generational trauma. [Primary care physicians] are given ten minutes to put that all together. It's totally unfair and unrealistic and isn't going to solve the problem."
So what is going to solve the problem? "...Get Big Pharma out," she said adamantly. "Stop all the lobbying and the kickbacks and the favors and the influence. We need to get that kind of big moneyed influence out of our healthcare reform and our healthcare policy and decision-making. We need to give doctors more time."
The fall issue of Stanford Medicine magazine features an excerpt of Drug Dealer, MD.
Previously: The power and limits of zeroing in: Stanford Medicine magazine on diagnostics, Overprescribing of opioids is not just limited to a few bad apples, The problem of prescription opioids: "An extraordinarily timely topic" and Stanford addiction expert: "It's often a subtle journey" from prescription-drug use to abuse
Illustration by Francesco Bongiorni