THE LATE DR. WALTER F. WRENN, MD: OPIATE ADDICTION THE PATHOPHYSIOLOGY OF A CHRONIC DISEASE (A DEEP DIVE UPDATE)

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NORMAN J CLEMENT RPH., DDS, NORMAN L. CLEMENT PHARM-TECH, MALACHI F. MACKANDAL PHARMD, BELINDA BROWN-PARKER, IN THE SPIRIT OF JOSEPH SOLVO ESQ., IN .THE. SPIRIT OF REV. IN THE SPIRIT OF WALTER R. CLEMENT BS., MS, MBA. HARVEY JENKINS, MD, PH.D., IN THE SPIRIT OF C.T. VIVIAN, JELANI ZIMBABWE CLEMENT, BS., MBA., IN THE SPIRIT OF THE HON. PATRICE LUMUMBA, IN THE SPIRIT OF ERLIN CLEMENT SR., IN THE SPIRIT OF WALTER F. WRENN III., MD., JULIE KILLINGWORTH, LESLY POMPY MD., CHRISTOPHER RUSSO, MD., DR. TERENCE SASAKI, MD, NANCY SEEFELDT, WILLIE GUINYARD BS., JOSEPH WEBSTER MD., MBA, BEVERLY C. PRINCE MD., FACS., NEIL ARNAND, MD., RICHARD KAUL, MD., LEROY BAYLOR, JAY K. JOSHI MD., MBA, ADRIENNE EDMUNDSON, ESTER HYATT PH.D., WALTER L. SMITH BS., IN THE SPIRIT OF BRAHM FISHER ESQ., MICHELE ALEXANDER MD., CUDJOE WILDING BS, MARTIN NJOKU, BS., RPH., IN THE SPIRIT OF DEBRA LYNN SHEPHERD, BERES E. MUSCHETT, STRATEGIC ADVISORS

DR. WALETR F. Wrenn, MD on Opiate Addiction: Pathophysiology and Treatment Strategies

Dr. Walter F. Wrenn argued that opiate addiction should be recognized as a chronic disease rather than a moral failing, emphasizing that the “War on Drugs” has been ineffective and new strategies are urgently needed.

He advocated for a shift in focus from blaming individuals or entities to reducing overdose deaths through practical, medically-driven interventions.

Key to his approach are two parallel treatment options: Medication-Assisted Treatment (MAT) using medications like Suboxone, and a mitigated technique that involves providing regulated opiates to those addicted, alongside safe injection sites and fentanyl testing.

Dr. Wrenn also directly appealed to Pennsylvania Governor Josh Shapiro to vacate sentences for healthcare providers, including himself, who were wrongly prosecuted for prescribing controlled medications, asserting their innocence in light of a 2022 Supreme Court ruling in Ruan, Khan vs United States.

OPIATE ADDICTION The Pathophysiology Of A Chronic Disease

It was recently reported that Suboxone has been greatly underutilized. I wrote about this in my unpublished paper in 2016, “Opiate Addiction: The Pathophysiology Of A Chronic Disease “. I treated opiate addicted individuals for more than 11 years. I did it based on several medical facts that I learned about and believed in.

Neither the medical community nor the general public has widely accepted any of these facts. The emphasis has been on blaming someone or something for the opioid crisis.

No one wants to admit that you can’t cure opiate addiction.

No one wants to admit that you can’t stop illegal drugs from entering the country.

No one wants to admit that the “War On Drugs “ is a total failure and new methods must be instituted.

First, our emphasis should be on reducing overdose deaths, not addiction. Stop the blame game and recognize that opiate receptors and metabolism determine the physiological action of opiates, not pharmaceutical companies and health care providers.

In determining pain treatment, realize that most patients who present to a physician for treatment have already tried and failed the alternative treatments recommended before opiate pain medication is started.

Realize that addiction to opiate pain medication affects only 1 percent of patients treated with opiate pain medication.

Once addiction is identified, two parallel treatment options should be instituted.

The first is the use of Medication Assistance Treatment ( MAT). This should be done with Suboxone or Sublocade. For those few who are allergic to Suboxone or Sublocade, Methadone at its lowest dose is an alternative.

