Does U.S. Have Opioid Crisis or Overdose Crisis?

By Pat Anson, PNN Editor

A lot of people were surprised by an alarming report from the CDC last week, showing that a record 100,306 Americans died of a drug overdose in the 12-month period ending in April, 2021. That’s a 28.5% increase in a single year.

Among those who were caught off-guard was Andrew Kolodny, MD, an opioid researcher at Brandeis University and founder of Physicians for Responsible Opioid Prescribing (PROP), an anti-opioid activist group.

“I was surprised by the latest tally from the CDC showing that for the first time ever, the number of Americans who fatally overdosed over the course of a year surpassed 100,000,” Kolodny wrote in an op/ed for The Conversation that’s been republished in several major newspapers.

“The soaring death toll has been fueled by a much more dangerous black market opioid supply. Illicitly synthesized fentanyl – a potent and inexpensive opioid that has driven the rise in overdoses since it emerged in 2014 – is increasingly replacing heroin. Fentanyl and fentanyl analogs were responsible for almost two-thirds of the overdose deaths.”

It’s refreshing to see Kolodny finally address the elephant in the room – illicit fentanyl – instead of always blaming prescription opioids for America’s addiction and overdose problem. But he continues to frame the drug crisis as an “opioid crisis” when repeated studies show that multiple substances are usually involved in overdoses, including non-opioid drugs like cocaine and methamphetamine.  

“It is especially tragic that these deaths are mainly occurring in people with a disease – opioid addiction – that is both preventable and treatable. Most heroin users want to avoid fentanyl. But increasingly, the heroin they seek is mixed with fentanyl or what they purchase is just fentanyl without any heroin in the mix,” Kolodny wrote.

“Opioid-addicted individuals seeking prescription opioids instead of heroin have also been affected, because counterfeit pills made with fentanyl have become more common.”

Here Kolodny sidesteps the fact that many pain patients are turning to street drugs because of government and law enforcement policies that restrict the prescribing of opioid medication – policies that Kolodny and PROP had a significant role in creating. They’re not addicts “seeking prescription opioids instead of heroin.” They’re patients seeking pain relief.

“Our misdirected efforts to solve the overdose epidemic have led to even more deaths. As long as we myopically focus on reducing prescription opioids for people in pain, the overdose epidemic will continue and worsen,” says Lynn Webster, MD, a pain management expert, Senior Fellow at the Center for U.S. Policy (CUSP) and Chief Medical Officer of PainScript.  

“Some of those who need opioids will be driven to the streets where they will find illicit and, potentially, lethal opioids. Some people may even choose to end their own lives. Your readers may have seen the recent article that described a suit against a physician for denying opioid treatment of a patient. The patient committed suicide as a result.” 

Webster says it is wrong to single out opioids – legal or illicit – for America’s escalating drug problem when the causes are complex and embedded in society. 

“We do have an overdose epidemic. Unfortunately, policymakers and the media have wrongly categorized it as an opioid epidemic rather than a drug overdose epidemic,” says Webster. “The roots of the overdose crisis are deep and seeded in despair from major shifts in socioeconomic conditions and lack of adequate and affordable healthcare. The Covid pandemic has made clear that social and mental health issues must be addressed if the overdose crisis is to be reversed. 

“The only solution to the overdose epidemic is to lower the demand. This will require a broad approach that involves addressing socioeconomic and mental health drivers of demand. More affordable and accessible treatment is important but will not solve the crisis.” 

Invested in Opioid Crisis 

Changing the narrative about the overdose crisis won’t be easy, since so many lawyers, politicians, healthcare companies and media outlets have invested in perpetuating the “opioid crisis.” Kolodny and other PROP board members have lucrative side hustles testifying as expert witnesses in opioid litigation cases for plaintiff law firms, which stand to make billions of dollars in contingency fees if their lawsuits are successful. 

