Dr. Jonathan Avery was in the right place at a bad time. Avery, now in his late 30s, began his medical education as the opioid epidemic was surging. “I broke my foot in med school, and I got 180 Percocet,” he said, citing a classic example of the kind of over-prescribing that helped drive the catastrophe that has killed hundreds of thousands of Americans in the last 20 years.
Motivated by the unfolding public health disaster, Avery decided to become an addiction psychiatrist. His choice of specialty was questioned by some who thought he was wasting his medical education.
“Part of that was this old narrative that addiction is not a part of medicine proper, that it's handled in the support groups or elsewhere,” he said. “And part of it was the idea, you know, that these are folks that don't get better."
But Avery didn’t see it that way. “It was silly from the beginning that we separated out addiction from the rest of medicine,” he said. “Now more than ever, as doctors, we need to step up and treat this as any chronic disease. The reason I was encouraged as a young student is, I saw the most change with these folks versus others. I saw people get better.”
As the director of addiction psychiatry and associate professor of clinical psychiatry at Weill Cornell Medicine and New York Presbyterian, Avery is on the front lines of the opioid crisis, treating his patients with medications like Suboxone and methadone, as well as with private and group therapy sessions. When possible, he includes his patients’ families in his treatment plans.
He also has a robust outreach program that includes in-hospital sessions as well as visits to schools, bars and clubs, homeless shelters and community groups to raise awareness about addiction. There is, for example, a monthly event in the pediatric clinic where parents and kids can learn about substance use.
Underscoring the lethality of opioids, including the fentanyl that has been coming into the U.S. from China and Mexico, Avery’s presentations include information about the use of Narcan for the emergency treatment of overdose victims. As part of his efforts, he provides free Narcan kits for those who want them.
As Avery points out, the striking thing about the opiate epidemic, here and elsewhere around the country, is that no one is immune to it. “It spans the socio-economic spectrum, it spans race, gender, age,” he said. “There are areas in the South Bronx and Harlem and Staten Island that have received more publicity, and where the overdoses are more well documented. But we see quite a few people on the Upper East Side struggling with opioid misuse.”
One of the insidious things about opioid addiction, Avery said, especially when the drugs are prescribed by a physician, is that it tends to sneak up on a person. And healthcare providers can exacerbate the situation, he adds, because “people feel fearful to present because we haven’t provided good treatment options, or we haven’t been the friendly face of the medical community.”
In addition to working with his patients, Avery researches and writes about the stigma that people struggling with addiction experience in the healthcare system .
“My research has been on characterizing the attitudes of the medical community towards patients with substance use disorders,” he explained. “And it's clear that attitudes are worse towards patients with these disorders than towards any other medical or psychiatric condition.”
It’s a common enough tendency, Avery acknowledges. “Doctors aren't different than anyone,” he said. We're prone to the same societal biases, and we tend to be finger waggers.” To counter that, he holds educational events about stigma with doctors where they meet and hear from people who are in recovery. “We're just trying to help them get a narrative that's more hopeful, that's more rounded, and make sure they have the necessary knowledge and skills.”
It’s simply impossible, Avery said, for a doctor today to avoid addiction in their practice. “You can’t be any kind of a doctor without encountering substance use on a daily basis. And so if you're going to ignore it, you're going to do your patients a disservice.”
“You can’t be any kind of a doctor without encountering substance use on a daily basis."