Putting Pressure on Opioid Prescribing: Novel Approaches to Pain Management

Mark S. Gold, MD, is a teacher of the year, translational researcher, author, mentor, and inventor, best known for his work on the brain systems underlying the effects of opiate drugs, cocaine, and food. He has worked as an advisor to many White House Drug Czars, White House NIDA and NIMH directors over his career of 40+ years. He is an author and inventor who has published over 1,000 peer-reviewed scientific articles, texts, and practice guidelines. This pioneering work started with detoxification studies using clonidine and lofexidine as a non-opiate detox followed by oral naltrexone at Yale in the late 70s and continued at the University of Florida (UF). Dr. Gold translated opioid studies using mouse, rat, and non-human primate models before developing his opioid withdrawal hypothesis with his Yale colleagues. He then led the first studies to demonstrate non-opioid treatment efficacy for alpha-2 agonists. He also led rapid detoxification and clonidine to naltrexone studies in the late 70s and early 80s. Dr. Gold, trying to find patients who would take oral naltrexone, began his studies of Impaired Health Professionals and employees in health and safety occupations.

Dr. Gold has received a number of national awards for his research, including the Lifetime Achievement Award of the National Association of Addiction Treatment Professionals, Foundations Fund Prize (APA), PRIDE Lifetime Achievement Award, DEA 30 Years of Service Pin, the McGovern Award for Lifetime Achievement (ASAM-ABAM 2015), National Leadership Award (NAATP), DARE Lifetime Achievement Award, Public Relations Society’s Silver Anvil Award, and China Academy of Sciences and DARE awards for his career in research and prevention (2015). More recently, he received the PATH Foundations Lifetime Achievement Award (2016) as one of the “fathers” of addiction medicine, presented to him by President Obama’s White House Drug Czar Michael Botticelli. Dr. Gold was awarded Distinguished Alumni Awards at Yale University, University of Florida, and Washington University in St. Louis as well as the Wall of Fame at the UF College of Medicine.

Dr. Gold was a Professor, Eminent Scholar, Distinguished Professor, Distinguished Alumni Professor, Chairman, and Emeritus Eminent Scholar during his 25 years at the University of Florida. His work is widely cited by his peers. It includes citation classics in cocaine neurobiology, opioid addiction neurobiology and treatment, and food and process addictions. He proved that cocaine was misclassified as safe, or the champagne of drugs, leading to revision in the DSM 3 and diagnosis of addiction. He has been called a groundbreaking researcher, father of medication-assisted recovery, the first to translate rat experiments into theory and treatments for human addicts, and mentor of the next generation of addiction researchers and clinicians. Working closely with Bart Hoebel at Princeton University, Dr. Gold helped develop the food addiction theory he posited in the 80s. With Nicole Avena, he worked on sugar self-administration models for hedonic overeating and developed new treatments for overeating and obesity. Kelly Brownell and Dr. Gold’s Food and Addiction, published by Oxford University Press, has been widely recognized as groundbreaking. Although working on food and drug-like reinforcement systems has been an important part of his work for 30 years, he has also worked on dual disorders, anorexia and bulimia nervosa. Dr. Gold worked closely with Al Rhoton and Bill Luttge to establish the UF Brain Institute. He was an original member of the McKnight Brain Institute and Director working to develop programs in Psychiatry, Addiction, Neurology, and Neurosurgery.

Since his retirement as a Director of the McKnight Brain Institute, Chairman, Distinguished Professor, and a full-time academic in 2014, Dr. Gold has continued his teaching, mentoring, research, and writing. He finished his 5-year State Department grant on opium smokers and the effects of second- and third-hand opium on children in Afghanistan. He has worked on de novo clinical addiction programs at the Medical College of Georgia, Northwestern, UF, and Tulane Lakeview Health. Dr. Gold regularly lectures at national and international meetings, medical societies, grand rounds around the United States, and international and national scientific meetings on his career, bench-to-bedside science in eating disorders, obesity, and addictions. Recently, he gave a keynote speech at the National Opioid Summit and Florida Opioid Summit as well as for the DEA-DOJ. He speaks regularly at medical schools across the United States, recently at Yale University, Mayo Clinic, Tulane, Washington University in St. Louis, Stanford, University of Connecticut (UConn), UCSF, Emory, Harvard-McLean-Borden Cottage, and UNC. He has given recent keynote addresses at American College of Psychiatrists, CADCA, ASAM, NAATP, APA, and Biological Psychiatry as well as a many states, medical, and psychiatric associations, dealing with the opioid epidemic.

Dr. Gold is an Adjunct Professor in the Department of Psychiatry at Washington University and an active member of the Clinical Council at the Washington University School of Medicine’s Public Health Institute. He has Wash University mentees and works with them regularly. He is the Director of Research for the DEA Educational Association, working closely with DEA and moderating their quarterly educational events broadcast from DEA Headquarters around the world.