One such case was decided by a federal jury in Cleveland today, which found that Walgreens, CVS and Walmart substantially contributed to addiction and overdoses in two Ohio counties by dispensing opioids in their pharmacies. The companies said they would appeal. 

“Plaintiffs' attorneys sued Walmart in search of deep pockets while ignoring the real causes of the opioid crisis-such as pill mill doctors, illegal drugs, and regulators asleep at the switch,” Walmart said in a statement. “And they wrongly claimed pharmacists must second-guess doctors in a way the law never intended and many federal and state health regulators say interferes with the doctor-patient relationship.”

Judges in Oklahoma and California recently ruled that opioid manufacturers are not “public nuisances” and can’t be held responsible for what people ultimately do with their drugs.  

PROP Plans to Hire New Executive Director

By Pat Anson, PNN Editor

An influential anti-opioid activist group -- Physicians for Responsible Opioid Prescribing (PROP) – is raising money to hire a new Executive Director to replace Dr. Andrew Kolodny, PNN has learned.

There is no indication that Kolodny is leaving PROP, a volunteer organization that he founded in 2011 to “turn the tide of opioid overprescribing.” But in an unsigned email sent to supporters this week, PROP asked for donations so it could hire a new Executive Director, a position long held by Kolodny.

“We’ve retrenched and brainstormed and have great plans to expand our reach and impact. Our next big step is to hire a paid staff person. Will you help to make this plan a reality? We are trying to raise $100,000 by December 31st to ensure that we can hire an executive director with resources to take PROP's work to the next level. Please help by donating what you can,” the email said.

Supporters who click the donate button on the email will be taken to a PayPal account operated by the Steve Rummler Hope Foundation, which is PROP’s “fiscal sponsor.” PROP is not a charity, but can collect tax deductible donations under the foundation’s non-profit status.

Like PROP, the Rummler foundation’s main goal is to reduce opioid prescribing. Kolodny works closely with the organization and serves on its Medical Advisory Committee, along with PROP President Dr. Jane Ballantyne.   

Kolodny declined to talk with this reporter about what his future role with PROP will be.

“I haven’t had a good experience answering questions from you in the past, so I’m not going to talk with you,” Kolodny told me in a brief phone call.

‘Heroin Pills’

It would be hard to overstate the influence that Kolodny and PROP have had on opioid prescribing in the United States. A psychiatrist who specializes in addiction treatment and former Chief Medical Officer at Phoenix House, Kolodny is the public face of PROP. He lobbied Congress and federal health agencies for years to limit opioid prescribing, and gives frequent media interviews on opioid-related issues.

In a 2015 C-SPAN interview, Kolodny called opioid painkillers “heroin pills” and suggested pain patients shouldn’t trust their own doctors.  

“I wish I could tell you that you should trust your doctor and talk to your doctor about this, but that may not be the case,” he said. “We have doctors even prescribing to teenagers and parents not recognizing that the doctor has just essentially prescribed the teenager the equivalent of a heroin pill.”

PROP achieved its greatest success in 2016, when the CDC released its controversial opioid prescribing guideline, which several PROP members helped draft. Although voluntary, the guideline was soon adopted as mandatory policy by many states, insurers, law enforcement and health organizations

DR. ANDREW KOLODNY

Opioid prescriptions were declining even before the guideline was released and now stand at their lowest level in over a decade. But overdoses keep rising, fueled largely by illicit fentanyl and other street drugs, not pain medication.

PROP’s fundraising pitch takes credit for the decline in prescriptions and doesn’t even mention the role of street drugs in the overdose epidemic.

“PROP has helped turn the tide of opioid overprescribing.The good news is that opioid prescribing has decreased. The bad news is that the US still leads the world in opioid consumption, drug companies continue to undermine progress, and -- since the SARS CoV-2 pandemic -- opioid overdose deaths are on the rise again while prescription opioid use remains a route to opioid addiction and death,” the PROP email states.

