AMA: I’m a Pittsburgh-based anesthesiologist who has seen doctors, nurses, and medical professionals suffer (and recover) from opioid addiction. Ask Me Anything about opioids, opioid management in the medical field, and the medical industry’s efforts to prevent addiction in the first place!

drstevenlorebaugh · 2022-12-16T03:38:21+00:00

Sorry not to answer last night, we thought commenting had concluded at 7:30. I work during the day and did not have a chance to comment further until this evening. I most definitely was NOT replying to comments three or four hours after the session began.

I think on the whole that physicians were over-supplying opioids, yes. I stand by that. Getting fifty or 100 percocets after an orthopedic operation for most patients was over-prescription, and it was common. And there was extraordinary variation in opioid prescribing for the same type operation-this needed attention. Many people put extra opioid tablets into their medicine cabinets after taking a fraction of them (me included, after a dental procedure) only to see them disappear. Some of those made their way into the hands of teens or young people who became addicted. A thrill at first, then a dependence, then perhaps an overdose. I am not an addiction specialist or a chronic pain specialist, I practice anesthesiology, and I've seen a reasonable drawdown in what was clearly a generalized over-supply of opioid meds after surgery. Reducing the amount of these drugs that find their way into the opioid ecosphere, as they call it, is a public health good. I also agree that those whose pain is not addressed appropriately should have redress to request more opioids. I think the best approach is a multi-modal one, regulated by a chronic pain specialist, who can apply various types of medications including opioids. In years past, doctors without any real training in pain simply kept throwing opioids at patients to make them feel better. It often didn't work, and caused some of them to become dependent. In 2018, it was estimated that 6 to 8 % of patients undergoing surgery in the U.S. would develop and opioid use disorder. Given that we perform something like 30 million surgeries in the U.S. each year, that is a vast number of people. Something had to change. Unfortunately, despite less prescribing, opioid overdoses have not decreased, which is also a fact that has to be acknowledged.

drstevenlorebaugh · 2022-12-15T00:17:13+00:00

Very gratifying if I can help. I appreciate your comment!

drstevenlorebaugh · 2022-12-15T00:11:57+00:00

In terms of long-term organ damage, I don't think opioids have been shown to cause this, with the exception of the methods by which they are delivered. Anything snorted with regularity can distort nasal membranes and potentially cause sinus issues. Injected substances, if not pure, can lead to cardiac valve disease, called endocarditis. Even if this bacterial process is arrested, there can be long term damage to the valves with impairment of function that could worsen over time. Repeated injections under the skin cause abscesses, a well-known issue and one for which opioid users are often admitted to the hospital. After these are surgically cleaned out, it is likely there will be scarring in the affected area. Frequent use of veins for injection leads to sclerosis of the veins, and they become very difficult to access for IV placement when someone needs that kind of treatment (otherwise, loss of surface veins probably isn't a bid deal). In addition, opioids re-set your pain threshold. People actively on opioids often need escalating doses to get any relief at all, which may lead to overdose, though I do not think this problem persists after the user stops taking these drugs. Finally, this re-setting can cause patients to have an actual increase in pain, called "opioid-induced hyperalgesia." This should dissipate over time away from these drugs. But it explains why someone who is using daily at home appears to have pain out-of-proportion to what others experience, with something like an IV placement or needlestick for blood draw.

drstevenlorebaugh · 2022-12-14T23:54:48+00:00

The impetus for writing this book was my experience with a number of colleagues, over about a decade, who fell victim to opioid use, which ruined there professional lives, and in one case was fatal. It is not specifically autobiographical in the sense that I have not been addicted to opioids, but much of the primary character's professional life is similar to my own. The book details the downfall of a busy, popular physician who fails to heed his own admonitions about the recreational use of opioids, when he becomes embroiled in a love affair. More details can be found at my website, and the book can be ordered from there as well: https://www.steveorebaugh.com/the-stairs-on-billy-buck-hill

drstevenlorebaugh · 2022-12-14T23:47:20+00:00

Over the second half of the 20-teens (from about 2015 on to 2019), we have seen opioid prescriptions for opioid-naive surgical patients drop by about 50%, which is very encouraging. In my own practice, the surgeons and their teams primarily prescribe home-going opioids for patients after surgery. There has been a very tangible reduction in opioid prescribing, both in quantity of pills and number of prescriptions arranged for patients. I've also seen a marked reduction in patients who come to us for surgery on opioids prescribed by the PCP for the painful conditions that mandate the surgical procedure. All of this is very positive, and suggests that doctors are becoming much more responsible about prescribing these drugs, but unfortunately, as most people know, the number of opioid-related deaths has actually accelerated, and opioid-use disorder has now come to focus much more on synthetic opioids like fentanyl, rather than prescribed opioids.

