Suffolk Closeup: The epidemic

After a decade of treating people with opioid use disorder, Dr. Allen Fein has been speaking about what he’s learned, what can work and how enormous the problem is. He’s offering his presentation for free in as many places as possible.

A clinical professor at Stony Brook University School of Medicine, Dr. Fein welcomes invitations from churches, synagogues, civic and community groups, anywhere really, to discuss the crisis.  He noted that last month at the Westhampton Library, a person commented, “This is a depressing talk.”

Dr. Fein agrees. “Yes, it is horribly depressing,” he said at his Southampton office last week. “Most of these are young people. But we all need to know what is happening and become engaged.”

As awful as people believe the situation is, it’s even worse, he said. “It’s an epidemic. And what I hear from my patients is that we’re losing the fight.”

He spoke of one patient telling him that three friends died after overdosing last week from the opioid drug fentanyl, which is “50 times” more potent than heroin, far easier to manufacture and is flooding this county and this country. This patient also said “half of his teammates” from a high school baseball team have “lost their lives to opioids.”

Dr. Fein said he didn’t comprehend the sweep of the problem himself when another physician, Dr. Arne Skilbred, the late medical director at Southampton Hospital, told him a decade back about a new treatment for opioid use disorder, a drug called Suboxone, and suggested he might want to make use of it in his practice to treat addicts.

Dr. Fein said his initial reaction was, “I didn’t want drug addicts in my waiting room.” But he came to realize from his work through the years that the widest variety of people are addicted to opioids “and that patients with opioid problems were already in our waiting room, unknown to the staff.”

He added, “They come from all professions.”

The PowerPoint presentation at the Westhampton Library stated: “Addiction. A chronic disease of brain reward, motivation and memory, where an individual pathologically pursues reward and/or relief by substance use … with inability to abstain, impairment in behavior control, cravings, diminished recognition of significant problems with one’s behaviors and interpersonal relationships and a dysfunctional emotional response.”

“Opioid addiction is life-long with recovering and relapsing phases,” it continued.

Dr. Fein treats with very tight supervision. He said in his decade of caring for those with opioid use disorder, “perhaps 50 percent have remained off their previous abused opioids and have stayed the course with the safer opioid Suboxone, or with the non-opioid Vivitrol.” Also, “all patients are encouraged to seek counseling.”

Suboxone “has built-in brakes. It doesn’t provide a high. And patients on Suboxone will not overdose unless they mix in other drugs.” Vivitrol is “desired by patients who want to be entirely free of opioids.”

Then there’s Methadone, with a “main drawback that it may only be prescribed in specially operated treatment centers and very frequent visits are the norm. Suboxone usually requires monthly visits to a physician’s office. Vivitrol shots are every 28 days.”

Critically, in dealing with those with opioid use disorders, said Dr. Fein, the person doing the treatment must be “compassionate and patient, but firm … Unfortunately, the physician and loved ones of those in trouble learn that they are often untruthful and in denial.”

The physician also suggested if someone believes a person in her or his family is addicted, “tough-love” should be practiced. Signs of addiction red flags include “large pupils when a person is in withdrawal and is edgy, small or pinpoint pupils when taking opioids, sweating, diarrhea” and “storing urine” likely from someone else in order to pass a drug test. “They often need pressure from loved ones and the legal system before seeking treatment.”

Dr. Fein, who is active in the New York chapter of the American Society of Addiction Medicine, is “currently treating about 150 patients with opioid problems. My practice is very busy and I’m not looking for new patients,” but seeks to get other doctors involved in providing treatment.

He’s speaking out because “I want to give back to the community,” and tells of those with opioid problems “coming into my office looking like drowned rats” but in short order “having their lives back. It’s very rewarding helping them.”

Anyone with questions about these matters or with interest in having Dr. Fein address his or her group is urged to call (631) 283-6446.