‘Killer Kolodny’

Kolodny has drawn the ire of many pain patients, who blame him for their increased suffering, loss of access to opioids, and anecdotal evidence of a rising number of suicides in the pain community.  A small group of patient advocates recently staged a “Killer Kolodny Rally” outside Brandeis University, where he co-directs opioid research at the Heller School for Policy and Management.   

Kolodny dismissed the rally, telling the Brandeis student newspaper that the protestors who want him fired worked for the opioid industry or had fallen under its sway, and were “trying to controversialize science.”      

“There were climate change scientists who were similarly attacked and their universities stood by them, and I think that Brandeis would stand by science,” Kolodny said. 

Many pain patients believe Kolodny has enriched himself by promoting the use of Suboxone, an addiction treatment drug. That unproven allegation led Kolodny to ask for and receive a letter from Indivior, Suboxone’s manufacturer, stating that he does not have a financial interest in the company.    

As PNN has reported, Kolodny has made a substantial amount of money working as a consultant and expert witness for law firms involved in opioid litigation. During Oklahoma’s lawsuit against Johnson & Johnson, Kolodny testified that he was being paid $725 an hour and would collect up to $500,000 for his services in that trial alone.  

Kolodny has not always been upfront about who is paying him. Last year he revised his conflict of interest statements on two medical journal articles to include his work in malpractice lawsuits. The articles were co-authored with former CDC director Thomas Frieden.

Doctor Who Lost Medical License Leading Effort to Sue Kolodny

By Pat Anson, PNN Editor

Pain patients and their supporters are planning to rally Wednesday at Brandeis University in Massachusetts, a protest against Dr. Andrew Kolodny, a senior scientist at Brandeis who co-directs opioid research at the Heller School for Policy and Management.

Kolodny is the founder and Executive Director of Physicians for Responsible Opioid Prescribing (PROP), an influential anti-opioid activist group that has led efforts to reduce opioid prescribing in the U.S. Many patients blame PROP for their poorly treated or untreated pain, as well as increased suicides in the pain community. The so-called “Killer Kolodny Rally” is being organized by Claudia Merandi of the Don’t Punish Pain rally organization.

“If we in the pain community want to make changes, we have a lot of work to do. We have been damaged severely. And Kolodny’s largely responsible,” says Dr. Arnold Feldman, a retired anesthesiologist who is working with Merandi to raise money for a possible class action lawsuit against Kolodny,

As PNN first reported, Kolodny and PROP played influential roles in drafting the CDC’s controversial 2016 opioid prescribing guideline. Kolodny is also a well-paid expert witness in opioid litigation cases.

“Kolodny is enriching himself to a very large degree,” Feldman told PNN. “Every day I am finding weblike connections between Kolodny and pharmaceutical manufacturers.”

Feldman and some patient advocates have claimed — without offering any proof — that Kolodny has benefited financially from promoting addiction treatment drugs like Suboxone.

The allegation led Kolodny to ask for and receive a letter from Indivior, Suboxone’s manufacturer, stating that he does not have a financial interest in the company and has received no payments from it as a consultant, speaker or in any other capacity.    

Nevertheless, Feldman claims that he has evidence of Kolodny’s culpability and will be able to uncover more once a class action lawsuit is filed.  He and Merandi have not been able to find a law firm willing to take the case.

DR. ARNOLD FELDMAN (YOUTUBE IMAGE)

“I’ve got lots of evidence. I’m not going to put it out in public because we’re going to need this in our case,” Feldman said. “Unfortunately, I’m not a stranger to lawyers.”

Medical License Suspended

Feldman has indeed fought and lost a number of legal battles, including an unsuccessful effort to get his medical license back after it was suspended in 2016 by Louisiana’s Board of Medical Examiners. The disciplinary action came after a patient died three years earlier while getting an epidural steroid injection at Feldman’s surgery clinic in Baton Rouge.

