Peter Grinspoon got addicted to Vicodin in medical school, and still had an opioid addiction five years into practice as a primary care physician.
Then, in February 2005, he got caught.
One day, during lunch, the state police and the DEA showed up at his medical office in Boston.
“I start going all, ‘I’m glad you’re here. How can I help you?’ ” he says. “And they’re like, ‘Doc, cut the crap. We know you’re writing bad scripts.’ “
He was fingerprinted the next day and charged with three felony counts of fraudulently obtaining a controlled substance. He also was immediately referred to a Physician Health Program, one of the state-run specialty treatment programs developed in the 1970s by physicians to help fellow physicians beat addiction. Known to doctors as PHPs, these programs now cover other sorts of health providers, too.
The programs work with state medical 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 explains. It’s a significant incentive.
“The PHPs basically say, ‘Do whatever we say or we won’t give you a letter that will help you get back to work,’ ” Grinspoon says. “They put a gun to your head.”
But the problem, he and other critics say, is that, for various reasons, most PHPs don’t allow medical professionals access to the same evidence-based, “gold standard” treatment that addiction specialists today recommend for most patients addicted to opioids: medication-assisted treatment (MAT).
Grinspoon was told that to avoid a criminal record he would need to spend 90-days at an inpatient center in Virginia; there, he was not allowed access to the most common MAT prescription of counseling plus buprenorphine or methadone. These drugs are particular members of the opioid family that have been shown to suppress cravings for heroin, fentanyl and other frequently abused opioids. At the same time, Grinspoon was forced off all the drugs he’d been taking “cold turkey,” without the medical support that would have eased withdrawal pangs and cravings. “It was completely insane,” he says.
“Why on earth,” Grinspoon adds, “would you deny physicians — who are under so much stress and who have a higher access and a higher addiction rate — why would you deny them the one lifesaving treatment for this deadly disease that’s killing more people in this country every year than died in the entire Vietnam War? There’s no reason for it.”
While there is some variation in the particular rules and policies that each state’s physician health program follows, Dr. Sarah Wakeman of Harvard and the Massachusetts General Hospital Substance Use Disorder Initiative, says most PHPs don’t refer patients to addiction programs that include medication as part of their treatment. And that’s a problem, she says.
“I think the underlying issue is stigma and a misunderstanding of the role of medication,” Wakeman says, “and this idea that a non-medication-based approach is somehow better than someone taking the medication to control their illness.”
She co-authored a recent opinion piece in the New England Journal of Medicine titled “Practicing What We Preach — Ending Physician Health Program Bans on Opioid-Agonist Therapy,” along with collaborators Leo Beletsky and Dr. Kevin Fiscella.
“Systematically denying clinicians access to effective therapy is bad medicine, bad policy and discriminatory,” they write in NEJM. “We call on the health care sector to practice what it preaches, by discarding this antiquated norm.”
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