IN THIS ISSUE

By Thomas E. Kottke, MD, MSPH Editor-in-Chief, MetroDoctors

Gaining the Upper Hand

“We conclude that despite widespread use of narcotic drugs in hospitals, the development of addiction is rare in medical patients with no history of addiction.” Since 1980, these 25 words in a brief letter to the editor of the New England Journal of Medicine by Porter and Jick have been cited more than 400 times to promote the prescription of narcotics. Purdue Pharma, in particular, used them to market OxyContin and encouraged physicians to use the opioid with impunity. At the same time, wholesale distributors ignored signs of abuse as their profits soared. The gravy train for opioid manufacturers and distributors may be coming to an end, but the human suffering they caused isn’t. Over the past 20 years, 10,000 Minnesotans have died from drug overdose, and mortality from drug overdose jumped 34% between 2019 and 2020, driven to a large extent by synthetic opioids like fentanyl. The events that precipitate substance use are diverse, the substances being used are many, and the needs of individuals vary. Therefore, the solutions proposed by the authors in this issue of MetroDoctors are many and diverse. Some address opioids, some address alcohol, and some address tobacco. Others propose innovations in service delivery, and still others propose new curricula. What they all have in common is seeking to understand. Not moralize. Not shame. Understand. It would behoove our politicians to do the same and consider the policies of Portugal and Finland that have produced promising results. The substrate that nourishes substance use disorder—despair from poverty and lack of opportunity—must be addressed. While most newspaper readers will know that per capita alcohol consumption increased during the pandemic, fewer will be aware that suicide rates in Minnesota have been rising since the year 2000, driven by a rise in death by suffocation. We need to find and address the root causes. Those who take advantage of human frailty to market their products don’t deserve the empathy we give our patients. The drug companies, the tobacco companies, the alcohol producers must be held accountable. The FDA needs to hear that you support the proposed menthol ban—right now! They are certainly hearing otherwise from the friends of Big Tobacco. Periodic escape from daily life is not inherently pathological; everyone seeks it. Religious experience, physical activity, meditation, or yoga are frequent vehicles. Escape can become pathological, however, when it is fueled by opioids, alcohol, or other drugs. By assisting in making periodic escape safe and effective, healers can help their patients achieve their goal without harm to themselves or to society. For physicians on the edge for whatever reason—substance use disorder, family break-up, financial difficulties, despair—the Physicians Wellness Collaborative offers confidential resources (https://www.metrodoctors. com/pwc). In closing, I’d like to welcome three new members to the MetroDoctors editorial board: Drs. Lynne Ogawa and Dennis Cross, and medical student Carol Coutinho. Lynne is a family physician who practiced for many years in St. Paul. She brings that experience to her current position as Medical Director for Saint Paul–Ramsey County Public Health. Dr. Cross practiced nephrology for many years but says that his true passion is general internal medicine. An associate medical director at HealthPartners health plan, Dennis also provides medical hospice services at Our Lady of Peace in St. Paul. Carol is a 3rd year medical student at the Twin Cities campus and has been a TCMS advocacy fellow. One of her interests is the intersection of social justice and sports medicine. I am excited about the breadth of experience and perspective that these three new members bring to the MetroDoctors editorial board.