Bill Alden has spent his entire distinguished career of nearly 50 years in the field of drug enforcement and abuse prevention, first as a DEA agent on the front lines, where he was the youngest agent ever promoted to front line supervisor, then, as the Chief of DEA’s Office of Congressional and Public Affairs. While heading the Office of Congressional and Public Affairs, he was instrumental in raising public awareness of drug related issues through developing Drug Wars: The Camarena Story, and by appearing in the print and TV media to promote awareness of DEA’s mission. His diverse experience led him to become the Deputy Director of DARE America and later to operate his own consulting firm, The Alden Group, providing law enforcement and drug prevention services to organizations including DARE America, Noblis, Verint Technology Inc., and Lafayette Group.

In 2001, Mr. Alden proposed the concept of a DEA Educational Foundation which came to fruition through his efforts and of which he was first the president and is now the Chairman of the Board. He currently lends his talent and expertise to the Foundation in support of the DEA Museum soliciting sponsors and partnerships to allow the museum to develop state-of-the-art displays and traveling exhibits. One such traveling exhibit, Drugs: Cost & Consequences has been seen by more than 22 million teachers, students and parents in 14 cities across the country. Another exhibit was created to educate Afghans on the dangers of opium use. Thousands of students in Afghanistan have viewed the exhibits as they traveled the countryside.

The Foundation also supports the DEA Youth Dance Program which provides an afterschool dance program to children across the country giving them an alternative to drugs while teaching them to make healthy and smart choices. The DEA YDP is currently in 47 cities across the U.S. The DEA EF developed an Opioid Awareness strategy which focuses its efforts on educating the public on the dangers of Opioid misuse.

As these examples illustrate, Mr. Alden’s dedication to drug awareness and his wide range of experience and skills continues to be an invaluable asset to the Foundation.

Mr. Alden received his B.A. degree from Indiana University in 1966.

Addiction is a personal issue for our founder, Jessica Hulsey Nickel. Both of her parents struggled with heroin addiction, which led to homelessness, foster care, and eventually her mother’s incarceration, after which Jessica was raised by her grandparents.

Jessica began working in prevention at age 15 through an anti-drug coalition in southern California. The next chapters included an appointment by President Bill Clinton to serve on the Drug-Free Communities Commission, serving as a legislative aid in the U.S. House of Representatives, and work to pass and fund the Second Chance Act to help individuals returning home from prison and jail.

In 2015, Jessica founded the Addiction Policy Forum to help families and patients struggling with the disease of addiction. Frustrated by the lack of progress in improving outcomes for those individuals and families struggling, she started the nonprofit with $13,000 from her own savings account and long hours at the dining room table.

Since then, the organization has set out a big mission, grown a team of dedicated and talented staff, and raised funds to deploy need programs and resources.

Steven P. Stanos, DO currently serves as Executive Medical Director of Rehabilitation and Performance Medicine, Swedish Pain Services at the Swedish Health System in Seattle, Washington. Aside from directing pain management services for the hospital system, he also leads Swedish’s pain rehabilitation center, Functional Restoration, an integral part of the pain medicine continuum of care. In addition to his work with Swedish Health System, he is active with committees work at Providence St. Joseph Health related to the system integration of pain management including primary and specialty care. Prior to joining Swedish and Providence, he served as medical director of the Center for Pain Management at the Rehabilitation Institute of Chicago (RIC) Northwestern University Medical School from 2002-2014, and served as an Assistant Professor at Northwestern University Feinberg School of Medicine and program-co chair of the multidisciplinary pain fellowship.

Dr. Stanos is board certified in physical medicine and rehabilitation and pain medicine by the American Board of Pain Medicine and by the American Board of Anesthesia.

Dr. Stanos is a Past President of the American Academy of Pain Medicine and serves on the Board of Directors of the American Board of Pain Medicine. He served as a panel member on the Service Delivery and Reimbursement work group for the National Pain Strategy, an invited consultant to the CDC for the CDC Opioid Guideline for Prescribing Opioids for Chronic Pain, and as a work group member for Healthy People 2020 and Healthy People 2030. He is active with the American Academy of Physical Medicine and Rehabilitation and has served as the co- chair of education for the Pain and Neuromuscular Council.

Dr. Stanos’s work also includes ongoing educational initiatives for primary care, pain medicine, and physical medicine specialists around the United States and abroad. Dr. Stanos has published numerous scientific articles and book chapters related to pain management. He has been involved in the development and publication of treatment guidelines related to rehabilitation approaches for chronic pain and low back pain conditions. He also serves on the editorial board for the journal Pain Medicine and as a reviewer for other pain and rehabilitation journals.

A Mayday Foundation Advocacy fellow in 2013, Dr. Stanos’s advocacy has continued to focus on increasing awareness and access for inter-disciplinary biopsychosocially-based pain care for patients suffering with chronic pain. In 2014, the University of Washington Department of Pain Medicine awarded Dr. Stanos with the John J. Bonica, MD lecture. He has appeared on CNN, National Public Radio, Fox News, regional print, and television news covering various topics related to pain medicine and pain rehabilitation.