Two doctors weigh in on Matthew Perry's death, the American addiction crisis, and the role physicians and Big Pharma play

Two very different perspectives, both worth a read

I’ve said it before, I’ll say it again: one great pleasure of writing Unreported Truths is hearing from you.

The media pretends you are a bunch of wannabe Nazis (who I guess didn’t notice I’m Jewish). In fact, you are pilots and soldiers, lawyers and doctors, nurses and engineers.

You had a lot to say about yesterday’s piece about Matthew Perry, the actor, who struggled with addiction his entire adult life and died in 2023 of a ketamine overdose. But I wanted to highlight two thoughtful notes from physicians.

As you will see, they come at the problem of medicine and addiction from different places. One is a primary care physician struggling with troubled patients, the other a pain specialist who sees a place for long-term opioid use. It’s fair to say the first believes the system is broken. The second sees the problem as more limited, a relative handful of bad doctors abusing (or ignoring the addictions of) troubled patients.

I suppose I lean toward the first view, but then again I have never been a doctor faced with patients in intractable pain. In any case, enjoy the discussion.

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(Pay for me, get the readers for free!)

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The first note was posted as a comment on the Perry piece. I’ve reproduced it in full.

35 years of experience here as a general internist - primary care provider.

First of all -

When I was in training and then the first 10 years or so of my career, we were trained to give opiates to patients in only 3 situations -

1) Dying patients - especially those with cancer

2) Immediate care post trauma - like car accidents

3) Immediate care post surgical - for surgical pain. That would also include a few doses of opiates for those in the ER in agony from appendicitis or whatever who would soon be going to the ER.

That was it - THE END. And I mean The End.

And then along came the late 1990s. If a patient even said they hurt just a little bit - we were encouraged to dose them up with opiates to the max. Not just encouraged - pain became the 5th vital sign - and if you did not treat it you could face sanctions, etc.

At the same time, the benzo overprescribing became a national epidemic. It had been a bit of a problem with housewives in the 70s - but in the late 90s - it just exploded. The main impetus for this seemed to me to be the introduction of drugs like Ambien. Big Pharma was all over the airwaves extolling the virtues of meds like OxyContin and Ambien and Lunesta.

So now fast forward 25 years - and I am dealing with all kinds of patients who are on all kinds of meds - given to them by specialists just wanting to get them out of the office. When they invariably get hooked - “Oh, go see your PCP - they will take care of you.” I am absolutely swamped by patients addicted to all manner of these agents - often 2-4 at a time. Almost always on all kinds of other meds - like SSRIs, Abilify, seizure meds like Lamictal, etc. I am horribly equipped in my office ( and I would dare say most PCPs across the country are the same) and I was NEVER EVER trained as a general internist to deal with this problem at this magnitude.

There is literally no help from psychiatry - and sending them to pain management physicians for the most part is like sending them to Dr. Feelgood. I feel trapped and out of my league constantly all day - there is simply no way to begin to deal with this - and the PCPs of America literally have no help at all.

It is a national tragedy and a national disgrace. I have personally witnessed countless lives and families being trashed before my eyes. It burns me up to see doctors like you describe here making profit on this tragedy.

Retirement cannot come soon enough for me.

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(Yesterday’s article, if you missed it.)

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The second note was emailed directly to me.

I’m an anesthesiologist/pain management specialist. I appreciate what you do despite not always agreeing with your position. There is an entire field of medicine dedicated to multimodal pain management which involves prescribing chronic opiates for patients that fail literally everything else and are good candidates. I’m also the one that would have given you the injection for your sciatica.

Anyway, I would have pointed out that neither of these doctors [NOTE: Drs. Salvador Plasencia and Mark Chavez, the physicians charged in the Perry case] were trained with any formal fellowship in prescribing and managing long term controlled substances. One guy was a primary care doctor and one was an ER doctor.

These two knuckleheads were probably “addiction medicine specialists”, but in my eyes, they just succumbed to oldest of traps: greed. Sanchez ran a cash wellness clinic, and Plasencia did med/peds [pediatrics]. Neither mention any addiction medicine fellowships. Everyone that wears a white coat and pays for your Substack is a not a greedy, money-hungry drug pusher.

I run a tight ship, could make way more money doing what these guys did and charge cash, but I don’t because of an old school character trait called integrity and trying to actually improve people’s quality of life. 

Keep up the good work. Take care. 

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