An Open Letter to Dr. Andrew Kolodny

Update 6/27/18: I am overwhelmed by the positive responses I have received for this letter. I would ask that readers also take a look at all the articles and references cited in this piece, and share those as well. Those references go into much, much more detail and research than I have had space or time for here. Thank you all so much for reading and sharing, I believe we will make a difference and win this fight for our lives! #wearehere

See also: A Rock and a Hard Place, The Truth About the Opioid Crisis, and Strangulation on Medicine

Dear Dr. Kolodny,

I am one of millions of chronic pain patients in the United States who has been continually and increasingly oppressed over the past few years by progressively invasive and prohibitive laws at the state and federal levels concerning the delicate relationship between doctors and patients, particularly when it comes to a certain class of drugs, i.e. opiates.

Ever since my very real, physical condition began about 4 years ago, my family and I have been disoriented again and again by a lack of what might be termed, “help,” from doctors. We have discovered a very confused medical community, corruption, and a growing collection of laws being passed so fast and furiously hardly anyone seems to know just what is going on.

This has resulted in doctors leaving my city, doctors outright refusing to accept chronic pain patients (or, if they do accept these patients, refusing to treat them with medications that suit the patient best) or new patients, and unprecedented referrals to pain management clinics and psychiatrists. I have a detailed post planned addressing the pain management clinics, but the psychiatrist referrals were more baffling to me. My local psychiatrists even refused me as a patient about a year ago because, “we don’t see chronic pain patients.” That made sense to me as I don’t suffer from mental illness, still my providers insisted I must be mistaken.


Down the Rabbit Hole

I began researching you and your career last night out of curiosity. I wanted to answer the question, “Who is this Dr. A. Kolodny, that everyone from journalists to policy makers and bloggers keep quoting as an “expert on opiates”?” And I found out. You, sir, are a psychiatrist and board-certified addiction specialist-turned policy maker (1) and buprenorphine (Suboxone) “evangelist” (2).

Your first private clinic was a Suboxone clinic in New York City, established sometime around 2003-2005, and it appears you (and/or other health officials) felt stymied by the federal limit at the time of just 30 patients for such clinics (put in place to stem corruption), because said health officials have been in the background, quietly working away at this very limit which was amended in 2006 (called DATA), to allow 100* patients after 1 year, and is now up in the House for being overturned altogether, along with expanding legal prescribers to nurses and other non-doctor medical staff. And look what has happened as a result:

Health officials, concerned about restricted access, lobbied alongside Reckitt Benckiser for the patient cap to be raised. “Why should we bind a healer’s hands from helping as many as he or she could?” Senator Hatch said, getting an amendment passed in 2006 that allowed doctors, on request, to go from 30 to 100 patients after a year.

The stage was set for more patients, prescriptions and problems. “It’s when the limit was raised from 30 that doctors started to get commercial about it,” said Dr. Art Van Zee, whose buprenorphine program at a federally funded community health center in rural Virginia is surrounded by for-profit clinics where doctors charge $100 for weekly visits, pulling in, he estimated, about $500,000 a year.

“They are not savvy about addiction medicine, don’t follow patients very closely, don’t do urine testing and overprescribe,” he said. “That’s how buprenorphine became a street drug in our area.” https://www.nytimes.com/2013/11/17/health/in-demand-in-clinics-and-on-the-street-bupe-can-be-savior-or-menace.html (4)

“In the early days of Suboxone, with Reckitt Benckiser barely marketing its own drug, Dr. Kolodny, then a New York City health official, crisscrossed the city with colleagues to spread the word about the new medication, entice public hospitals to try it with $10,000 rewards and urge doctors to get certified.”

https://www.nytimes.com/2013/11/17/health/in-demand-in-clinics-and-on-the-street-bupe-can-be-savior-or-menace.html (4)

Since at least 2005, you have been marketing buprenorphine as if you had a personal stake in the drug, to government institutions and agencies including prisons, public hospitals, and rehabilitation facilities (2). In the fall of 2013, you were appointed Chief Medical Officer (5), of the largest chain of non-profit detox/rehab facilities in the USA (cited for questionable practices and abuse from at least 2012-2015) (6) called Phoenix House, which received $131 million in June 2013 (7), championing the use of MAT, or “Medication Assisted Treatment”. I wonder which drug Phoenix House used?


