Contents Vol. 82, No. 3 on the Cover: the Opiod Crisis
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MAY / JUNE 2018 contents Vol. 82, No. 3 on the cover: the opiod crisis 6 Editorial 17 Caring for Patients after Overdose: Michael Hirsh, MD and Jane Lochrie, MD Reflections of the UMass Medical Toxicology Fellows 8 My Recovery Story Katie Devin-Holcombe, MD, and Jeffrey Lai, MD Rep. James O'Day 18 As I See It: Substance Use Disorder in 9 One Family's Journey with Substance Our Community Abuse Disorder Matilde Castiel, MD, Commissioner of Health and Human Deborah Dowd-Foley and Elizabeth Foley, MBA Services 10 Pharmacy Perspective: Variable Response 19 As I See It: Jargon 101 to Opioid Analgesics: The Role of Gerard Aurigemma, MD Ethnicity, Gender and Genetics 20 Introduction: The 2018 Creative Writing Dinesh Yogaratnam, PharmD, BCPS, BCCCP, and Nnamdi Okeke, PharmD, MBA Exposition Robert Sorrenti, MD 12 Pharmacy Perspective: Role of Acupuncture in Management of Pain and 20 A Patient Doctor – Doctor Moment the Opioid Crisis Sarah Sullivan, MD Meredith St. John, MAc, Lic.Ac. 21 Death of My Father Irma Szymanski, MD 14 Student Perspective: A New Generation of Prescribers 22 In Memoriam: John J. Darrah, MD Matthew Carroll, MS4 23 In Memoriam: Stuart H. Bentkover, MD 15 Student Perspective: The Role of Opioids in an Opioid Crisis 24 In Memoriam: Rashmi Patwardhan, MD Jonathan Quang, MS4 25 Society Snippets: Call for Nominations 16 A Multidisciplinary Approach to Post 26 Society Snippets: 2018 Annual Business Operative Opioids Meeting Olivia Karcis, MS1; Sardis Harward, MS1; and Kavita Babu, MD 27 Society Snippets: Scholarships Available The WDMS Editorial Board and Publications Committee gratefully acknowledge the support of the following sponsors: UMass Memorial Health Care Reliant Medical Group The Louis Albert Cottle, MD Trust Fund 4 | Worcester Medicine May/June 2018 WORCESTER Worcester Medicine is published by the Worcester District Medical Society 321 Main Street, Worcester, MA 01608 e-mail: [email protected] web: www.wdms.org phone: (508) 753-1579 WDMS Officers President: Sahdev Passey, MD Vice President: Spiro Spanakis, DO Secretary: Giles Whalen, MD Treasurer: Robert Lebow, MD Joyce Cariglia, Executive Director Martha Wright, MBA, Assistant Director Melissa Boucher, Administrative Assistant WDMS Editorial Board Jane Lochrie, MD, Editor Lisa Beittel, MBA Anthony Esposito, MD Michael Hirsh, MD Anna Morin, PharmD Nancy S. Morris, PhD, ANP Thoru Pederson, PhD Joel Popkin, MD Robert Sorrenti, MD Peter Zacharia, MD Alex Newbury, Student Representative Production and advertising sales by Pagio Inc. 88 Winter Street, Worcester, MA 01604 (508) 756-5006 [email protected] Paul Giorgio, President Donna Roberson, Editor Vanessa Herbold, Art Director David Simone, Vice President/Sales Chris Reddy, Account Executives Kati Nalbandian, Event Manager Worcester Medicine does not hold itself responsible for statements made by any contributor. Statements or opinions expressed in Worcester Medicine reflect the views of the author(s) and not the official policy of the Worcester District Medical Society unless so stated. Although all advertising material is expected to conform to ethical standards, acceptance does not imply endorsement by Worcester Medicine unless stated. Material printed in Worcester Medicine is covered by copyright. No copyright is claimed to any work of the U.S. government. No part of this publication may be reproduced or transmitted in any form without written permission. For information on subscriptions, permissions, reprints and other services contact the Worcester District Medical Society. May/June 2018 Worcester Medicine | 5 editorial Editorial In the first article, Representative James O’Day gives a poignant and frank account of his road to recovery. His first experience with intoxication was in the seventh grade, and his addiction was exacerbated by owning his own bar at the age of 23. He tells us how this insidious and complicated disease strained every aspect of his life. When he was able to fully embrace recovery, his life markedly improved and he was able to become a productive member of society and even become a state representative! In our next article, Deborah Dowd-Foley relates her family’s struggles with a son who was addicted. This started when he was a high school student at St. John’s. He spent five months at Spectrum Residential Treatment Center, and sadly, a year later, his mother found his lifeless body in bed when he did not get up for work. She describes how addiction affects the entire family and how she is able to cope. Sharing her story with many different venues, helping others and raising awareness of this problem is her way of keeping her son’s memory alive. The role of acupuncture in pain management and addiction is explained by Meredith St. John, MAc, Lic.Ac. She states that there are numerous systemic reviews and meta- Michael Hirsh, MD Jane Lochrie, MD analyses confirming the effectiveness of acupuncture in treating chronic pain. In