The second treatment is a mitigated technique explicitly designed to reduce overdose deaths from illegal substances.

Many countries have embraced this technique and have had a tremendous impact on reducing overdose deaths.

Those individuals addicted to Heroin are given Heroin. 

Those individuals addicted to opiate pain medication are given opiate pain medication. Safe injection sites and the ability to test for fentanyl have also reduced overdose deaths.

These common-sense approaches will cause an immediate reduction in overdose deaths.  Long-term clinical trials should be conducted to determine best practices. 

MESSAGE FOR PENNSYLVANIA GOVERNOR JOSH SHAPIRO

On June 27, 2022, the United States Supreme Court ruled 9-0 that a healthcare provider could not be charged with a crime for prescribing a controlled medication they were authorized to prescribe. Despite this ruling, other healthcare providers and I have not had our sentences vacated. As Governor, you have the authority to vacate those sentences.

As the former Attorney General of Pennsylvania, your office was responsible for the prosecution of these innocent healthcare providers. I would like you to immediately vacate these sentences and restore these falsely accused individuals to their pre-conviction condition.

Walter F. Wrenn III, M.D.  

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REFERENCE:

This study guide is designed to help you review and understand the key concepts presented in Walter F. Wrenn’s “Opiate Addiction: Pathophysiology and Treatment Strategies.”

Core Concepts to Review:

• Wrenn’s Central Arguments on Opiate Addiction: Understand Wrenn’s fundamental beliefs regarding opiate addiction, particularly his stance on its curability, the effectiveness of the “War on Drugs,” and the primary focus for intervention.
• Physiological Basis of Addiction: Grasp the role of opiate receptors and metabolism as described by Wrenn in determining the physiological action of opiates.
• The Problem of Blame: Identify Wrenn’s criticism of the “blame game” in the context of the opioid crisis.
• Incidence of Addiction from Pain Medication: Recall the statistic Wrenn provides regarding addiction rates among patients treated with opiate pain medication.
• Wrenn’s Proposed Treatment Strategies:Medication-Assisted Treatment (MAT): Understand the primary medications Wrenn advocates for MAT and the alternative for those with allergies.
• Mitigated Technique for Overdose Reduction: Describe the controversial second treatment approach Wrenn proposes to reduce overdose deaths from illegal substances, including specific examples and supporting measures.
• Role of Safe Injection Sites and Fentanyl Testing: Understand how these measures contribute to Wrenn’s proposed strategy.
• Critique of the “War on Drugs”: Summarize Wrenn’s view on the success of the “War on Drugs.”
• Call to Action for Governor Shapiro: Understand the specific request Wrenn makes to Governor Josh Shapiro, including the context of the Supreme Court ruling and the rationale behind his plea.

Quiz

Instructions: Answer each question in 2-3 sentences.

1. According to Dr. Wrenn, what is the primary focus that society should have concerning the opioid crisis, rather than addiction itself?
2. What does Dr. Wrenn state about the curability of opiate addiction and the effectiveness of the “War on Drugs”?
3. How does Dr. Wrenn explain the physiological action of opiates, and what does he argue is not responsible for it?
4. When considering pain treatment with opiates, what common experience does Dr. Wrenn suggest most patients have had before being prescribed opiate pain medication?
5. What percentage of patients treated with opiate pain medication does Dr. Wrenn state develop an addiction?
6. What are the primary medications Dr. Wrenn recommends for Medication-Assisted Treatment (MAT), and what alternative does he suggest for those with allergies?
7. Describe the controversial “mitigated technique” Dr. Wrenn proposes for individuals addicted to illegal substances like heroin.
8. Besides providing specific substances, what two additional measures does Dr. Wrenn mention as effective in reducing overdose deaths from illegal drugs?
9. What significant legal ruling does Dr. Wrenn reference in his message to Governor Josh Shapiro?
10. What specific action does Dr. Wrenn request from Governor Josh Shapiro regarding healthcare providers?