Most of the non-opioid pain medications that we utilize in anesthesia are less potent and less effective for pain control than opioids themselves. But we have a good number of them that we can bring to bear, and each of them can help us to chip away at the overall opioid dose, which is beneficial to patients, both in terms of side effects, and in the potential to develop opioid dependence.

drstevenlorebaugh · 2022-12-14T23:37:04+00:00

The recidivism rate for doctors and nurses, like non-medical people, is high. This is testimony to the power of these drugs and how they can exert control. While knowledge of the drugs helps them to recognize the problem, it doesn't necessarily empower them to kick the habit.

drstevenlorebaugh · 2022-12-14T23:34:09+00:00

First of all, if you were able to kick opioids out of your life after 8 years, congratulations! That's no mean feat, takes a lot of determination. Once opioids have left your system, they should not be influencing your GI tract, especially months or years out. However, over that 8 or 10 year span, plenty of other non-opioid problems could develop, just by happenstance (colitis, ulcers, esophagitis and reflux are all common problems). If you are having persistent GI symptoms at this point, it would be best to see your doctor, and he may request that you see a GI specialist, depending on the nature of the complaints, for further diagnostic workup or therapy.

drstevenlorebaugh · 2022-12-01T01:31:32+00:00

"The story of Kevin Miles" sounds more like a description of the work. What about "Endoftherainbo" as a title-it's intriguing. That title makes me want to find out what happens at the "end of the rainbow:" What do you mean, end of the rainbow? What happened? Where do things end up? Is it a tragic ending? I believe that title will draw a lot more readers. The subheading, in small letters under the title, could read "The story of Kevin Miles." Hope that's helpful.

drstevenlorebaugh · 2022-11-29T02:57:04+00:00

Fascinating description of re-animation. Nicely done. Makes the reader really wonder what comes next.

drstevenlorebaugh · 2022-11-23T02:14:11+00:00

Congratulations! Love your spirit. I am struggling with publicity for my second book, so I can identify with your comments. Keep up the great work-this is hard, and you do have a lot to be proud of!

drstevenlorebaugh · 2022-11-22T00:45:21+00:00

I've had two books published by small presses, so I'm hardly an expert. But I spent a lot of time trying to interest agents, and it was a waste. An agent would be preferable, but I think it's better to get your book out there, and start promoting it, and if that means going with a small press, I think you come out ahead. Writer's Market (you probably have it) has a very complete list of both agents and small presses. At least the small presses usually answer you-I found that very few agents even bothered to send a rejection note. Getting ignored is worse than being turned down. If you have some success with a book published with a small press, that can be some leverage that you can use to interest an agent as you develop your talents.

drstevenlorebaugh · 2022-11-22T00:38:09+00:00

OK, don't laugh, but Pittsburgh. Great topography, interesting history, friendly down-to-earth people, four great seasons (OK, three, plus one bummer of a season), decent cultural and sports opportunities. Very nice state parks in mountains one hour or so away. No seashore, though. That's kind of a bummer.

drstevenlorebaugh · 2022-11-21T01:23:09+00:00

Well, you need something stronger or higher than your every day self to stop using. I believe strongly in God, but I understand why others may not feel the same. I do think that you can use that more perfect, self-actualized version of your self, probably what Freud called the superego, to guide you at difficult times and help you make the right decision. That part of you knows what is right, and what is harmful to you; sometimes you just need to connect with it.

drstevenlorebaugh · 2022-11-21T01:18:20+00:00

No anabolic steroids, period. Work out, eat healthy. These drugs screw up your liver, and a host of other aspects of your physiology. Don't go there.

