In a Fox News segment, host Speaker A moderates a panel featuring Dr. Joseph Audette (chief of pain management at Atrius Health), Dr. Tiffany Di Pietro (internist, cardiologist, women's health expert), and addiction specialist Joe Schrank. The discussion centers on the U.S. opioid crisis, the impact of recent prescribing guidelines, and how physicians are navigating the tension between curbing addiction and adequately treating chronic pain. Dr. Audette emphasizes that regulations alone cannot solve the crisis and calls for a multifaceted strategy, including reducing excess prescriptions while ensuring access for severe pain patients. Dr. Di Pietro notes that a recent survey shows over a third of physicians believe reduced opioid prescribing harms chronic pain sufferers, and she advocates for referring non‑malignant chronic pain patients to pain‑management specialists rather than managing them herself. Both physicians discuss the importance of physician boundaries, common‑sense assessment of patient needs, and alternative therapies such as cannabis. Joe Schrank contributes the addiction perspective, underscoring that addicts will seek substances regardless of prescription practices. The panel concludes with a call for moderation and thoughtful, patient‑centered prescribing.
Chapters
Some new information on the opioid crisis in this country. With addiction on the rise, doctors have been more careful in writing prescriptions for pain medication. But now a new nationwide survey finds some doctors are having misgivings about that, with more than a third saying the change has actually hurt some patients who suffer from chronic pain. Joining us now, Dr. Joseph Audette, chief of pain management at Atrius Health. Dr. Tiffany Di Pietro, internist, board-certified cardiologist, and women's health expert. And Joe Schrank, an addiction expert who runs the recovery program Rebound Brooklyn and is a frequent guest on our program. Thanks to each of you for being here. Dr. Adet, I want to start with you. Um, the, the overall feeling is that opioid addiction has gone through the roof in this country, and so the approach has been to what, tell doctors to stop writing prescriptions?
Thanks for having us on, Joe, um, John. So no, I don't think that's the message. The message is to try to do a better job at understanding is the patient that we're seeing dealing with a primary pain problem or is it in fact being, are the waters being muddied by the fact that the patient may have a primary addiction disorder. And that sometimes is harder than it may seem to sort out, but we don't— as physicians, we don't want to be contributing to a national health crisis that we're seeing all around us. We want to—
obviously not, but you're quoted as saying that regulations won't solve the addiction problem.
Well, I think the problem is that there is a tremendous issue of addiction in the United States, and so I don't think these regulations will be the only answer. That there's— there has to be a multifaceted approach to try to help this crisis in the United States. One aspect of that is to try not to have an excessive amount of prescription drugs in the general population that are not being used for medical purposes. And so that is important, but it's not the whole story of what we're dealing with with this crisis.
Dr. Sizemore, uh, roughly a third of all physicians, a little bit more than that, Dr. Odette said that they think this pullback from prescribing pain medication has actually hurt their patients. It sort of prolongs the pain and misery and hurts their recoveries. Do you find that in your practice?
You know, I think Dr. Odette is completely accurate. I think it's multifaceted because what we know is there's been a parallel increase in prescription drug deaths at the same time there's been a— at the same time that there was an increase in the amount of times these drugs were written. So we know that the doctors are contributing factor, but at the same time, an addict is an addict, and they're going to find their fix somehow. So in my practice, you know, I don't treat a lot of what we call chronic non-malignant pain. Why? Because I send those patients to a pain management specialist. That is who should be managing their pain. You know, unless you have cancer that is a malignant cancer, there are very few people who should be on long-term pain medications. You know, if you broke your leg 5 years ago, you should not be on Percocet still for the broken leg from 5 years ago. And the problem is, is a lot of doctors don't want to take the time to counsel these patients and explain to them the problems that they're having.
Joe Schrank, I've had a bunch of surgeries— knees and shoulders and everything else— and my physician has always prescribed, you know, one bottle or whatever of pain medication. I rarely find that I need to use the whole thing, but he's very careful about making sure that I don't just stay on these pain pills for more than a week or so. Is that the solution, Joe?
Well, that's part of the solution. Look, if the culture is flooded with pills, somebody's going to swallow them. So the overprescribing of these medications has contributed to the opiate crisis. There are safer forms of pain management. There's also a level of entitlement among Americans to never feel pain. Life is painful. You know, we can all expect to have pain. So the idea that, you know, we should just never experience any kind of pain and we need a pill to fix that is wrong from the get-go. Also, there are other forms of pain management. Cannabis is a much safer form. There's no known lethal dose of it. And so the opiate crisis and the overdose crisis absolutely is partially due to the overprescription of these medications, and it should be looked at. That doesn't mean that anybody should suffer. We're not looking for states for cancer patients or people who are in severe pain to not be able to access medications that would help them. What we're looking for is barriers to accessibility, which does help people and that does help the recovery process.
But Dr. Sizemore, you know, we hear from, from, you know, stories about especially family practitioners who feel overwhelmed by the patient load, first of all, and just the regulations of this kind of thing, and their natural response is to pull back and say Listen, I'm not gonna write you that prescription.
You know, I think that's somewhat of a fair response, but again, it's that family practitioner or the internist's responsibility to know their own boundaries. You know, if someone— again, if there's an acute injury, I don't think anyone, at least that I know, is going to have a problem prescribing, you know, 15 or 20 pills of Percocet. But the problem is, is that when you feel that someone's trying to take advantage of you, that's your responsibility as a physician and as an adult to step back and refer to an appropriate psychologist or pain management doctor. I mean, we are expected to have some level of common sense.
Yeah, moderation in all things, as Benjamin Franklin said, right?
Right.
We're gonna have to leave the discussion there. Great panel. Thanks for the information, Dr. Adet, Dr. Sizemore, Joe Schrank. We appreciate it. Thank you.
