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A New Normal

For the last 19 years I have worked in busy Emergency Rooms where all I wanted to see was acute care and action “ like on TV”.

Richly rewarded emotionally by the sudden onset nature of the business and knowing that I (occasionally) made a difference in someone’s life…

I find myself in an interesting and thought provoking chapter in my career.  

I, like many others in my field, am guilty of saying : 

“How many Norco’s will it take to get him out of here?”

Drug seeking behavior in the ER is one of most unpopular patient groups since there is an underlying dishonesty, manipulation and  coercion to the patient interaction which leads to animosity and resentment.

“I’m here to help real patients in need and this one is wasting My/our time…”

Nurses have for years jaded me with “ listen doc… this one in room 5 is here ALL THE TIME…for (insert body part here) pain and just wants drugs…get him/her out of here…”

Another reason for the difficulty in management of these patients is that this disorder is closely tied with psychiatric conditions that are both chronic and difficult to manage and can not be cured with a chest tube or 150 joules of electricity.

“How long has your back been hurting you sir?”

“7 yrs..”

“ what made you come in to (my) ER (at 300am)?”

“it’s a lot worse”

On the 0-10 scale what would you rate this pain?

“ 20”

“ I said 0-10…”


I see here you have listed Toradol as an allergy. What happens?

“ I stop breathing”

What does your primary care doctor do about it and does he know you’re here?

“He’s out of town. He always gives me Percocet, it’s the only thing that works…”

“ he thinks I have Fibromyalgia..”

But at the end of the day I got into this business to help people and feel the satisfaction that I have done a good thing and made a difference in someones life.

My colleagues will be very surprised to hear an Emergency Room Physician has opened an opiate addiction treatment clinic. Like a staunch vegetarian that just bellied up to an all you can eat beef buffet…

What do we really know about the “chronic pain” patients and how they got to us at  3:00 am with a 7 yr history of back pain that began with a legitimate MVC or work/sport/home injury.

What do we know about the psycho-social issues they have tied closely to their addiction?

Do we know about the real neuro-chemical changes in the brain that result in the compulsive behavior that is the hallmark of addiction?

What do we know about this patient population? 

Just that its growing and the problem worsens every year.

*Heroin use more than doubled among young adults ages 18–25 in the past decade.

*More than 9 in 10 people who used heroin also used at least one other drug.

*75% of people who used heroin were also addicted to prescription opioid painkillers.

*Each day, 175 people die from an overdose in the US.

*Health care providers wrote 259 million prescriptions for painkillers in 2012, enough for every American adult to have a bottle of pills.

Nearly 48,000 women died of prescription painkiller* overdoses between 1999 and 2010.

*Deaths from prescription painkiller overdoses among women have increased more than 400% since 1999, compared to 265% among men.

*For every woman who dies of a prescription painkiller overdose, 30 go to the emergency department for painkiller misuse or abuse.

*In 2010, 1 in 20 people in the US (age 12 or older) reported using prescription painkillers for nonmedical reasons in the past year.

*Enough prescription painkillers were prescribed in 2010 to medicate every American adult around-the-clock for a month.

ED’s are overcrowded enough.

Patients with opioid addiction come to us in one of 3 ways:


-drug seeking behavior


2 liters of isotonic, 20mg Bentyl IM, 4mg of Zoran , 1mg Ativan and they now feel “15 out of 10”.

Not very rewarding and not patient satisfying.

Here is another fact: there is very little resource for these patients.

They are shuffled from office to office or ER to ER looking for  ( not a solution ) a temporary fix.

They don’t get high anymore, they just don’t want to be sick from withdrawal.

They will never achieve that euphoria they did the first time they used.  

Their bodies have up-regulated their opiate receptors to a level that now to just to “be normal” they must use more and use more often.

This has now become a physiologic and neuro- chemical problem that requires treatment. No different than Diabetes, hypertension or heart disease.

It deserves the same respect and compassion.

The old adage of abstinence being the cornerstone to addiction treatment is changing… 

Diabetics needs insulin.

There are no diabetic groups anonymously getting together in church basements drinking bad coffee and sharing storied about their experiences.. are there?

Opiate Dependent people need Suboxone.

(or some form of Medically Assisted treatment)

While 12 step may work for some it certainly is not for all.

I distinctly remember my senior resident in training telling me patients in opiate withdrawal will not die… they will just wish they were dead…”

If snorting, shooting or popping a pill will make the worst stomach flu of your life coupled with a panic attack GO AWAY…ask yourself wouldn’t you do it?

The recidivism for opiate addiction is 87-92%.

What they DO NOT need:

1)The threat of the nausea vomiting diarrhea and the worst “ whole body pain” of their lives.

2) The stress of running out of meds.

3) The stress of wondering if they will be able to get money or drugs to stay out of withdrawal.

4)To have thoughts of whether to feed their kids or pay for a fix….

5) The guilt, the shame and the endless financial and psycho-social cycle of addiction.

What they DO need is: 

A New Normal.

With appropriate medically assisted treatment (MAT) and counseling, addiction patients can return to a life style prior to their downward spiral.

Suboxone will allow patients to take a daily medicine and go back to being a good parent, a productive employee and a loyal friend.

Suboxone will allow patients to rebuild broken lives, broken bodies and mend relationships. 

Suboxone will help patients to fight the “monster of addiction”.

Suboxone will give patients:

A New Normal….

Here is something else they need: Empathy

This is a patient group that has been looked down upon, cast aside and told that they are “weak” or “bad” and made to feel even more guilt and shame than they already have placed on themselves.

The addiction community’s view on opiate addiction has changed in the past several years. We now see it for what it really is: a brain disease. Not a character flaw. The decision to start using drugs may have been their choice.  The disease of addiction is not.

The compulsive behavior associated with addiction in many cases can not be treated with behavioral therapy alone. In fact, one can not participate in therapy while the craves and withdrawal symptoms consume their lives.

Addiction patients need to know that there is someone who cares. Someone who will support them on their road to recovery.  They may have never tried. They may have failed in the past.

Many have not heard a kind word in years. It is virtually impossible to break the cycle of addiction without an empathetic ear and opportunity to get the treatment they need.

What we have found is that the people that come to us looking for treatment have looked for a long time before they found us. The “online list” of qualified buprenorphine providers is inaccurate and useless to say the least.

Creating a badly needed resource for an ever growing patient population is paramount to the success of reducing the number of opiate related deaths in this country.

ModernMed Recovery offers that opportunity.

A chance at a new normal.

Kenji Oyasu MD

ModernMed Recovery


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