United2Fight Podcast Interview
Information: United2Fight’s podcast series highlights the work of key figures in the fight against opioid use and major activists in combating the opioid epidemic.
Mission Statement: United2Fight works to help rebuild communities facing rampant opioid addictions, through education tools, strengthening public health infrastructure in needy areas, reaching out to marginalized communities, and galvanizing widespread support to help end this epidemic.
Introduction: My name is Saanvi Mittal, founder, and president of United2Fight – a non-profit organization based in Richmond, VA. I’ve started this podcast series to highlight the work of key figures in the fight against opioid use and major activists in combating the opioid epidemic.
Today’s discussion features Dr. Gaurav Gupta. Dr. Gaurav Gupta is a transplant nephrologist at the Medical College of Virginia. He conducts research on enhancing access to kidney transplantation by the safe utilization of high-infectious risk donor kidneys (PHS high risk, HIV+, and HCV+ donors). The issues (such as Hepatitis C) caused by these donors are often caused by drug use and their kidneys are often only viable when people overdose.
Saanvi: Welcome, Dr. Gupa. Thank you for joining us.
(response) Thank you for having me on the show.
Saanvi: I’d love to start our conversation with you more about you and how you got into this line of work. Tell us a bit more about your background.
My name is Gaurav Gupta and I am a transplant nephrologist, so I take care of patients with kidney transplants. I have been practicing in this discipline for the last 10 years. I do come across a lot of patients with problems with pain and opioid overdose, et cetera, in my line of work. We will talk more about this.
1) For listeners who may have heard the word “opioid” thrown around a lot in the news but don’t know exactly what it is, how do you define an opioid?
So, opioids are a class of painkillers that are commonly called narcotics. The reason they are called opioids is that they work on the opioid receptors in the brain and these receptors trigger significant pain relief. But the problem is that they come with a lot of side effects if they're not used appropriately. And the primary side effects are that they induce euphoria and physical dependence. Opioid dependence can cause issues and complications that could include depression of breathing muscles as well as even more serious complications like death.
2) The opioid epidemic is an issue with which all states in our country struggle; however, certain areas are more dramatically impacted – especially Appalachia. How do you see the opioid epidemic differing in Virginia than in other areas?
So, while Virginia is not a state which I would categorize as one that is severely impacted by the opioid epidemic, there has been a significant impact in many areas of Virginia. Having said that, there have been significant complications because of the opioid epidemic in Virginia including many drug overdose-related complications and deaths over the past couple of years. The part of Virginia most affected by the opioid epidemic is primarily in areas which are inner city or in the countryside.
3) What groups are at risk for opioid addiction? Do you see any general characteristics?
The people most prone to the opioid epidemic are the ones with poor socioeconomic status and inadequate family or social support. People, who live in inner city areas, people who live in the countryside, where there are not a lot of jobs out there, are the ones that have been most significantly impacted by these issues. A theme with opioid addiction is also age. People who are younger are at a higher risk of opioid addiction.
4) Do you believe that the crisis we are facing is more about prescription painkillers or recreational drugs, such as heroin?
So initially, this epidemic started out as a drug epidemic because of recreational drugs, but unfortunately, most recently this has been fueled primarily by prescription drugs. In the 1990s and the early 2000’s many of the clinical studies, which were immediately funded by the pharmaceutical companies, suggested that these drugs were safe and should be prescribed for anybody who has any pain and there was no real risk of side effects or dependence. And that resulted in a massive influx of these drugs, into prescriptions for patients with small problems. And I think that has been the major trigger for the epidemic. And over time as more and more people got hooked on these drugs, we realized that they caused a significant amount of dependence that was an addiction.
5) You touched on this in your previous answer, but how do you think the epidemic has changed over the years and why do you think it has gotten worse?
As more and more prescriptions were sent to the community, an increasing number of people got hooked on these drugs. Easy cheap access both by prescriptions as well as on the street has made it worse. So people who got prescription drugs were then sending them to other people on the street. And that really is the reason why this addiction epidemic has snowballed into this national problem that we now see.