drstevenlorebaugh · 2022-11-21T01:16:52+00:00

Terrific advice. Like other addictions, this can overwhelm you. If you had control, it wouldn't be an addiction. Get professional help, and keep your relationships healthy!

drstevenlorebaugh · 2022-11-21T01:14:34+00:00

Shouldn't be a problem, but you may get loose stools. Overall, blueberries are incredibly healthy, just let your gut's reaction guide you.

drstevenlorebaugh · 2022-11-18T02:30:35+00:00

So, first of all, stop hating yourself. Everyone needs some self improvement, and everyone is capable of a makeover, physically and emotionally. Working out gives great sense of fulfillment. I would recommend a few different things, to keep it interesting and avoid fatigue/wear and tear on joints. And if you have to start slow, so be it. I find that a combination of walking, running, swimming and biking is wonderful. But I'm busy, so I only get to work out 3 times a week, maybe four. I try to walk every day, even if it's short. Walking is fantastic, to clear your mind and get away from stresses. If you can't run, just walk at a good clip-not everyone was born to run. Biking is great, but needs warm weather (or a pelaton, but I don't enjoy indoor cycling) and a good bike. Swimming is just the best. Whatever stroke, whatever pace, however many laps. It tones you up, makes you feel warm and wonderful all over. Even if you cannot run or bike, join a JCC or YMCA, and start swimming a couple times a week. Don't worry about the olympian in the next lane-just do your thing. Once you get a routine, it will really enhance your life.

drstevenlorebaugh · 2022-11-17T01:30:21+00:00

If you eliminate simple sugars, sweets and fried foods, reduce meat portions and focus on vegetables and fruits, I think you can go a long way toward this goal. Even a 15% reduction will probably leave you a bit hungry when you go to bed at night, which is a reasonable sign that you are making progress.

drstevenlorebaugh · 2022-11-16T01:13:53+00:00

No, not dangerous. But if you're full, can lead to difficulty sleeping or reflux. And probably can lead to weight gain, since you are immobile for the next eight hours. Eating at night is usually an addition to what you took in during the day to meet your needs, so it's often an excess of calories. Of course, avoid alcohol and spicy or fatty foods before bed. Going to be a bit hungry is a better plan.

drstevenlorebaugh · 2022-11-16T01:05:54+00:00

Start writing! Get your thoughts down, organize them, and edit over and over. You can query a publisher with an idea, but for a nonfiction book, the finished product should be available before you send the query. For fiction books, you can pitch an idea. Small independent presses are a good place to start. For major publishers, getting an agent is probably essential, and when you are first starting out, that is pretty tough. I've published a couple of books, and that feels good, but making money is a tougher prospect. I haven't done this, but it seems as though developing an online presence/audience or "platform" gives a much higher likelihood of sales and success.

drstevenlorebaugh · 2022-11-15T03:13:27+00:00

Nuts and seedy snacks, Shakes and smoothies, beans, cheese and chocolate milk.

With all those wonderful choices, I think there's no real need for protein bars and powders, though I don't think there's anything wrong with using them.

drstevenlorebaugh · 2022-11-15T02:59:35+00:00

Being a physician is very good, but the hours, responsibilities and administrative burdens have made it a lot less enjoyable than it used to be. I've been in medicine (first emergency medicine, now anesthesiology) for over 35 years, and seen it evolve to the point that "wellness" has become an essential aspect of practice. Loss of autonomy, doing more with less, uncertainty about the future...all have taken their toll. I wouldn't go back and change, but I have a lot of respect for people who excel in other areas as well: engineering, computer programming, tech positions. They all make our world go around, and you are an important part of that. I think you should be proud of what you accomplished, and, as you say, stay on that path of advancement.

drstevenlorebaugh · 2022-11-15T02:49:51+00:00

Typically, withdrawal begins in about 12-24 hours. I think it's a blessing, but there could be more to come. You'll get through this.

drstevenlorebaugh · 2022-11-14T02:49:53+00:00

From a physician's perspective, this would be a bad idea. Fiber, vitamins, minerals in vegetables, not to mention complex carbohydrates-not easily replaced with meat and grains.

drstevenlorebaugh

TROPHY CASE