Hang ‘Em High?

salem witch hanging.PNG
An innocent “witch” (woman) is hanged at the Salem Witch Trials, much like other innocent pain patients are persecuted.

Since you often cite the United States vs. Purdue Pharma (2007) settlement in your interviews and writings, perhaps you saw an opportunity to expand the use of buprenorphine by targeting and demeaning chronic pain patients as mere “addicts”.
It was odd to me in researching that incident, in the official “Purdue Guilty Plea” document (8), the very words they were condemned for, claiming OxyContin to be “less addictive” and “less subject to abuse and diversion” (8), appear to be the exact words you use time and again when describing the benefits of buprenorphine (2).

Kolodny reminds his colleagues of the drug’s advantages. He stresses that bupe in the form of Suboxone is safe and almost impossible to abuse, a huge selling point at many of the clinics they will visit. Suboxone has a second active ingredient in the mix, he explains, an anti-overdose drug called naloxone.

It does nothing if you take bupe as directed. But if you sniff bupe or inject it or otherwise try to pack enough into your bloodstream to get high, the naloxone acts like a chemical booby trap, erasing the effects of any opiate, bupe included, and bringing on sweaty, nauseating withdrawal. “That’s the last time you’ll do it,” Kolodny says dryly. https://www.wired.com/2005/04/bupe/

In 2016, your organization, PROP (Physicians for Responsible Opiot Prescribing), got the ear of the CDC and helped to write the now-infamous, misinformed, and rushed guidelines for prescribing opiates. While these guidelines were fairly general in nature, they have been used as a springboard for countless pieces of state legislation and DEA investigations, which has, in turn, led to the above-mentioned abuse and abandonment of chronic pain patients and doctors, as well as opiate shortages in hospitals and ERs (The DEA, in an attempt to prevent diversion of opiates to the black market, has cut production by an incredible 45% in the past 2 years). I imagine that suits you just fine, since you have publicly stated you believe opiates should be discontinued for all but the dying and post-major surgery “for a few days” (https://www.ket.org/opioids/inside-opioid-addiction-10-questions-with-dr-andrew-kolodny/), and that “more treatment” is needed (https://www.vox.com/science-and-health/2017/8/3/16079772/opioid-epidemic-drug-overdoses), i.e. MAT/Suboxone clinics like Phoenix House.

'The National Gesture' 1926
“The National Gesture” 1926

You have hailed local municipalities and states in their further pursuit of legal action against American Big Pharma, the companies who make such things as Vicodin and Percocet, but not Suboxone/buprenorphine (which is also an opiate), which is made by an overseas company, Reckitt Benckiser, or Naloxone (Narcan), which is produced in a nasal spray exclusively by Amphastar Pharmaceuticals (10), a relatively new company founded in California in 1996 (11),  whose stock (and Narcan prices) has been rising quite a bit, lately (12, 13). Are you truly against the use of opioids, or just the ones that help pain?


The Opioid Epidemic!

mccarthyism
McCarthyism Propaganda

Although your policies, based on inaccurate data (14-15) https://www.acsh.org/news/2017/10/12/opioid-epidemic-6-charts-designed-deceive-you-11935 (15), and http://www.mdmag.com/journals/pain-management/2012/october-november-2012/just-how-responsible-is-prop, have been wildly ineffective at stopping heroin/fentanyl overdoses; although you are not a pharmacologist, opiate researcher, pain doctor, pain patient, surgeon, or even general practitioner; although you ran a private clinic for a short time in 2005 (as far as I’ve been able to learn) that dispensed buprenorphine/Suboxone, you have, for the majority of your career as far as I can tell, been a policy-maker and not directly involved with addiction patients or chronic pain patients whom you recently claimed were simply addicts who needed compassion and “treatment” (and, presumably, Suboxone).

“Many Americans are truly convinced that opioids are helping them. They can’t get out of the bed without them.”

