Treatment Limitations For Physicians With Opioid Addictions

Sep 5, 2019
Copyright 2019 NPR. To see more, visit https://www.npr.org.

MARY LOUISE KELLY, HOST:

When doctors and nurses become addicted to opioids and they get caught, they have to follow strict treatment guidelines to get their licenses back. Often that means they're not allowed to use the so-called gold standard of treatment - medications such as methadone and Suboxone. NPR's Selena Simmons-Duffin has more.

SELENA SIMMONS-DUFFIN, BYLINE: Here's how this played out for Dr. Peter Grinspoon. He got addicted to Vicodin in med school and still had an opiate addiction five years into practice as a primary care physician. Then, back in February 2005, he got in trouble.

PETER GRINSPOON: In my addicted mind frame, I was writing prescriptions for a nanny who had since returned back to another country. And it didn't take the pharmacist long to figure out that I was not a 19-year-old nanny from New Zealand.

SIMMONS-DUFFIN: One day during lunch, he says the state police and the DEA showed up at his medical office.

GRINSPOON: I start going, oh, I'm glad you're here. You know, how can I help you? And they're like, Doc, cut the crap. We know you're writing bad scripts.

SIMMONS-DUFFIN: He was fingerprinted the next day, charged with three felony counts of fraudulently obtaining a controlled substance. And he got referred to his state's physician health program or PHP. They work with state licensing boards. If you follow the treatment and monitoring plan they set up for you, they'll recommend to the board that you get your medical license back.

GRINSPOON: The PHPs basically say, do whatever we say, or we won't give you a letter that will help you get back to work. So they put a gun to your head.

SIMMONS-DUFFIN: And, Grinspoon says, they gave him very little choice. To avoid a criminal record, he needed to spend 90 days at an inpatient center in Virginia.

GRINSPOON: Why would you send this Jewish atheist to a Christian rehab place in Virginia? Didn't make any sense. I was just sitting there listening to people recite the Lord's Prayer and hold hands. They took me cold turkey off all my medications. It was completely insane.

SIMMONS-DUFFIN: He says medication-assisted treatment with Suboxone or methadone was off the table for him. Those medications are similar to opioids and work by suppressing cravings to the abused drug. Physician health programs, he says, effectively banned the use of these medications in the treatment plans they set up for physicians like him.

GRINSPOON: Why on earth would you deny physicians who are under so much stress and who have a higher access - they have free refills - and they have a higher addiction rate, why would you deny them the one life-saving treatment for this deadly disease that's killing more people in this country every year than died in the entire Vietnam War?

SIMMONS-DUFFIN: Grinspoon recovered despite what he called several awful rehabs. Today, he's a licensed primary care doctor and teaches at Harvard Medical School. He also wrote a book about his experience with addiction called "Free Refills." Now, this was over a decade ago, but Dr. Sarah Wakeman - also at Harvard - says most physician health programs still don't promote medication and treatment for addiction.

SARAH WAKEMAN: The sort of general standard of care is to send people to abstinence-based residential treatment programs that don't offer medication treatment.

SIMMONS-DUFFIN: She just co-authored a piece in The New England Journal of Medicine which called this, quote, "bad medicine, bad policy and discriminatory."

WAKEMAN: I think the underlying issue is stigma and the sort of misunderstanding of the role of medication and this idea that a non-medication-based approach is somehow better than someone taking the medication to control their illness.

SIMMONS-DUFFIN: So what do the institutions getting blamed here - physician health programs - have to say about all this? Dr. Christopher Bundy runs Washington state's PHP and the federation of all the state PHPs. He says it's true that these medications aren't often used, but that's not because of stigma or ideology.

CHRISTOPHER BUNDY: Proceeding with caution is understandable and warranted.

SIMMONS-DUFFIN: He says medication may be the gold standard of treatment in the general population, but there should be an asterisk when it comes to so-called safety sensitive workers, not just health care providers, also pilots, for instance. He says the concern is that these medications can affect cognition. So the idea of people caring for patients while taking something like buprenorphine makes some people nervous.

BUNDY: We only need one bad outcome involving a physician with substance use disorder who's back to work, then immediately the PHP is under the microscope.

SIMMONS-DUFFIN: He says then the criticism would be, how could you let that doctor work on a medication that could have played a role in that bad outcome? He doesn't know of a case where that's happened. Wakeman and her co-authors also argue there isn't clear evidence that these medications do impair cognition. Still, that fear could be what's driving the reluctance here. Bill Kinkel is currently navigating all of this. He lives outside Philadelphia.

BILL KINKLE: I'm a nurse, and I'm also a person in sustained recovery from opioid use disorder.

SIMMONS-DUFFIN: He'll be eligible to practice nursing again next fall after three years of documented sobriety. And he's public about being in recovery. He even has a podcast. When he was addicted, he said he was under a strong impression he wouldn't be able to go back to nursing if he was in a medication-assisted treatment program. So he went to abstinence-based rehabs over and over again. And over and over again, as soon as the rehab ended, he relapsed.

KINKLE: A lot of those I overdosed. And had my wife not found me on the floor and been able to take care of me, I very well may have died. And all that possibly could have been mitigated had I gotten either buprenorphine or methadone.

SIMMONS-DUFFIN: He doesn't fault the PHPs or the licensing boards for these policies even though he thinks they put his life at risk. He thinks stigma against those with addiction is so ingrained in our culture, there's no one institution to blame. What's important is that this changes, he says, and health professionals have access to all possible tools in recovery.

Selena Simmons-Duffin, NPR News. Transcript provided by NPR, Copyright NPR.