The Role that Gender Plays in Pain Perception, Treatment, and Addiction

Faculty

Mark S. Gold, MD
Adjunct Professor of Psychiatry, Washington University School of Medicine, St. Louis, MO
ASAM's Annual Lifetime Achievement John P. McGovern Award & Prize Winner
17th University of Florida Distinguished Alumni Professor, Gainesville, FL
Mark S. Gold, MD

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.

Statement of Need

Studies have shown that gender plays an important role in pain, pain perception, and opioid use. Women are more likely to gain access to opioids through their medical treatment. Not only are women prescribed opioids more often than men (53% vs. 46%), but this number increases with age. Often there is a lack of attention to underlying causes of opioid use disorder (OUD), particularly past sexual or emotional trauma, which can put women at a significantly higher risk for addiction and relapse. Gender-responsive treatment programs, such as the one led by Dr. Ovson at Lakeview Health in Jacksonville, FL, help women address their substance use in an environment that removes stigma and bias.

It’s important to identify gender-specific needs when addressing pain management and OUD, with open discussion being the key to their resolution. “We rarely think about what the person brings to the drug challenge. When it comes to someone who has experienced sexual trauma, a single dose of an opioid might be enough to make continued use more likely and addiction inevitable; a couple of doses, and they feel such relief and lack of tension that they think they’ve found the lock and key to their mental well-being and are more likely to rely on opioids to treat their psychological, rather than physical, trauma. Therefore, screening for prior substance use and trauma prior to prescribing opioids is essential,” stated ASAM McGovern Lifetime Achievement Award winner, Dr. Mark Gold, in this CME Outfitters Snack on how gender effects a patient’s proclivity to substance abuse disorders and engagement in treatment, as well as the emotional components that are often underlying causes of addiction.

Learning Objectives

At the end of this CME/CE activity, participants should be able to identify gender-specific treatment needs when addressing substance use disorders.

Financial Support

Supported by an educational grant from Johnson & Johnson.

Target Audience

Physicians, physician assistants, nurse practitioners, nurses, and pharmacists.

Credit Information

Physicians (ACCME) 1.0

CME Outfitters, LLC, designates this enduring material for a maximum of 1.0 AMA PRA Category 1 Credit™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Disclosure Declaration

It is the policy of CME Outfitters, LLC, to ensure independence, balance, objectivity, and scientific rigor and integrity in all of their CE activities. Faculty must disclose to the participants any relationships with commercial companies whose products or devices may be mentioned in faculty presentations, or with the commercial supporter of this CE activity. CME Outfitters, LLC, has evaluated, identified, and mitigated any potential conflicts of interest through a rigorous content validation procedure, use of evidence-based data/research, and a multidisciplinary peer review process.


Dr. Gold has no disclosures to report.


Dr. Ovson has no disclosures to report.


Disclosures were obtained from the CME Outfitters, LLC staff: No disclosures to report.

  • Mae Ochoa, RPh (peer reviewer) has no disclosures to report.
  • Jan Perez (planning committee) has no disclosures to report.
  • Sharon Tordoff (planning committee) has no disclosures to report.

Faculty of this CE activity may include discussions of products or devices that are not currently labeled for use by the FDA. The faculty have been informed of their responsibility to disclose to the audience if they will be discussing off-label or investigational uses (any uses not approved by the FDA) of products or devices.

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The Role that Gender Plays in Pain Perception, Treatment, and Addiction
Event Date: 03/01/2019