“Policy makers were told by industry-funded pain organizations not to penalize pain patients because of drug abusers. We realized that this wasn’t true. We don’t have these two distinct groups, one for pain patients and the other for drug abusers.” https://www.kolmac.com/2015/12/qa-dr-andrew-kolodny-chief-medical-officer-phoenix-house/ (15a)


If You’re Not For Us, You’re Against Us

sen. joe mccarthy demonstrates the communist threat
Senator Joe McCarthy Demonstrates the Communist Threat in America

You are cited and quoted in an impressive number of articles and interviews as a compassionate person who wants to see people and their families heal from the devastation of addiction, which is why it surprised me to find quotes from you that didn’t seem, well, “nice.”

It is the FDA’s role to vigilantly regulate the approval, labeling, and promotion of  pharmaceutical products, not that of counties or municipalities. County and municipal lawyers are inadequately qualified to make or enforce federal drug policy, and these lawsuits serve as a vehicle for local governments to seek revenue  through ill-informed measures under the guise of drug abuse prevention. In a May 30,2014, interview with   FDA Week, a CLAAD spokesman voiced these positions and expressed concern that these lawsuits are part of “a trend that will distract us from the real meaningful approaches to reducing prescription drug abuse.”

After reading the interview, Dr. Andrew Kolodny, president of Physicians for Responsible Opioid Prescribing (PROP)and Chief Medical Officer of Phoenix House,  contacted CLAAD via telephone to condemn its comments. During this conversation, Kolodny threatened that the Internal Revenue Service would revoke CLAAD’s tax-exempt status when alerted to the comments, which he believes conflict with CLAAD’s charitable mission.  CLAAD takes these false allegations and threats very seriously, and  responded in a letter which is publicly available for view on our website.

Critics who categorically dispute the motives of organizations like CLAAD and its diverse coalition members are, at best, narrowly focused. Their zealotry reveals their otherwise undisclosed health insurance industry bias.  At worst, they endanger the lives of people who live with pain and other conditions that can require controlled substances by stifling access to quality care. http://paindr.com/claad-and-phoenix-house-square-off/ (16)

Anyone who questions your authority, expertise, policies, or the efficacy of your pet drug, buprenorphine, is loudly dismissed by you as uneducated (17), addicted (15a), or corrupt (15a, 18), regardless of how closely they actually work with addicts and pain patients (17).

But Dr. Kolodny, I have nothing left to lose — your policies and attitudes have directly impacted my health, my freedom, my ability to be a parent, my work, my hobbies, my family, my finances, my friends, and my personhood. I have no problem announcing to the public, as loudly as I can, “The Emperor is not wearing any clothes!”

emporer has no clothes


Citations

(1) http://www.cecentral.com/search/faculty/136145

(2) https://www.wired.com/2005/04/bupe/

(5) https://www.phoenixhouse.org/news-and-views/news-and-events/phoenix-house-appoints-dr-andrew-kolodny-as-chief-medical-officer/

(4) https://www.nytimes.com/2013/11/17/health/in-demand-in-clinics-and-on-the-street-bupe-can-be-savior-or-menace.html

(6) https://www.reuters.com/investigates/special-report/usa-rehab-phoenixhouse/

(7) http://www.phoenixhouse.org/wp-content/uploads/2014/06/2013-Financial-Report.pdf

(8) https://assets.documentcloud.org/documents/4378824/Purdue-Guilty-Plea-Copy.pdf

(9)

(10) https://www.npr.org/sections/health-shots/2015/09/10/439219409/naloxone-price-soars-key-weapon-against-heroin-overdoses

(11) http://www.amphastar.com/about-us.html

(12) https://www.equities.com/news/naloxone-stocks-who-s-really-winning-the-battle-against-the-opioid-epidemic

(13) https://thinkprogress.org/pharmaceutical-company-with-monopoly-on-lifesaving-treatment-jacks-up-prices-3883e95f88c7/

(14) https://medium.com/@stmartin/neat-plausible-and-generally-wrong-a-response-to-the-cdc-recommendations-for-chronic-opioid-use-5c9d9d319f71

https://www.ket.org/opioids/inside-opioid-addiction-10-questions-with-dr-andrew-kolodny/

