Chief Medical Officer at Baystate Franklin: Should we prescribe opioids to addicts?

  • Baystate Franklin Medical Center Emergency Room entrance. Recorder Staff/Paul Franz

Recorder Staff
Sunday, March 12, 2017

“Jake Leg” is one of those forgotten learning points from American history that may have modern application in a time of opioid addiction.

During the Prohibition, those who were looking for a hard drink sometimes turned to an illicit libation called “Jamaica ginger extra.” The bad booze could cause paralysis of parts of your body, like the leg.

Today, local addiction expert Dr. Thomas Higgins sees a parallel in the current spike in opioid overdose deaths blamed on a powerful synthetic painkiller called fentanyl. Legally, it is used for cancer patients. A form of it is also used as elephant tranquilizer. Illegal fentanyl, sometimes laced with heroin, has dramatically climbed as the leading cause of opioid-related deaths in the state — present in more than 70 percent of opioid deaths in 2016.

In the past few years as doctors have learned that abuse of painkilllers has led to addiction for some people, medical professionals have dialed back the amount of opioids they prescribe.

Consequently, “people are seeking out fentanyl on the street because they cannot get the opioids that they’re used to,” said Higgins, a published researcher on opioids. “So you have to ask yourself, are we re-creating the Jake Leg crisis? — but only worse because people are not just paralyzed, but they’re dying.”

Estimated opioid-related deaths in Massachusetts doubled from 2013 to 2016, climbing to nearly 2,000 in the past year. For years in the 2000s, the death rate was at about 500 per year, but Higgins, the chief medical officer of Baystate Franklin Medical Center in Greenfield, thinks one effort to combat addiction — cutting back on prescription painkillers — may have had the unintended consequence of driving addicts to the black market where the unregulated drugs can be more dangerous.

“Personally, I worry we may have inadvertently made the problem worse by cutting off the supply of legal opioids and driving people to the streets,” Higgins said.

Fentanyl is often presented as typical heroin but can be a hundred times more potent.

While not suggesting that doctors should return to more lax prescribing practices, Higgins has outlined a plan of action to address opioid deaths, specifically those caused by fentanyl use.

“First, we need to stop the pipeline,” Higgins said. “We need to stop people getting into the addiction role.”

Next, he suggests addressing addiction with medication-assisted therapy, like what is provided at suboxone and methadone clinics.

“Methadone is another option for people who are addicted to opioids, not ready yet to go through withdrawal, but can be maintained in a state on methadone where they’re not getting the cravings for opioids,” Higgins said.

He names two issues with methadone clinics: not enough providers and not enough allotment of prescribed medication-assisted therapy as warranted by federal regulations. Furthermore, there is stigma surrounding these clinics.

“If people fully understand what’s going on, there’s no reason to be scared of this,” Higgins said of methadone clinics. “It’s a knee-jerk reaction — I don’t want a methadone clinic in my facility, in my neighborhood.”

The other option he suggests is a system used in parts of Canada and Europe, like in Vancouver, British Columbia. In this case, opioid addicts are allowed access to pharmaceutical-grade drugs rather than using what’s on the street. This technique is known as a maintenance program to help addicts stay out of trouble and curb their substance abuse in a controlled environment using drugs stronger than methadone or suboxone.

“I’m not sure if that’s politically possible in the U.S., but that is an approach that’s been tried and somewhat successfully elsewhere” at reducing deaths from bad drugs, Higgins said.

It’s a difficult situation the medical world has been presented: take away drugs and have people turn to more potent, unregulated drugs or prescribe painkillers as a means of trying to aid the recovery process.

“We don’t want people to use opioids, but we’ve gotten to a point that the risk of dying from unregulated drugs out there is such that maybe having regulated drugs would be a better alternative,” Higgins said.

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Joshua Solomon at:


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