Ask The Expert: Dr. Stacy Seikel And Opioid Addiction

Dr. Mark Gold and Dr. Stacy Seikel discuss opioid addiction

Experts have concluded that the opioid crisis started with physicians overprescribing opioid pain medication.

Q – You are one of the few double board certified, pain evaluation and treatment experts, and addiction evaluation and treatment expert. How do you decide who should be given opioids for chronic pain? What are your advantages in patient evaluation and treatment as a clinical expert in having such training?
A – The first thing when you are evaluating a patient who has pain, or pain and addiction, is that all pain is real. The patients who have chronic or intermittent pain have an underlying fear of suffering. They may appear controlling or resistant to treatment, but actually it is this “fear of suffering” that is driving most of their behavior.

Q – If the person in recovery needs opioids for chronic pain or acute pain how do you manage that and prevent abuse and/or addiction?
A – If the person in recovery needs opioids for acute pain, such as due to an injury or surgery, we develop a “Pain Management Relapse Prevention Agreement”. I have the patient, family, surgeon, sponsor, caregivers and anesthesiologist involved in that plan.

Q – You have written about how to get off Suboxone. Why is it so hard to get off Suboxone and how do you get off Suboxone?
A – First of all, the goal of patients on Suboxone is not to get off Suboxone. The goal is to get into recovery. The Suboxone and other buprenorphine formulations is one tool, among many, to help patients have a meaningful self-directed life, and not a drug directed life.

Q – You have run methadone programs, how do you get off methadone?
A – I taper methadone the same way I taper buprenorphine, that is slowly and with the patient able to stop the taper at any time. I would typically start a methadone taper in a motivated patient at about 10% per month if tolerated. Maybe less. As you can see it can take over a year to successfully taper someone.

Q – How do you detox and get on naltrexone or Vivitrol. How do you get off naltrexone?
A – In order to start a patient on Vivitrol, the patient needs to have the opiates out of their system and not have any withdrawal symptoms. Typically a patient must be off short-acting opiates for one week or long-acting opiates for 10 to 14 days. There are rapid induction techniques for Vivitrol, but I do not use those in an outpatient setting.

Q – Do you have any advice on how to use Narcan in a suspected opioid overdose?
A – Georgia has made naloxone for overdose reversal available in pharmacies without a doctor’s prescription. With one person dying of overdose every 15 minutes, I believe every citizen needs to be trained in overdose reversal and carry Narcan.

Q – What makes fentanyl so deadly? How do you reverse the fentanyl overdose? Does the overdose reverse successfully?
A – Fentanyl is a very potent opioid and it is very easy to take too much. Most of my patients do not realize that the heroin that they have been using has fentanyl in it. So as you can see, a person may not even know they are taking fentanyl. They may think they are taking heroin and take too much and overdose.

Q – MAT programs often have too little in the way of behavioral health and psychiatric treatment. You do the opposite, please describe.
A – I provide MAT within a treatment program in an outpatient setting. We provide intensive outpatient (three hours per day) or PHP (six hours per day) of counseling and group therapy. In addition we provide a psychiatric evaluation, weekly physician visits, med management, individual therapy and a very robust family program.

Q – Describe your program. Who benefits from this program?
A – Atlanta Addiction Recovery Center, AARC, our Christian program, combines our scientific evidence-based treatment with Christian principles. Biblical teachings are embedded in all aspects of our programming. Though we welcome patients from all faiths, Christian teachings are utilized.

Q – Do you see an upswing in cannabis addiction?
A – I have seen an increase in cannabis addiction. Typically we see young adults who have not been able to move through “adulting” because their cannabis use got in the way of their school, their relationships, their work and their ability to mature.

Source: Email from Mark Gold, MD <>  February 2018

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