PHOTO: Dr. Michael Genovese, Acadia Healthcare’s CMO, inside the company’s headquarters at Franklin Park in Cool Springs on July 18, 2018./Brooke Wanser
By BROOKE WANSER
From a glass-paneled office on the ninth floor of their Cool Springs office, Acadia Healthcare CMO Dr. Michael Genovese explained the facets behind the nationwide opioid crisis.
“Franklin’s a really nice area,” he said, “not the kind of area you would think” to be home to addicts. “You wouldn’t think that anyone’s using here. The breadth of people affected by this is shocking to people.”
Genovese, a former medical malpractice lawyer and psychiatrist, has seen the effects of addiction firsthand: he has a brother in long-term recovery.
After serving as the chief medical officer for rehabilitation center Sierra Tucson, Genovese took on the same role for Acadia last December after the center was acquired by the company.
Opioid crisis in Tennessee
Genovese, who is from New York and lives in Northern California, travels to Acadia’s Franklin headquarters at least once each month.
Here, he hears from doctors that the epidemic has not discriminated against Williamson County.
“There are places that are better, there are places that are worse, in terms of how bad they’ve been affected,” he said. “Certain states, like New Hampshire and West Virginia, have been crippled by it.”
Tennessee, he said, seems like it has been hit like the rest of the country.
“In speaking with a lot of doctors who are outside the scope of addiction medicine, there is still, even within the medical community, some reluctance to accept the notion that addiction really is a disease,” he said. “They still think of it as a moral failing where you can just stop.”
Science of addiction
As a disease, addiction affects people based on their genetic predisposition and traumatic experiences. Veterans and law enforcement officers have a higher likelihood of becoming addicted, he added.
In functional magnetic resonance imaging (fMRI), activity differences can be detected between the brains of addicts and non-addicts.
The pathway to addiction often occurs through prescription opioids after an injury. Getting more medication prescribed often dead ends when doctors stop prescribing.
When purchasing pills on the street becomes too expensive, addicts often turn to heroin or other cheaper, more addictive substances.
“These people are sick,” Genovese said simply. “No one chooses to live this way.”
Each day, more than 115 people in the nation die of an opioid overdose. “That’s why people are calling it a crisis,” he said. “When people say, ‘oh, it’s overblown, it’s not really a crisis,’ it is.”
Origins of crisis
In the ’90s, Genovese said doctors were told they were under-treating pain, and that the fifth vital sign is questioning a patient about pain.
Purdue also made commercials and published material saying the drug was not addictive.
“It became apparent that Purdue Pharma had not only been sort of cagey about it, they were fraudulent about it,” he said, noting the $634 million fine the company incurred in a 2007 legal battle.
“But now you had all these people on prescription medication, and you can’t just take them off of their medication, because they’re dependent on it,” Genovese added.
For doctors, the strain of seeing too many patients and wanting everyone to “get better” can lead to overprescription.
“The system hasn’t really been set up in a way that lends itself to screening for addiction,” he admitted.
Tennessee and current Purdue Pharma lawsuit
Tennessee Attorney General Herbert H. Slatery III announced in May the state’s lawsuit against Purdue for “unlawful marketing and promotion of OxyContin and other drugs and its role in causing and prolonging the opioid epidemic in Tennessee,” thus violating the state’s consumer protection act.
In that statement, Slatery said, “Our office has conducted an extensive investigation into Purdue’s highly aggressive marketing practices and other unlawful conduct. We believe Purdue’s conduct has been unconscionable, and we intend to hold the company accountable. Three Tennesseans are dying each day from opioid-related overdoses, and we are committed to the hard work that needs to be done to address this tragedy.”
Likewise, Williamson County commissioners voted earlier this year to join a mass tort lawsuit against pharmaceutical companies and distributors AmerisourceBergen, Cardinal Health and McKesson Corporation, which also churn out opioid medications.
In his career as a lawyer, Genovese said he would have taken such a case.
“They knew or should have known what they were marketing was false,” he said. “Should other people have known? Maybe. But when you’re being told directly that we’ve studied it, and this is not risky, you should bear some liability for that.”
Will the lawsuits solve anything?
“Maybe if they use the money to put towards treatment,” Genovese said, and education.
Treatment options for addiction
Genovese suggested the crisis of addiction speaks to a larger cultural issue.
“What are we trying to treat?” he asked. Painkillers, he said, not only numb physical pain, but also emotional pain.
In treatment, though, “There is no cookie cutter approach to treating addiction,” Genovese said. “Addiction doesn’t happen in a vacuum, there are many paths to get to this one place where everyone looks the same.”
Just like there are many paths to opiate addiction, there are many spots to target for treatment.
Genovese likes the holistic approach, which may include behavioral therapy, support groups, treatment of depression or anxiety, and physical symptoms of opioid withdrawal.
Methadone, Naltrexone, and Suboxone are the most commonly used drug treatments given to treat withdrawal, all with different pros and cons.
His brother tells him, “‘Mike we don’t all get high the same way, we’re not all going to get sober the same way,’” Genovese said.