(15) https://www.acsh.org/news/2017/10/12/opioid-epidemic-6-charts-designed-deceive-you-11935

(15a) https://www.kolmac.com/2015/12/qa-dr-andrew-kolodny-chief-medical-officer-phoenix-house/

https://abcnews.go.com/Health/deaths-drug-overdoses-continue-rise-us-blacks-hispanics/story?id=54094943

(16) http://paindr.com/claad-and-phoenix-house-square-off/

(17) https://www.nytimes.com/2016/05/29/opinion/sunday/addicted-to-a-treatment-for-addiction.html

(18) https://www.kolmac.com/2015/12/qa-dr-andrew-kolodny-chief-medical-officer-phoenix-house/

https://www.vox.com/science-and-health/2017/8/3/16079772/opioid-epidemic-drug-overdoses

https://www.cdc.gov/drugoverdose/prescribing/guideline.html


Further Resources

https://www.cdc.gov/drugoverdose/prescribing/guideline.html

https://www.bendbulletin.com/topics/5342867-151/opioid-crisis-pain-patients-pushed-to-the-brink

http://www.mdmag.com/journals/pain-management/2012/october-november-2012/just-how-responsible-is-prop

http://nationalpainreport.com/cdc-does-not-comply-with-federal-law-8828305.html

https://www.chronicle.com/article/To-Counter-Opioid-Crisis-NIH/240219

https://www.painnewsnetwork.org/stories/2016/8/11/prop-ends-affiliation-with-phoenix-house

https://www.drugabuse.gov/publications/research-reports/relationship-between-prescription-drug-abuse-heroin-use/introduction

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73 thoughts on “An Open Letter to Dr. Andrew Kolodny

  1. Yeah, I’m within about 7 wks of my 68th birthday. I started having symptoms of CRPS in 1994 following back surgery, needle-like pain, severe cramping in my calf in the middle of the night, extreme coldness, pain, Pain & More PAIN! The only thing one doctor fixated on was my bunion, which made no sense to me, I WAS an OR nurse,as well. Finally, in late 1999-2000, I received a diagnosis. CRPS, type2. No cure. They tried the usual series of blocks(epidural), then sympathetic, but none gave any persisting relief. I was placed on Neurontin which destroyed my esophagus and still suffer from those side effects. Then oxycontin, which at that time was beyond my income-I was disabled, but still had not received benefits! Then methadone & Soma, which helped. Then we moved to another state, & was able to locate a doctor in the little town who would prescribe those meds, however he left his practice. I had to go through detox. Then I did find a pain doctor who did a DNA test which discovered, my body does not metabolize methadone, but it does metabolize oxycodone. I was place on a schedule of that w/ Xanax to help w/ all the other symptoms that go along w/ this “syndrome.” I never ONCE overused, abused, misused, but once I reached the age of 66, I was officially OVER THE AGE to received opiates. Had I ever gotten dizzy or had adverse effects I would have understood, but NO! So now I’m in constant pain, intractable pain which COULD be treated but the government inserted itself into the physician-patient relationship, which I had always been instructed was as sacrosanct as the client-attorney privilege. Why are Pain Patients being punished while we are being law-abiding citizens, for what drug users do?

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    1. I’m so sorry for your pain, Lorna. I do believe the tide is turning in our favor, finally, but we must continue to fight and bring attention to our plight. Wishing you well.

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  2. In Jan., 2015, my 68 year old dad (a disabled chronic pain and palliative care patient with many painful diseases/conditions confined to a wheelchair 24/7 and on oxygen 24/7 and on 19 to 20 different medications, not one for the pain he suffered from) was denied pain relief while hospitalized just a week prior to being placed in hospice care, three weeks prior to his death.

    He developed avascular necrosis of both hips in his lower 30’s and had hip replacement surgeries on both hips that were botched. It took him three or four years to find another surgeon willing to clean up the last surgeon’s mess. By that time, severe infection set up inside his hips, which he carried for over 30 years. He ended up having 7 (or more) major hip surgeries on one hip and one on the other.