Feldman was charged with seven counts of negligence and unprofessional conduct, such as allowing an unlicensed and unsupervised employee to insert an IV into the patient and give him medication. The patient went into cardiac arrest during the procedure and Feldman was unable to revive him. 

“I had a patient who passed away. Not from anything I did. He had a cardiomyopathy and passed away. They tried to get me for that. But they couldn’t because the autopsy said he died from natural causes,” Feldman told PNN.

The state medical board felt otherwise and accused Feldman of a coverup, saying he gave investigators a “quite staggering” amount of false records and testimony about what happened.

“Dr. Feldman failed to adequately monitor the patient, exercised poor management or care of the patient after complications arose, and all of his resuscitation attempts were contributing factors to the patient’s death,” the board said in its ruling.

Feldman’s clinic had previously been cited in 2010, 2011 and 2013 for not following safety standards, putting patients in “immediate jeopardy” of injury and death.

Investigators also said Feldman allowed his employees to forge his signature and sign opioid prescriptions, and that he gave pre-signed prescriptions to patients without seeing them.

Feldman says he was denied due process by the medical board and appealed his suspension twice in court, but it was upheld both times.

“Dr. Feldman failed to adequately monitor the patient, exercised poor management or care of the patient after complications arose, and all of his resuscitation attempts were contributing factors to the patient’s death.”

— Louisiana Board of Medical Examiners

Because of the disciplinary action in Louisiana, Feldman’s medical licenses were also suspended in California, Alabama and Mississippi. Feldman had previously been reprimanded and put on probation by Mississippi’s medical board in 2000 after he “violated numerous laws and regulations” involving the prescribing, dispensing and administration of controlled substances.

In 2017, the Drug Enforcement Administration effectively ended Feldman’s career by revoking his DEA license to prescribe opioids and other controlled substances.   

No longer able to practice medicine, Feldman lost his home, car and clinic, and for a time lived in a motor-home, according to testimony he gave at a legislative hearing. He now lives in Florida. Feldman says he could have his medical license reinstated in Louisiana, but it would cost $460,000 that he doesn’t have.

‘I Know Pain Management Better Than Anyone’

Although he hasn’t practiced medicine in years, Feldman still considers himself an expert in pain management because he “learned skills that nobody else had.”

“I know this business, meaning pain management, better than anyone living. I’m a surgeon. I’ve done disc surgery. I’ve done pain pumps, (spinal cord) stimulators, and 100-thousand nerve blocks. I know what’s going on,” he said. “Most of these pain conditions are incurable, and I’ll tell you what, half of them are created by the medical profession.”

Since his forced retirement, Feldman has become something of a gadfly in the pain and legal communities, joining with another doctor whose medical license was revoked in filing a $28,000 trillion lawsuit against the Federation of State Medical Boards, the American Medical Association and other entities.

Feldman and Merandi have established a non-profit called The Doctor Patient Forum to advocate for doctors in legal jeopardy and pain patients who can’t get proper treatment. “He is brilliant. We work well together,” says Merandi.

The two have raised nearly $12,000 for the lawsuit against Kolodny, with most of the money coming in small donations from pain patients who know little or nothing about Feldman or how the money will be spent. 

“It’s in a bank account. I don’t touch it. I haven’t taken a dime. Nor will I ever. When we have enough money and find a law firm, that’s where the money will go,” he promised. 

“The only way to bring awareness to this is with litigation,” Merandi said in a recent radio interview. “We believe we have to bring Andrew Kolodny before a court of law. We have to bring the others before a court of law. We need an investigation done and that costs money.”

Legal experts say attorneys in class action lawsuits are typically not paid for their services and expenses unless they prevail in court. All payments have to be approved by a judge, with the money coming from the award or settlement — not the plaintiffs. Legitimate attorneys will not ask for upfront money in a class action case, according to consumer advocate Ron Burley.

