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Pain management doctor or pusher?

Dr. Joseph Zolot is on trial in federal court charged with causing the deaths of six of his patients through the “irresponsible” prescription of powerful pain killers. The trial is raising interesting questions that challenge the fields of pain management and drug addiction. While there are many people with chronic, sometimes debilitating pain, there are many others that use the subjectivity of their experience to present with exaggerated symptoms and feed a drug addiction.

Dr. Zolot practiced in Needham from 2003 to 2007 and is described by one pain management colleague as compassionate and following accepted protocols for treating chronic pain. Prosecution witnesses, however note that he consistently missed key indicators of drug addiction in his patients, including ignoring their disclosures to him that they were in fact addicted and abusing prescribed and other drugs. Zolot and his former nurse practitioner, Lisa Pliner, are charged with conspiracy and drug trafficking in a case that began in the courts in June of this year.

Most doctors and health care professionals are in fact not trained in assessing and treating substance use and addictive disorders. Addiction may hide itself in many ways and learning how to assess someone’s behavior for addiction issues is a highly specialized set of techniques that most health care professionals never learn. This lack of training is often complicated by the nature of pain management which at times calls for the use of highly addictive medications.

The drugs used by Zolot include methadone, fentanyl and oxycodone, all heavy duty pain killers but all with highly addictive properties and very high value on the street. Other similar drugs that are at risk for abuse are Vicodin and Percocet.

In addition to medications, there are other means to manage chronic pain. Physical therapy, stretching exercises, yoga, meditation and acupuncture have all proven useful in the management of long-term pain.

It is unclear how many of these alternatives Dr. Zolots utilized in his pain management practice or if, in fact, he was simply providing addictive drugs to many who were addicted when they got to him or became addicted through his treatment.

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