    Throughout my life, he was hospitalized many times due to becoming septic (from the infection), along with other complications. He also went on to develop chronic gout (acute flare up while hospitalized), rheumatoid arthritis, osteoarthritis, COPD (end-stage at the time of his hospitalization), chronic kidney failure, emphysema, congestive heart failure, severe diabetes with large open wounds up and down his lower legs, black/blue often numb toes and feet, mixed connective tissue disorder (unspecified), along with the chronic infection.

    He eventually ended up having a drain implanted in one hip that was so badly infected. This was so the infection (pus) would drain outside of his body instead of back inside).He’d been on a low dose of oxycodone for over 20 years when his doctor retired and he was unable to find another one willing to continue prescribing the medication that he’d taken for over 20 years with no issues.

    Within a year or two of being taken off the pain medication, he no longer could stand to put any pressure on his hips. The medication had allowed him to stay somewhat mobile though he could only walk short distances with the aid of a cane or walker. Due to his untreated pain, he missed watching youngest daughter’s wedding and his only grandson’s high school graduation. Although these two events took place less than 5 miles from his house, his untreated pain confined him to his hospital bed or lift chair/recliner.

    When he told the nurse that he was in severe pain (along with spiked blood pressure, which put him at risk of a stroke, despite pumping him full of bp-lowering medication) and needed something, she came back after speaking with the “doctor” (hospitalist), who said he did not want to give him pain medication and “risk addiction.” When we demanded he be moved to another hospital that would also treat his severe pain, they threatened us that medicare would refuse to pay for any of the medical services he had needed up to that point if he left AMA. (Mind you, he could hardly sit in a wheelchair, much less load himself into a vehicle).

    I finally went back up there and (nicely and calmly) told the nurse that if they did not address his pain and he ended up having a stroke or heart attack in this facility, the hospital would be hearing from our attorney. (I was bluffing at that point because I did not know much about how severe pain could affect the human body). I guess it got her attention since she relayed the message to the “doctor” and finally was receiving adequate pain relief.

    Our government and their restrictions have become cruel and barbaric. Forcing one group to suffer for the actions of another group (a much smaller group btw) does nothing to stem the tide of substance abuse and addiction. If anything, it just drives some who are often chronically ill, disabled, and desperately in pain to search for relief from black market substances with pain-relieving properties, large amounts of alcohol, and/or suicide.

    I suspect many of them invested years ago in pharmaceutical companies that are now pumping out Suboxone and new, “improved” Suboxone-like formulations, naloxone, naltrexone (and newer, “improved” formulations of both), and newer, fancy implants (Probuphine about $1,000 to $1,500 a month) and are ensuring they make a profitable return on those investments. One of these days, karma will come back to bite Special K and his lemmings on their rear ends. I wish I could be there when it happens!

    Bravo to your letter to he-who-shall-remain-nameless. You said everything I’ve been wanting to say to him (except you said it much more eloquently, with more class and details and without using a few choice 4-letter words that probably would not have been printed lol). I found this thanks to Pain News Network posting another article of yours on their facebook timeline, Kudos to you! I look forward to reading your other articles 🙂

    (Please keep in mind that I have no issues with MAT becoming easier to access – though I believe recovering addicts should also take part in counseling, therapy, and mental health screenings to also treat the underlying issues that lead to their abuse of substances resulting in an addiction. My issue is with the sheer hypocrisy and double standard policies he-who-shall-remain-nameless and his gang of zealots place upon opioid prescribing . . .

    advocating easier access to an opioid that is 40 times more potent than morphine (buprenorphine, the active medication in Suboxone, Subutex, etc) along with chronic, lifelong use for those with recent histories of abusing opioids while denying even moderate access to opioids, even weak ones, for those experiencing chronic physical pain

    Liked by 1 person

    1. Tracy, oh my…I am so deeply sorry for the pain you and your father and family have suffered because of such laws. Reading about your dad has made me nauseous and furious, and I agree with your thoughts about investment “opportunities” at the expense of the least of these. Such people are not ignorant, neither are they innocent or full of compassion. I believe karma is coming…

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