The Expert: Dr. Andrew Kolodny, the medical director for opioid policy research at Brandeis University’s Heller School for Social Policy and Management, testifies for the state, to provide background on opioids and addiction.
This video clip captures testimony offered by Dr. Andrew Kolodny, one of the nation’s foremost experts on the prescription opioid and heroin crisis, during a 2022 trial out of Florida, State of Florida v. Walgreens. The Florida Attorney General claimed that the Walgreens pharmacy chain contributed to the state’s opioid crisis by failing to properly vet prescriptions. Kolodny, the medical director for opioid policy research at Brandeis University’s Heller School for Social Policy and Management, is testifying here for the state.
This clip opens with a discussion of the “Opioid Risk Assessment Tool.” This was a survey that a doctor could provide for a patient to fill out, that purported to help caregivers understand who was most likely to have a problem with opioid addiction. The expert speaks disparagingly of the “tool,” saying that its usefulness was “a made-up thing” and of no real use in predicting who would likely become addicted to opioids. This is still widely used today.
The Opioid Risk Tool was eventually studied and found to be useless. The theory of the survey emphasizes that the drugs are safe, it is only certain people who will abuse them and become addicted, rather than recognizing that “the drug is inherently risky” and it is unpredictable exactly who might be adversely affected, though every patient is at risk.
Commenting on questioning by the attorney concerning “patient agreements” signed before opioids are prescribed or dispensed, which are ostensibly done to prevent doctor shopping, pharmacy shopping, sharing medications with other people, and early refills, Kolodny expounds on this agreement. These promises are totally ineffectual once a patient is addicted, and they are just promises, easily broken. These agreements do not protect the patient, what they actually do is protect the doctor or pharmacist by providing an easy way to blame the patient if something goes wrong. The healthcare provider points to the signed agreement to claim that it is not their fault that things went bad. “Can’t blame me,” the expert explains that a hypothetical doctor will say, the patient is the one that broke these promises.
Kolodny responds to a question about a communication sent out by the CDC to the public in 2016 in which guidelines were used to discourage primary caregivers from using high dose opioids. The notice pointed out that there was no evidence that using opioids long term was effective for pain relief, but that using higher doses had proven to be very risky. This guideline was supported by a submission to the New England Journal of Medicine from the CDC. The government was trying to impress the medical community that the risks of using opioids long term outweigh the benefits.
The practice of prescribing opioids long-term had become so common that the CDC felt the need to remind the medical community of what they already really knew. Long term, high dose opioid abuse leads to increasing pain and decreasing functional status, as well as addiction.
The doctor’s testimony preceded a mid-trial settlement for $683 million.
Gary Gansar, MD, is residency-trained in general surgery. He served as Chief of Surgery and Staff at Elmwood Medical Center and on the Medical Executive Committee at Touro Infirmary and Mercy Hospital in New Orleans, LA. Dr. Gansar was Board Certified in general surgery while in active practice. He joined AMFS in 2015 as a Physician Medical Director.
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