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. Srikanth Kunaparaju. Dr. Srikanth Kunaparaju is a nephrologist in Richmond, Virginia and is affiliated with multiple hospitals in the area. He is the Medical Director of the DaVita Three Chopt dialysis unit and Chair of Medicine for Bon Secours St Mary's Hospital .
Saanvi: Welcome, Dr. Kunaparaju. Thank you for joining us.
[response] Thank you for allowing me to participate in this discussion about Opioid addiction and solutions.
Saanvi: I’d love to start our conversation with more about you and how you got into this line of work. Tell us a bit more about your background.
I am a physician of Indian origin and have done my medical school in India. After completion of medical school, my post graduate training happened in India, UK and US.
I noticed a stark contrast in opioid use in a developing country like India and developed countries like the UK and US. In India, the laws for prescribing controlled substances are very strict. While in the UK, I had a similar experience as the rules were very strict as well. However, in the Us, there was a huge difference in the way Opioids were treated. It was so much easier to prescribe pain medication and opioids here, while in India I had to go through many more steps to get through
Since starting practice in Richmond, I have focused on addressing the opioid dependence in my patients with Kidney diseases including End Stage Kidney disease requiring dialysis. In dialysis patients the opioid dependence is significantly higher due to their comorbidities
In 2017, Our Practice, Richmond Nephrology Associates made it a practice policy not to prescribe any opioids. While we recognize that Pain is genuine and some patients need opioids, in order to reduce the dependence on opioids, we have been seeking help from experts in Pain management who practice evidence based medicine in managing these patients with pain.
Saanvi: 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?
A substance used to treat moderate to severe pain. Opioids bind to opioid receptors in the central nervous system to control the pain. Opioids are like opiates, such as morphine and codeine, but are not made from opium. Opioids used to be called narcotics
2) The opioid epidemic is an issue with which all states in our country struggle; however, certainly areas are more dramatically impacted – especially Appalachia. How do you see the opioid epidemic differing in Virginia than other areas?
Certainly there is a difference across the states that share the Appalachia. There is a huge difference just between Virginia and West Virginia which are on opposite ends in this epidemic. In Virginia, the opioid crisis predominantly affected rural areas. This is largely due to low literacy level population, shortage of pain management specialists and inadequate resources for the primary care physicians to manage these patients and lack of awareness among doctors on ineffectiveness of these drugs in lot of conditions
Thanks to a lot of initiatives taken by Virginia Governors in the last decade , there is now more awareness among doctors about use of these medications and PMP (prescription monitoring program) is helping in identifying the addiction problems sooner.
3) What groups are at risk for opioid addiction? Do you see any general characteristics?
History of Substance use - including prescription drugs, illicit drugs, alcohol
Patients on high dose of opioids, particularly in combination with benzodiazepines
People with psychiatric illness - depression, anxiety, sleep disorders
Middle aged unemployed men
recent release from prison
recent release from addiction treatment programs
4) Do you believe that the crisis we are facing is more about prescription painkillers or recreational drugs, such as heroine?
I think it's both. In the past, until 2015-2016, the prescription overdose was the bigger problem. But the recognition of this epidemic both by federal and state governments and thanks to the initiatives taken by several agencies, the prescription related opioid addiction has been improving but at the same time, use of illicit drugs has increased significantly.
5) How do you think the epidemic has changed over the years and why do you think it has gotten worse?
This epidemic for the most part happened in the last 20 years. While several european countries realized this problem sooner and took initiates, in the US this continued to get worse until 3-4 years ago. I believe the problem has gotten worse due to lack of stringent rules in opioid prescription and monitoring of patient use. The US for decades has remained the biggest market for illicit drugs smuggled through our southern border.
6) What issues have you experienced firsthand in your workplace with opioid issues and drug prescriptions?
A significant number of patients conditions / problems are being treated with opioids without strong evidence to suggest benefit.
Very few patients are actually managed by pain specialists
Lack of adequate support systems for patients with Psychiatric illnesses
7) What would be one suggestion you would have as a health care physician for improving how doctors approach prescriptions?
Evidence based Medical practice in using these drugs and seek help with Pain specialists in managing complex patients
8) What methods have you seen been effective in fighting opioid addiction?
Evidence-based methods of pain management.
Prescription Monitoring Program (PMP)
Dept of health and human resources (HHS) allowing states to take initiatives to support treatment, prevention and recovery through their medicaid programs
Mandatory Opioid prescription course for all doctors at the time of their yearly state medical license renewals
9) What can others do to help those in the throes of addiction?
recognizing the problem
seeking help on the subjects behalf sooner than later
being aware of the support programs
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?
While the medical community has been able to recognize the seriousness of this epidemic in the last decade and through federal and state government initiatives I have large hopes to control prescription based opioid addiction, but widespread availability of illicit drugs in our communities is my biggest concern. Much bigger and serious initiates are required to control illicit drugs. Until that's done, this epidemic will not end !!!
You can find more about Dr. Kunaparaju at https://health.usnews.com/doctors/srikanth-kunaparaju-773069
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