addition, she describes the role of acupuncture in treating addiction, due to its effect on the release of dopamine. Regrettably, the lack of insurance coverage is a huge barrier to obtaining treatment, as each session cost $75-$100. This month’s edition of Worcester Medicine represents a collaboration of the Worcester Department of Health and Human Services (WDHHS), the Dinesh Yogaratnam, PharmD, BCPS, BCCP, and Nnamdi Okeke, PharmD, MBA, Worcester Division of Public Health (WDPH) and the Worcester District define the variable response of individual patients to analgesics. They describe how Medical Society (WDMS) to bring to the attention of our leaders the need for gender, race, ethnicity and genetics influence opioid responsiveness among patients. They describe the fascinating role that genetic polymorphisms play in these differences. everyone in our medical community to step up and face the scourge of opioid addiction and substance use disorder. As always, the UMass medical students are fully engaged in this epidemic. Matthew Carroll, a fourth-year medical student, described the disparity of what he learned in class To put things in perspective, 2016 statistics showed that firearms killed 38,000 and what he saw on his clinical rotations. He closes by stating that he is determined to Americans. Motor vehicles killed 40,000. But SUD claimed the lives of prescribe responsively. 60,000 Americans across the country. These victims of the opioid scourge have Jonathan Quang, also a fourth-year medical student, writes that overdose deaths have demographics that cross all socioeconomic and racial and ethnic boundaries. now overtaken automobile accidents as the leading cause of death in the U.S. There is The plague is upon us all. At the request of Dr. Matilde Castiel, Worcester’s an obvious role for opioids in end-of-life and post-operative pain management. He commissioner of health and human services and a past recipient of the advocates for the use of the CDC treatment guidelines for other situations, such as Worcester District Medical Society’s Lifetime Achievement Award for her chronic pain. work with SUD in the Latino population, Worcester Medicine picked up the gauntlet and decided to dedicate this edition to the crisis, as well as several First-year medical students, Olivia Karcis and Sardis Harward, along with Kavita Babu, MD, are actively engaged in trying to solve this emergency. They noticed that patients upcoming episodes of Health Matters, the cable access health news show who had unused opioids after surgical procedures had nowhere to dispose of them. They produced in collaboration with WCCA-TV, Channel 194. are working to provide secure and convenient disposal boxes for leftover tablets with the help of Dr. Michael Hirsh, medical director of the Worcester Division of Public Health, This edition features tragic tales of loss, tales of triumphant recovery, tales of and Chief John Luippold, of the University of Massachusetts Medical School Police. The new approaches to the crisis and affirmation that as a community, Central students are working with the Overdose Prevention Fund that was started in 2016 to Massachusetts is not taking this epidemic lying down. More than 180 make this happen. The Worcester District Medical Society was so impressed with their efforts that it made a generous donation to the fund. naloxone administrations by our Worcester first responders (many trained by the WDPH) saved lives in Worcster last year. But we still lost more than As always at this time of the year, we print the winning reflective writings by our colleagues 70 people to overdose. We are hoping that this edition will provide insight at the Massachusetts Medical Society. Sarah Sullivan, MD, offers a poem describing her into the magnitude of the problem and give physicians and patients alike the time as a patient and how she perceived her care. In her essay, Irma Szymanski, MD, gives agency to do something about the problem. a heart-wrenching description of her last day with her father. Please don’t leave this publication without enjoying As I See It and Society Snippets. Warning: Some of the submissions are quite raw but all the more inspiring for Over the past few months, the Worcester community has lost three of its physician the generosity of spirit that led the authors to share their heartbreak. We hope leaders, Drs. John Darrah, Stuart Bentkover and Rashmi Patwardhan. Please read the their candor will inspire our readers to step up and make a difference. memorials written by their close colleagues. Michael Hirsh, MD, Guest Editor Jane Lochire, MD, WDMS Editor 6 | Worcester Medicine May/June 2018 May/June 2018 Worcester Medicine | 7 the opioid crisis My Recovery Story Rep. James O’Day I am a person in long-term recovery it was one of the best days of my life. from addiction to alcohol and drugs, and I love being in recovery. Recovery Even though I didn’t stop using after my first treatment experience, the seed not only gave me my life back, but it of recovery had been planted.