My interview with Dr. Michael Stein, author of “THE ADDICT: One Patient, One Doctor, One Year”

"The Addict" by Michael Stein

I would like to thank Dr. Stein for granting me this interview,
which took place via e-mail. –Brian G.

_


Swallow
Your treatment program, as discussed in the book, revolves around the use of buprenorphine. In your opinion, what would make someone who is addicted to painkillers a good candidate for this form of treatment?

Dr. Stein
I’ve found buprenorphine to be helpful for anyone interested in getting out of the drug chase, who is willing to commit to regular medical office visits over a good number of months, and is not abusing other substances such as cocaine, benzodiazepines or alcohol. While certainly not the answer for everyone, the long-term success rates with buprenorphine are as good or better than any other existing treatment for opiate users.


Swallow
I have heard from a huge number of patients, who after being treated with opiates (often long term), have been “dropped” by their physician or pain clinic, for “breaking the rules” or for “addictive behaviors”—rocketing them into withdrawal. I feel this practice should be reformed, if not outright outlawed. I think my readers would be very interested in hearing your opinion on this:

Dr. Stein
I’ve heard this complaint from patients as well. Certainly, for any doctor to treat a patient long-term with opiates (presumably with a confirmed diagnosis requiring opiates) and then to stop this treatment abruptly, there should be an extremely good reason for this change of course. Otherwise it is cruel, capricious, and devastating for such a patient, sending him or her into a terrifying downward spiral of withdrawal and abandonment. Patients should not be left in the breach. A clear understanding up-front of “the rules” of any long-term patient relationship that involves the prescription of any medications with severe side effects or addictive potential is a must. As a physician who has heard such stories from patients, my first job is to call the treating doctor to hear the other side of the story. There are always two sides. Most offices have rules about discharging patients from a practice, and all offices need to provide alternative sites of care for discharged patients.

Swallow
Can you offer any advice to parents to help them determine if their children might be experimenting with painkillers?

Dr. Stein
With 15% of twelfth graders reporting the use of non-prescribed painkillers in the last year, there is a big problem out there. At least half of these painkillers being traded in schools and by adolescents come from visits to their parents’ medicine cabinets, so the first thing for all parents to be awake to is this possibility. That said, it is extremely difficult for parents to tell that their adolescents are dabbling in pain killers. And adolescents know this—there’s no sloppiness, no major hangover symptoms, pills can be swallowed in seclusion. While teenage experimentation is hard for parents to discern, parents are left to keep a sharp eye for behavioral changes—moodiness, difficulty sleeping, recurrent flu-like symptoms, depressive symptoms, and school problems—that signal more chronic use, and then explore any noted changes with their kids. Epidemiologically, trouble with drugs coincides with other kinds of trouble (including other drug use, such as nicotine and alcohol) in adolescent life, and that could be a clue too.

Swallow
Most addicts are in denial of their disease; this denial is often reinforced for the painkiller addict because many have become addicted “legally”. There may have been deception on the part of the patient, but nonetheless many of them have not committed any crimes. In your opinion does this make painkiller addiction “a different animal” when it comes to treatment?

Dr. Stein
There is no evidence from my research or that of others to suggest that prescription painkiller abusers do any better than heroin users in terms of treatment outcome. The particular drug of choice for the opiate user really doesn’t matter in terms of the treatment that should be offered; all the alternatives should be laid out on the table and the person seeking care should use any and every formal and informal therapy that may help. A high proportion of opiate users abuse other drugs concurrently (beyond nicotine), so for me, one patient is “a different animal” from the next, and all need to be treated individually.

Swallow
Lastly, could you offer some advice to readers who currently find themselves addicted to painkillers and wish to seek treatment?

Dr. Stein
The first step into treatment is tremendously scary. Everyone asks him or herself: how can I live a day without these pills? On top of the fear is the shame: How did it get to be so bad? I can guarantee that life will be better without vics or perc or oxy than it is now if you can stick with treatment. Treatment is unfortunately often dictated by what insurance you have, how much you have in your savings account, whether you’re working, and what experienced professionals are in your region. If you’re interested in getting some good anonymous advice (slanted toward medication therapy), I’ve been impressed that www.naabt.org is a fine website to check out to find honest, street-savvy peers. I’d also suggest that you buy a copy of my book, THE ADDICT: One Patient, One Doctor, One Year, to see the journey ahead and learn a bit about the folks who may treat you.

_

Michael Stein’s Website.

Images courtesy HarperCollins Publishers.

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7 Responses to “My interview with Dr. Michael Stein, author of “THE ADDICT: One Patient, One Doctor, One Year””

  1. Soon on SWALLOW: Interview with Michael Stein, author of “The Addict” « S W A L L O W Says:

    […] *UPDATE*: The interview is now posted. Click here. […]

  2. Ainhoa Says:

    Hi … I found your website by mistake. I was looking in Bing for Registry software that I had already bought when I found your site, I have to say your page is really cool I just love the theme, its amazing!. I don’t have the time today to totally read your site but I have bookmarked it and also signed up for your RSS feed. I will be back around in a day or two. Thanks again for a nice site.

  3. Lisa Says:

    I need some advice. I had been seeing a dr. since April ’09 who had been prescribing 140 30mg roxicodone and 45 2mg xanax monthly. I had tried to bring to his attention at my last appointment the unprofessional behavior of his staff in a calm manner, but he began berating me over it. He yelled at me repeatedly and when I told him I was calm and did not understand why he wasn’t, he told me he didn’t care. That he had over 800 patients in his office and if it was not a big deal to him if I left. Needless to say I received a letter in the mail stating I was being discharged because he was told from “several” people that I was saying rude things about him. This is untrue. It’s not even in my nature to do that. So now I am terrified as to what I am going to do without my medications. I feel that this was very irresponsible. Can you please tell me where to begin?

    • swallowed Says:

      Lisa:

      Sorry for the delay in approving/replying to your comment. E-mail me at swallowblog(at)gmail.com and I’d be more than happy to assist you in any way that I can…

  4. Kristina Hazel Says:

    I noticed your site when I was browsing for something entirely different, but this page showed up at the top of Google your web site must be enormously popular! Continue the awesome job!

  5. ronald parrillo Says:

    i have been treeating with dr stein for approximately 6 years for opiate addiction and he has helped me tremondously in my recovery i have been opiate free for that same period of time

    thank you so much for your caring and understanding

    ron parrillo

  6. Elizabeth Says:

    I cannot tell you how wonderful it is to see the information you are providing on your site. if only they Knew is my motto….. The countless people struggling with this addicition!

    Keep up the grest work! If you help just one person today it was alot!

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