Patient Advocates Call on Brandeis to Fire Kolodny

By Pat Anson, Editor

A coalition of physicians, patient advocates and pain sufferers has written an open letter to Brandeis University asking for the dismissal of Andrew Kolodny, MD, a longtime critic of opioid prescribing who is co-director of opioid policy research at the university’s Heller School for Social Policy and Management.

Kolodny is the founder and Executive Director of Physicians for Responsible Opioid Prescribing (PROP), an anti-opioid activist group that has lobbied politicians and regulators for years to enact stronger measures to limit prescribing of opioid pain medication.

“Dr. Kolodny has been prominent in a national campaign to deny chronic pain patients even minimal management of their pain.  His actions are directed toward forcing draconian restrictions or outright withdrawal of this class of medications from medical practice,” reads the letter to Brandeis President Ronald Liebowitz and other top administrators at the university.

“He calls for forced tapering of patients formerly prescribed opioids. Policy positions for which he advocates are leading to the deaths of hundreds of chronic pain patients by suicide or pain-related heart failure and medical collapse.”

The letter was drafted by Richard Lawhern, PhD, and signed by over 60 healthcare professionals and patient advocates, including pain management specialists Forest Tennant, MD, and Aimee Chagnon, MD. Lawhern is the corresponding secretary of the “Opioid Policy Correspondents List,” an ad hoc volunteer group that advocates for better pain care. The group receives no funding from outside sources.

To read the letter in its entirety, click here.

Kolodny is a controversial figure in the pain community and is often quoted in the news media as an expert on issues involving pain management, even though his professional background is in psychiatry and addiction treatment.  He often refers to opioid medication as “heroin pills” and has suggested that patients shouldn’t trust doctors who prescribe opioids.

“I wish I could tell you that you should trust your doctor and talk to your doctor about this, but that may not be the case,” Kolodny said on C-SPAN in 2015. “We have doctors even prescribing to teenagers and parents not recognizing that the doctor has just essentially prescribed the teenager the equivalent of a heroin pill.”

“Although Dr. Kolodny has a work history in public health and addiction psychiatry, he is neither qualified nor Board Certified in pain management -- a closely related field that has been profoundly and negatively impacted by his assertions concerning public policy. From his published articles and interviews, it is clear to many readers that he knows or cares little about chronic pain patients and their treatment,” Lawhern’s letter states.

In a series of Tweets earlier this year, Kolodny said patients on “dangerously high doses” of opioids should be tapered to lower doses even if they refuse. He then asked for specific examples of doctors “forcing tapers in a risky fashion.”

Dozens of people responded with examples of patients becoming seriously ill or committing suicide after forced tapering, which Kolodny ignored.   

The letter to Brandeis calls Kolodny "one of the most polarizing and hated figures in medicine" among people in pain.

“In our view and those of many people whom he has harmed, Dr. Kolodny makes no positive contribution to the work or reputation of Brandeis or its research centers.  To the contrary, we believe it is ethically and morally imperative that he be dismissed immediately from the University, before his presence further damages both your reputation and your financial endowments,” the letter states.

The university did not respond to a request for comment on the letter. Neither did Kolodny.

Brandeis is a well-regarded liberal arts and private research university located near Boston. The Heller School for Social Policy and Management is often ranked as one of the top ten schools in social policy.  Kolodny joined Heller last year as a senior scientist after resigning as chief medical officer at Phoenix House, which runs a chain of addiction treatment centers.

Kolodny and PROP played central roles in developing the 2016 CDC opioid guidelines, which discourage primary care physicians from prescribing opioids for chronic pain. Although voluntary and only intended for primary care doctors, the guidelines have been widely adopted as mandatory by insurers, federal agencies and throughout the U.S. healthcare system.

In an online survey of over 3,100 pain patients and healthcare providers on the first anniversary of the guidelines’ release, most said the guidelines were harmful to patients, had not improved the quality of pain care, and failed to reduce opioid abuse and overdoses. Critics also cite anecdotal evidence that the guidelines have contributed to an increase in patient suicides.