Drug Dealer, MD: How Doctors Were Duped, Patients Got Hooked, and Why It’s So Hard to Stop

Drug Dealer, MD: How Doctors Were Duped, Patients Got Hooked, and Why It’s So Hard to Stop

by Anna Lembke

In this excerpt from Anna Lembke's book, Drug Dealer, MD, she illustrates the dangers early access to prescription opioids can have even for kids who are not at high risk for addiction.

Editor's Note: The following is an adapted excerpt taken from Drug Dealer, MD: How Doctors Were Duped, Patients Got Hooked, and Why It’s So Hard to Stop, by Anna Lembke. Published by Johns Hopkins University Press © 2016.  Reprinted by permission of the publisher.

Neuroscientists speculate that brain changes that occur after continuous heavy use of addictive substances can cause damage that does not resolve even after years of abstinence. One of the ways these irreversible changes can manifest is that the brain is primed to relapse to addictive physiology even after a single exposure to the addictive substance. This is called “reinstatement” by neurobiologists, and “relapse” by those who are addicted.

Reinstatement is not triggered solely by the substance that the individual was previously addicted to. Reinstatement can occur with any addictive substance because all addictive drugs work on the same brain reward pathway. For example, animals repeatedly exposed to the addictive component of marijuana (tetrahydrocannabinol, or THC) and then not given THC for a period of time become addicted to morphine more quickly than animals not previously exposed to THC. This phenomenon is called cross-sensitization, or cross-addiction.

As many as 56 percent of patients receiving long-term prescription opioid painkillers for low back pain… progress to addictive opioid use, including patients with no prior history of addiction.
Although a history of addiction increases the risk of becoming addicted to opioid painkillers prescribed by a doctor, many people with no addiction history can become addicted to opioid painkillers in the course of routine medical treatment. Furthermore, they can become addicted quickly, in a matter of days to weeks. This is contrary to what doctors were told in the 1980s, 1990s, and early 2000s, when a pro-opioid movement in the medical pain community encouraged doctors to prescribe opioids more liberally and reassured them, based on false evidence, that the risk of becoming addicted to prescription opioids among patients being treated for pain was less than 1 percent. More recent studies reveal that as many as 56 percent of patients receiving long-term prescription opioid painkillers for low back pain, for example, progress to addictive opioid use, including patients with no prior history of addiction.
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Published by Johns Hopkins University Press © 2016.  Reprinted by permission of the publisher.
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Anna LembkeAnna Lembke, MD, received her undergraduate degree in Humanities from Yale University and her medical degree from Stanford University. She is on the faculty of the Stanford University School of Medicine, a diplomate of the American Board of Psychiatry and Neurology, and a diplomate of the American Board of Addiction Medicine. She is the Program Director for the Stanford University Addiction Medicine Fellowship, and Chief of the Stanford Addiction Medicine Dual Diagnosis Clinic. She has published over 50 peer-reviewed articles, chapters, and commentaries, including in the New England Journal of Medicine, the Journal of the American Medical Association, the Journal of General Internal Medicine, and Addiction. Dr. Lembke sees patients, teaches, and does research. She is the author of a book on the prescription drug epidemic: Drug Dealer, MD: How Doctors Were Duped, Patients Got Hooked, and Why It’s So Hard to Stop (Johns Hopkins University Press, October 2016).

Dr. Anna Lembke's key areas of interest include treating patients who have become addicted to prescription drugs. She takes a holistic, harm-reduction approach to each patient, and encourages spiritual and alternative therapies in the process of healing.
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CE credits: 1
Learning objectives:

  • Demonstrate the connection between access to prescription opioids and the rise in heroin addiction.
  • Describe the dangers of cyberpharmacies.
  • Understand how the epidemic of opioid addiction can affect even people who "seem" like they are low-risk.
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