Sunday, August 8, 2010

The Need for Medical Treatment for Addiction


It's been some time since I've blogged. For those of you who are followers or check in on the blog I'm sorry for the lack of activity. The transition to Minnesota has taken a lot of energy, but I have a lot of progress to report.

My practice here in Minnesota has really taken off. Once the other physicians in the hospital and indeed throughout the entire community have become aware of an alternative to another run through rehab the referrals have become consistent. I was just away from the hospital for a week, and I suspect that the hospitalists who take care of most hospitalized patients have missed me. Once they got a taste of getting help with complex pain patients, difficult withdrawal problems, and a physician who was willing to take their referrals for patients with addiction in conjunction with medical and psychiatric disorders, they have gotten very enthusiastic. This is similar to my experience when I first started a clinic for medically ill alcoholics at the Minneapolis VA hospital years ago. The attitude towards alcohol dependent patients admitted with liver disease, pancreatitis, withdrawal, and other problems up to then had been hopeless, nihilistic. What was the use when a consultation resulted in a nurse or counselor suggesting another run through rehab even if the patient had already had that treatment multiple times? But when there was a clinic where these patients could receive ongoing care that incorporated medical, psychiatric and addiction treatment, you could almost feel the change throughout the medical center. Staff became enthusiastic about identifying and referring patients like this to the clinic. It took about 3 years to develop the clinic and figure out how to provide this type of treatment. After that, I received a grant from the the VA to study whether this treatment was effective. In order to do that, we had to assign study participants to either this new clinic or to usual care which consisted of referral to primary care clinic. At that point, it became difficult, because staff were so enthusiastic about this new approach they were reluctant to have patients assigned to usual care. That's the hardest thing about test new treatments; although you might believe strongly in the new treatment you have to be willing to randomized and let the chips fall where they may. It turned out that the new approach was significantly more effective: mortality was reduce by 30% after two years, and more patients were able to achieve abstinence. So I'm finding that the same thing is happening where I currently work at United Hospital in St. Paul. Only it's even better: I'm providing a much broader range of services. One thing that has become apparent: there is a tremendous need for innovation in treating complex chronic pain. Chronic pain and how to appropriately use opioid (narcotic) medication is one of the most difficult and under-appreciated areas in medicine right now.

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