HUDSON–With the opioid use crisis as a springboard, Dr. Anna-Maria Assevero, an internist at Columbia Memorial Hospital, shared thoughts and insights with the Columbia County Board of Supervisors Health and Human Services Committee at its meeting Tuesday, May 16.
Her observations included:
• “Schools educate about drugs, and kids know a lot about them, and yet they still try them”
• Many people do not know where “to go for companionship” without “temptation to use” potentially harmful substances
• “We need a drop-in center” for people struggling with opioid use problems
• “Addiction is a chronic relapsing disease. People are doing well and then decide to go off the rails”
• Opioid addiction “sneaks up on you. Like cigarette addiction”
• Since many people get introduced to opioids as legitimate pain relievers prescribed by doctors, the crisis has put doctors under scrutiny. Yet in England, doctors prescribe higher doses, but the public has a lower addiction rate
• “Eighty to 90% of these drugs that are prescribed are prescribed in the USA. What are people elsewhere in the world doing with their pain?”
• “We have patients coming in for pain meds they have no intention of taking.” They sell them; it’s the only way they can pay their rent
• Oxycodone is more expensive than heroin
• “This epidemic will burn out as other epidemics have, but it will leave ravages”
Some people use opioids like comfort food for loneliness. “Everybody is trying to chase happiness,” Dr. Assevero observed.
“It’s not the high they’re seeking. It’s the withdrawal they want to avoid,” said Michael Cole, County director of Human Services.
Dr. Assevero noted that someone for whom she prescribed a pain medication “years ago” is “still on it.”
Supervisor Richard Scalera (D-Hudson, 5th Ward) said, “If you say your pain level is now zero, a doctor is likely to say: Stay on the same level of pain meds.” Mr. Scalera believes physicians don’t attempt to experiment with “lowering the dose.”
“If a patient asks for pain meds, how do you know if they want to lose pain or to get high?” Mr. Scalera continued. “Doctors should be able to “look a patient in the eye and tell if they’re really in pain or just an actor. But you don’t have time.”
“We need more treatment,” said Dr. Assevero. “But treatment isn’t just a pill. Because people are more complex than this. We doctors have to give patients time. But we don’t have time. It’s like an assembly line. We have to go go go.”
Some patients need to “be away, perhaps for as much as six months. If they’re not away, they’re going to use,” she said. But she added, “Where will we send the patients? There aren’t enough beds. There aren’t enough therapists. There aren’t enough treatments.”
When Supervisor William Hughes (D-Hudson, 4th Ward) asked whether doctors were talking about best practices. Dr. Assevero responded, saying, “We’re rather low on the totem pole.” She said that “the insurance companies are calling the shots. We’re now data entry clerks, essentially. Doctors get the highest score if they have the most compliant patients, according to what they put into the computer.” Meanwhile, she said, “I don’t think the patient can get two words in,” noting that “we don’t see” even some people who have insurance “because they’re bad for our business.”
“Does the American Medical Association talk about what we’re talking about today?” asked Robert Gibson, of the County Department of Social Services.
“Under the table,” Dr. Assevero replied.
“We have our work cut out for us,” she remarked. “We are under siege as doctors.” Many people “have access to lots of care but are not happy.”
Meanwhile, opioid addiction is “everywhere. It’s horrendous,” she said, adding that when she did her residency in Harlem 30 years ago, “we did not see what we are seeing now—opioid addiction as white and rural.”
The next meeting of the Columbia County Board of Supervisors Health and Human Services Committee will take place Tuesday, June 20, at 4 p.m. at 401 State Street in Hudson.