ZurMed: Dr. Susan Whitley

Dr. Susan Whitley is an addiction medicine specialist who is based in Brooklyn’s Kings County Hospital and has extensive experience in both family medicine and psychiatry. In this episode, Dr. Susan Whitley shares her expertise in this field.

Host: What exactly does addiction medicine specialty mean?

Dr. Susan Whitley: Well, there are two ways to go into addiction specialty treatment, either through psychiatry or traditional medicine, but to be an addiction medicine specialist you have to have done a year or two of additional training that focuses on the identification and treatment of addictions.

Host: Can you tell us a bit about the opioid epidemic in New York?

Dr. Whitley: We are in the midst of an opioid epidemic that we see due to the startling overdose death rates in New York and the whole country. Data from the department of health recently estimated that a New Yorker is dying of an overdose almost every six hours. That’s more than motor vehicle accidents, homicides, and other leading causes of death combined.

Host: What is the city and specialists like you doing to combat this terrible problem?

Dr. Whitley: Through the Department of Health, the city makes an effort to identify people with opioid use disorders, many times when they come into city hospital emergency rooms. They are not necessarily seeking help for an addiction, but we need to make sure we are asking the right questions, screening for these issues, and asking people direct questions about substance use. When we see they have an issue, we try to attach them o treatment. We are also taking the initiative on overdose prevention where we distribute drugs like naloxone. We had over 260 overdose deaths in Brooklyn alone in 2018 and approximately 80% of all overdose deaths are due to opioids.

Host: What are some of the more common names of the opioids that we might find on the street or even in our medicine cabinets at home?

Dr. Whitley: There are basically two categories of opioids. The first is heroine and morphine-type drugs, they are known as drugs of abuse that are popular on the streets. The second big category are prescription opioids which are initially prescribed to stop pain and become misused. These drugs can include Percocet and Oxycontin.

Host: Can you tell us a bit more about Naloxone?

Dr. Whitley: Naloxone is an opioid reverser that is essentially an antidote to opioid overdose. It’s used in emergency rooms and by EMTs who can save someone with it as soon as they arrive on the scene of an overdose. Friends and families of drug users can also attain it to possibly save someone from overdosing.

Host: How can you get Naloxone?

Dr. Whitley: You can visit a registered opioid overdose prevention program and at local pharmacies. Anyone who asks can get it, even without a prescription. We are making it readily available.

Host: How is Naloxone administered? Is it a pill or a spray or an injection?

Dr. Whitley: Naloxone is available in various forms but the most popular one right now is in the form of a nasal spray. So, it’s like an allergy medication pump that is administered through the nose.

Host: So, what can someone who is using Naloxone to save an overdose victim expect?

Dr. Whitley: Well, the first step is being able to recognize the signs of an overdose. Typically, this includes people looking sleepy, breathing slowly, and will not come to even if you shake them. Once you administer the Naloxone, the overuse will disperse immediately. It’s instantly life-saving but we still encourage people to call 911. Naloxone is not a substitute for professional medical invention, but it is an excellent tool to have in case of emergency.

Host: What are some of the risk factors regarding opioid addiction and overdose?

Dr. Whitley: Risk factors for addiction in general, not only opioids, include genetic components. If you have family members who have drug or alcohol addictions then you are at a higher risk rate. Using multiple drugs is a risk factor for overdoses. Mixing opioids with alcohol, for example, is disastrous. Lower tolerance can also lead to overdoses. So, if a person just came out of rehab or jail and hasn’t used drugs for a while, their tolerance will be lower. Upon going back to their neighborhood and regular lifestyle, if they attempt to use the same dosage of drugs that they used prior to their episode of absence then they are much more likely to overdose.

Host: What are the symptoms of opioid abuse and addictions in general?

Dr. Whitley: If a person is failing to meet their routine social obligations, like not showing up for work or family functions, they might have a problem. Their mood may change, they might not sleep well, and they might contract illnesses like liver disease and HIV.

Host: How are opioids typically ingested?

Dr. Whitley: Well, heroin can be snorted or injected. Pills can be taken orally or crushed up and snorted. Some people even dissolve the pills in water and then inject the water. You do get more impact from the drug if you inject it into your veins so many users consider injection to be the best way to get the most bang for your buck. Not every user injects so you don’t always see track marks and even those who inject it can hide the marks well.

Host: What steps can friends or family members take to help an addicted loved one?

Dr. Whitley: We are making an effort to educate primary care physicians and even pediatricians about ways to identify substance abuse and take heed of which patients are most at risk.

Host: What are questions that health care professionals use to identify addicts?

Dr. Whitley: We ask straightforward questions. It seems simple, almost silly, but it is effective. These screening questions can be the first step towards getting help?

Host: What exactly is detox?

Dr. Whitley: Detox is a method of treatment where people get withdrawn from the medications they are taking. This can be very uncomfortable—most people get very sick if they try to go cold turkey. They get flu-like symptoms such as nausea, vomiting, dehydration, and anxious. With detox you get medical help and get slowly weaves off the drug. It doesn’t need to be done in the hospital most of the time. They can detox at home with medicines.

Host: How do opioid addiction medicines work?

Dr. Whitley: Right now, two are approved by the Food and Drug Administration. One is methadone which has been around since the 1970s. Methadone helps people get clean and it is also a good long-term “maintenance drug” that can help recovering users for years. The other approved drug is called Buprenorphine and it’s been around since 2001. The drug binds in the same part of the brain as the opioid drugs do. It helps to stabilize the brain systems that are craving the harmful drugs. Methadone and Buprenorphine reduce cravings, reduce withdrawal symptoms, and help people focus on other aspects of treatment like therapy. These drugs also help people live more normal lifestyles and hold down jobs.

Host: Will patients have to stay on these drugs for the rest of their lives?

Dr. Whitley: Not in all cases. It depends on the level of addiction and everyone’s treatment requires different recovery times. Aside from the drug treatments, counseling is very important. We have many programs to help victims of use disorders. We have both group and individual sessions available and these focus on things like drug use triggers, identifying changes to be made to one’s lifestyle, and ways to prevent relapse. As health care providers, we look for what is going on in the lives of our patients. Most opioid addicts have complex things going on. For instance, conditions like depression and anxiety fuel a lot of drug use. In many cases, drug use can be seen as a symptom of an underlining mental disorder.

Host: How can someone begin the process toward entering a drug treatment facility?

Dr. Whitley: Having a conversation with your primary care physician is a good way to start. Many primary care physicians can even offer certain treatments. You could also visit the Kings County Hospital website to find information about drug treatments. We also accept people on a walk-in basis without appointments. Our doors are always open.