Welcome back to INTERVUE, last week I talked to Dr. Faye Jamali about the opioid crisis – specifically how she overcame opioid abuse and her viewpoint on how more celebrities can avoid opioid abuse. Today we focus more on her journey and discuss how more physicians can be more transparent about
opioid abuse and how that can be healing for both them and the community.
How can more physicians be more transparent about the opioid abuse?
DFJ: You mean opioid abuse amongst themselves?
DR: Amongst themselves, amongst when they issue the drugs and they didn’t realize they may be causing or contributing to the abuse.
DFJ: Well, there has been a huge shift in educating doctors, starting with medical schools, as far as teaching students and physicians that there are alternatives to pain medications, that opioids do carry the risk of addictions, which was not the knowledge back in 1996 to 2004, we were just told you can prescribe as much as the patient needs or wants, and there was a big push to deal with pain. They called pain another vital sign that we had to record and treat. We had to treat pain so that the patient had zero pain, and the way to do it is to give these drugs, and it was a big push on us from the pharmaceutical companies, but now, given what we are dealing with, there has been gradually much better education for doctors, so pretty much all across the board there is a decrease in what we’re allowed to prescribe, and we have to actually register what most physicians do, where they monitor how many narcotics you’re prescribing, so that is definitely a good first step. The other thing is teaching physicians that addiction can happen to us also. I remember as part of my residency training in anesthesiology, there was one lecture about addiction and all of it I was snoozing through because I was thinking, “this could never happen to me”.
At least a drink! This is not me, so I didn’t even think of it. But we realize that this disease does not discriminate. Just because you’re smart enough to go to medical school, doesn’t mean you’re going to be smart enough to realize you’ve become addicted to something. It creeps up on you. So, that is amazing. As far as physicians in recovery and being transparent, that’s a whole other can of worms, because most states in the country have what’s called “Physicians Health Programs”, where physicians who are struggling with addiction can go into this program, and as long as they are doing what the program prescribes them to do—drug tests, meetings, recovery programs—then, their license is safe. Which seems like a great idea; however, California decided to do away with their program. They’re one of three states that doesn’t have a Physicians Health Program.
Yes. And this Physicians Health Program was (laughs) a few months before disbanded before I had my problems with addiction, so what happened to me was the moment I went into rehab and had to be reported and my medical license went on probation. Yes. And it was public record, so if you google my name, it’s there forever!
Most criminals, for example, if it’s a misdemeanor, after a while, it gets dropped off their record, but as a physician, can you imagine how difficult it would be for someone to self-report, to want to get help when they know they’re going to be put on probation? Many insurance companies, health companies, won’t let you use them or be a part of their network if you’ve been on probation.
Wow! Is there any way to combat the probation?
No, that’s it. They finalized it. I went into rehab, I’ve admitted I had a problem, even though I had been in recovery. So, my probation lasted five years. I had even been sober for two years before the state of California had even gotten around to me, and I wanted to show them that I was sober, so I personally paid for once a week testing for drug use so I could show them I was sober, but that doesn’t matter to them. It was like, “OK, you’re going to get five more years of probation.” So, for seven years, I peed in a cup once a week. (laughs)
And I never tested positive. But I was willing to do that. It is a privilege and not a right to practice medicine. I will jump through whatever hoops you want to do this. So, this is a real problem for certain states. Right now, California is trying to put together a physicians’ health program, because I think it is a public safety issue.
Because a physician who is affected with this disease is not getting the help they need, they’re putting the public at risk. So, you need to have physicians be able to get the help they need without fear of retribution. Now look, if someone goes into a physicians’ help program and they keep repeatedly failing, then of course they should be put on probation and their license should be revoked if they’re not doing it.
It’s a public safety issue, absolutely! But a person who’s been in recovery—for example, I’ve left anesthesia a couple of years ago and I wanted to start a new business, a different type of medicine. And to get a loan—I wasn’t able to get a loan because they looked at my record and said, “but, you’ve been on probation, Doctor.”
That was ten years ago! (laughs) So, this is life. It happens. But, I do think as far as public safety, it is very important to have physicians be able to get the help they need. And as far as transparency, I think it is difficult for physicians, because they feel, “if I tell someone I’ve had problems with addictions in the past…” they face this whole issue with stigma and will my patients trust me? Which is…I ran that risk, but I thought, I had to be open about it, because if I could help just that one other person, physician or not, to get the help that they need, I’m willing to take that. During recovery, I realized I can’t control people’s judgment of me. I can just live my life and do the best I can; be kind, compassionate and helpful, especially to other people who are struggling with addiction and let that speak for it.
Agree, agree. I still can’t believe they’re keeping you on probation. That really sucks.
I completed my probation in 2015, but the record is there forever. You can’t take it down. It’s public record. (laughs)
What are some of the alternatives to opioids out there?
Being in the field of anesthesia, we’re experts in pain control, opioids definitely have a role to play in treating pain; especially during surgery. We do intravenous medications that are opioids among many other things, but after surgery, we can help patients with what we call “multi modal analgesia,” which means you use different processes of medication to help with the pain. You can help a little bit of pain medication that are opioids, but also have nerve blocks like local anesthetics or numbing medications placed in certain places. There’s physical therapy, there’s acupuncture. I think we need to combat this idea that patients who feel like they need to have zero pain after a major operation. That’s not realistic. We need to make sure that patients realize that we can manage the pain. It’s going to feel a little bit uncomfortable. It’s not like you haven’t had anything done. But to make sure that they’re able to do the things they need to do, like control their pain so they can get up and walk around, do their activities and daily living, and we can offer that. It’s very interesting when you look at patients who have cesarean sections in Europe, almost none of them get pain killers after the operation.
They’re told, “here! Have some Ibuprofen” or other medication like Tylenol. Go home, rest.”
“Let your body heal. Drink tea.” And I remember some expats telling me I was like, “What? No! I had a C-section in America and they gave me a whole bunch of medication.” And they realized, “you know what? Actually, I was clearheaded. I was a little uncomfortable the first day.” So, we also have to change people’s expectations of “you know what? We’re not going to numb you to everything.” It’s kind of like we don’t need to numb ourselves in life. There are going to be some painful moments at times, and just by numbing ourselves, we’re not dealing with the issue; we’re just masking the issue.
One last question: How can the average American citizen—what can they do to increase awareness of the opioid crisis? What can they do to combat that?
I think the best thing they can do is to listen without judgment to people who are struggling with this. A patient or someone who is trying to quit smoking. We applaud them, don’t we? “Good job! Keep going, you’re doing a good job!” But when it comes to someone who is addicted to pain killers, it’s not the same, is it?
So, I think that we just need to have compassion towards people, realize that this is not something they choose; this is not a moral failure on their part. Certain people are susceptible to it; there are certain genetic component to it; you’re at higher risk of addiction if you have certain comorbidities, such as depression, PTSD. For me, it was a perfect storm of having depression, pain and access to the medications. And a lot of these people, you start out being addicted to pain killers, then you can’t afford the pain killers anymore and your doctor won’t prescribe them to you and you then move to heroin, which is cheap and it involves this whole new criminality associated with it. So, I think compassion would be a great place to start.
It’s always a great place to start, with compassion. You’re right. Well, if people who are listening or reading this and they want to learn more about this, how can they find you?
DFJ: Well you can always e-mail me. I answer every email. My email address is DrFayeJamali@gmail.com, and I’d be happy to share with them my experience. You know, a lot of it is just listening to people and helping them make some choices that would help their life. Thank you so much for letting me share my story.