Dr. David L. Brown, is the founder of Curadux, and leads experienced physician Care Guides in providing 24/7 decision support and advocacy for clients (individuals and employer-referred) and their families facing chronic or advanced illness, including opioid misuse.

Prior to founding Curadux, Brown practiced medicine for 38 years and chaired the departments of anesthesiology and pain medicine at the Cleveland Clinic, University of Texas – MD Anderson Cancer Center, the University of Iowa Hospital and Clinics, and the Virginia Mason Medical Center, as well as serving as professor of anesthesiology at the Mayo Clinic.

Healthcare Business News: There’s been a lot of press and policy discussions devoted to the opioid crisis recently. Can you explain the context of the crisis?
Dr. David L. Brown: First let me say that the press and the policy discussions are warranted. The Department of Health and Human Services found that more people died from drug overdoses in 2014, the most recent year recorded, than ever before, and opioids factored into more than 60 percent of those deaths. There is also significant disruption to the social fabric including the destruction of families and highly negative impact on businesses and the economy. The scope of the epidemic is truly alarming, but it’s so troubling also because of its context: it’s partly an unintended effect of my own medical specialty, pain medicine.

HCB News: What do you mean?

DB: At least half of opioid overdose deaths involve a prescription opioid.

HCB News: Can you say a bit about how we got here?

DB: That’s a good idea—let me back up a bit. In the 1980s and 1990s, physicians started to approach pain as an important aspect of a patient’s experience and condition. Some referred to it as the “fifth vital sign.” This new stature led to technological and pharmaceutical advancements in pain medicine. One of these presumed advancements was the development of new opioids, often time-release synthetic drugs mimicking the action of older opiates-which derive from opium. All of these substances minimize pain by occupying an individual’s opioid receptors and complicate use by often leading to personality and mood changes.

HCB News: So was the increasing prescription of opioids to blame for today’s epidemic?

DB: Certainly, more drugs in circulation gave opportunity for the diversion of legally prescribed opioids to the street. The inherent slide from prescribed use to misuse is also to blame. People can become addicted to painkillers either with their own prescription or by buying them illegally. Either way, many people who find themselves addicted to opioids are at some point unable to pay for them.

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