The Opioid Epidemic has also gotten worse primarily because drugs are seen as a crime rather than the addiction that needs to be treated by trained professionals.
6) What issues have you experienced firsthand in your workplace with opioid issues and drug prescriptions?
So, all of us as doctors see a lot of patients who clearly are addicted. They have small issues with pain, which they keep seeking new and an increasing number of opioid prescriptions. It is tough to deal with these patients because there is not a super-specific protocol for handling these situations.
As a transplant doctor, the biggest problem I have seen, unfortunately, is a lot of deaths because of drug overdoses, and that unfortunately results in a lot of new organ donors, which is an unfortunate blessing of this epidemic.
7) What would be one suggestion you would have as a health care physician for improving how doctors approach prescriptions?
One of the things which we deal with is that we see pain as one symptom that needs to be treated at all costs. What many of us do not think about is that the pain has to be treated in a holistic fashion. We have to approach questions such as what are the drivers of pain in the people we see. Maybe there's underlying depression. Maybe there are other socioeconomic issues, maybe their family issues, maybe their social support issues. So, all those factors need to be thought about before we start prescribing an increasing number of these pain pills to our patients. So instead of throwing a prescription for the pain, as a symptom, addressing pain as a holistic problem, would help us solve this problem as doctors.
8) What methods have you seen be effective in fighting opioid addiction?
The first method would be at the medical level, at the doctor level. And then the second approach would be at the state and the federal level. At the medical level, the approach would be that we have to try to avoid prescribing pain medications for chronic use for people who have postoperative pain like they're getting surgery. It makes sense to give them a short supply of pain medications, but for chronic pain, we should be relying on specialists, doctors, and teams who take care of pain, uh, as a specialty. As I mentioned, the last answer, holistic view, rather than giving just a prescription for the problem, there are many, many options that don't rely on opioids to control pain, and those options should be explored. These include other medications, other therapies like psychotherapy or music therapy, or different things that can help with pain control beyond simply giving under the prescription. At the state and federal levels, there needs to be an increase in recognition of this problem. And therefore, they should be committed to ensuring that these prescriptions are used wisely and used in a controlled fashion.
9) What can others do to help those in the throes of addiction?
treat them with compassion, try to get them help, ensure that they are not treated with respect. Drug addicts remain at risk of relapse even after they get better due to different ‘triggers’. Help them avoid these triggers.
The one thing we need to kind of step away from is to treat, uh, addiction as a crime. We need to treat addiction as a medical problem like we do with a lot of other medical problems. We need to ensure that the people who we are seeing with addiction problems are treated with compassion, treated with understanding to ensure that we understand the problems that were available to provide help if we can. So if you were to come across somebody who has addiction problems, you would encourage them to find help professionally and encourage them to ensure that they discussed this with other people in their family or friend circle, so they can get the right help with the problem, rather than continuing to stay addicted and take more and more of these medications, which may result in significant problems, which as I mentioned, could include death.
10) Is there anything else you want to share with us about the future of this epidemic and ways we can galvanize community support to help break the cycle of addiction?
There is a much broader understanding of addiction now compared with 10 or 20 years ago. Take people like yourself, for example, are now talking about the addiction epidemic. 20 years ago nobody really wanted to talk about this problem.
I think there is a need to ensure that we approach this, as I mentioned as a medical disease, rather than a crime, which needs to be punished. It will help a lot if we can try to solve this problem as a community.
OUTRO – Thank you for being with us. You can find more about Dr. Gupta
at
Link to Podcast: https://soundcloud.com/saanvi-mittal/episode-2-a-perspective-on-the-opioid-epidemic-from-a-researcher-and-transplant-nephrologist
Interesting Articles from this week if you would like additional r
eading:
How pharmaceutical executives bribed doctors to prescribe dangerous fentanyl drugs
We’re dealing with a pandemic, but remember the opioid crisis? Coronavirus is likely to make it worse.
When Epidemics Collide: COVID-19 Upends Opioid Addiction Treatment https://www.medscape.com/viewarticle/932739
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