Massachusetts Drug Court Schooled By Expert Kolodny ... Or Is He?

Would someone kindly tell me who decided that prescribing medications need not be limited to, say, people who know how to prescribe medications, for example, physicians who prescribe medications?

That's mostly rhetorical because we all know that both the CDC and Physicians for Responsible Opioid Prescribing (PROP) and the not-entirely-beneficient DEA somehow managed to insert themselves into the process beginning in the 2010s. While it is indisputable that the DEA and CDC have no business whatsoever even looking at a "prescription pad," let alone writing on one, one could at least make the argument that Dr. Andrew Kolodny, the face of PROP, should be at the very least qualified to be consulted. After all, Kolodny, a psychiatrist, is the go-to source for media any time opioids are mentioned. Why is this? Is he the only expert on earth? Is he an expert at all?

More on this later.

While I remain unaware of medical advice being dispensed at the paint department at Home Depot, what was going on in one of the Massachusetts drug courts was arguably worse. According to Mark Herz, writing for GBH News, Boston's NPR affiliate, the court was ordering drug defendants to take one (of three) FDA-approved drugs (methadone, buprenorphine, and naltrexone) to treat addiction. The idea of mandatory treatment in lieu of prison for people with "opioid use disorder" (or whatever it's being called at the moment) is certainly sound. Addicts who have not harmed anyone other than themselves should not be thrown in jail. They should be treated. But not by judges.

Ken Paiva, of the Fall River Report, wrote:

"[A]s a condition of participating in drug court, participants were ordered or pressured to stop taking their lawfully prescribed [addiction medications], without an individualized assessment by a medical professional. In addition, drug court personnel – with no medical training – required or pressured drug court participants to specifically and exclusively take Vivitrol as a condition of participation in drug court, without regard to whether a health professional recommended that specific treatment option over others". [Emphasis mine]

The problems here are obvious. Having judges decide that defendants must take an addiction medication makes about as much sense as your kid's pediatrician arguing corporate tax law in front of the Supreme Court. 

Fortunately, Massachusetts U.S. Attorney Rachael Rollins got wind of what was going on and wasn't having any of that. Arguing that the court's practices violated the Americans With Disabilities Act, Rollins reached an agreement with the court, which included the following:

"No court shall have a policy or practice of requiring that a party be prescribed any one form of medication over another." 

Not surprisingly, Kolodny was consulted for the article:

”Even though, of course, they were not licensed or they had not gone to medical school, but they were prescribing treatment...And maybe that would have been less of a concern if they were prescribing the right treatment, but they weren't.” [Kolodny's choice was buprenorphine]

Dr. Andrew Kolodny, GBH News, March 25, 2022

Kolodny is certainly correct in his assertion that judges shouldn't be prescribing medications, but what about his choice of buprenorphine? Is this medical gospel or just his opinion? 

The press has unequivocally accepted Kolodny as the world's foremost expert on matters of opioid prescribing. With the exception of a small group of pain patient advocates, Kolodny's statements are taken as fact. But should he get a free pass? Is Kolodny really an expert in prescribing medications? I would like him to answer four questions:

• Where do you hold a license to practice medicine? 
• When was the last time you treated a patient?
• Have you ever treated a patient for pain? If so, what was the treatment?
• When was the last time you wrote a prescription of any kind?

I hope that Dr. Kolodny answers my questions. After all, any practicing physician would be able to respond in five seconds:

• Yes
• Today (maybe yesterday)
• Yes, whatever treatment/drug was appropriate for that particular patient. 
• An hour ago 

Can Kolodny make even these very basic claims about his clinical experience? Because if not, I would love someone to explain why he is the de facto spokesperson for almost any comment relating to all opioid and addiction questions.

So, Dr. Kolodny, I look forward to reading your answers in the comments section. I would normally suggest Twitter, except you blocked me long ago.