Quiz Answer Key

1. According to Dr. Wrenn, society’s primary emphasis concerning the opioid crisis should be on reducing overdose deaths, rather than solely focusing on addiction. He suggests moving away from a “blame game” mentality.
2. Dr. Wrenn asserts that opiate addiction cannot be cured and that the “War On Drugs” has been a total failure. He believes new methods are necessary to address the crisis effectively.
3. Dr. Wrenn explains that the physiological action of opiates is determined by opiate receptors and metabolism. He argues that this action is not determined by pharmaceutical companies or health care providers.
4. When considering opiate pain medication, Dr. Wrenn suggests that most patients presenting for treatment have already tried and failed alternative treatments. This often occurs before opiate pain medication is even started.
5. Dr. Wrenn states that addiction to opiate pain medication affects only 1 percent of patients treated with it. This statistic challenges common misconceptions about the risk of addiction from prescribed opiates.
6. For Medication-Assisted Treatment (MAT), Dr. Wrenn primarily recommends Suboxone or Sublocade. For the few individuals allergic to these, Methadone at its lowest dose is suggested as an alternative.
7. The “mitigated technique” involves providing individuals addicted to illegal substances with those same substances. For example, heroin addicts are given heroin, and those addicted to opiate pain medication are given opiate pain medication.
8. Beyond providing specific substances, Dr. Wrenn also mentions safe injection sites and the ability to test for fentanyl as effective measures. These tools help reduce overdose deaths by ensuring safer drug use environments.
9. Dr. Wrenn references a June 27, 2022, United States Supreme Court ruling. This ruling stated that a healthcare provider could not be charged with a crime for prescribing a controlled medication they were authorized to prescribe.
10. Dr. Wrenn requests that Governor Josh Shapiro immediately vacate the sentences of healthcare providers, including himself, who were prosecuted despite the Supreme Court ruling. He seeks to restore these falsely accused individuals to their pre-conviction condition.

Essay Format Questions

1. Analyze Walter Wrenn’s core arguments regarding the nature of opiate addiction and the effectiveness of current drug policies. How do his views challenge conventional understandings, and what evidence or reasoning does he offer to support his claims?
2. Compare and contrast Wrenn’s two parallel treatment options for opiate addiction. Discuss the potential benefits and controversies associated with each approach, particularly the “mitigated technique.”
3. Discuss the role of “blame” in the opioid crisis as described by Wrenn. How does he propose shifting the societal and medical focus, and what are the implications of such a shift for policy and public perception?
4. Evaluate Wrenn’s call to action to Governor Josh Shapiro. What is the legal and ethical basis for his request, and what larger issues about healthcare provider prosecution in the opioid crisis does it highlight?
5. Wrenn emphasizes the physiological basis of opiate action and the low percentage of addiction among pain medication patients. How do these points form the foundation of his overall argument for a new approach to managing the opioid crisis, and what are the potential challenges in implementing his proposed strategies?

Glossary of Key Terms

• Opiate Addiction: A chronic, relapsing brain disease characterized by compulsive drug seeking and use despite harmful consequences, involving the physiological and psychological dependence on opiates.
• Pathophysiology: The disordered physiological processes associated with disease or injury; in this context, the biological mechanisms underlying opiate addiction.
• Suboxone: A prescription medication containing buprenorphine and naloxone, used to treat opioid dependence. It helps reduce withdrawal symptoms and cravings.
• Sublocade: An extended-release injectable form of buprenorphine, used for the treatment of moderate to severe opioid use disorder in adults.
• Methadone: A synthetic opioid used for pain relief and as a maintenance treatment for opioid use disorder. It helps reduce cravings and withdrawal symptoms.
• Medication-Assisted Treatment (MAT): The use of medications, in combination with counseling and behavioral therapies, to provide a “whole-patient” approach to the treatment of substance use disorders.
• Opiate Receptors: Specific protein molecules on the surface of cells, primarily in the brain, spinal cord, and digestive tract, to which opiates bind to exert their effects.
• Opiate Metabolism: The biochemical processes by which the body breaks down and eliminates opiates.
• “War on Drugs”: A term referring to the U.S. government’s campaign of prohibition, military aid, and military intervention, with the stated aim of reducing the illegal drug trade. Wrenn characterizes it as a “total failure.”
• Safe Injection Sites: Legally sanctioned facilities where people can inject pre-obtained illegal drugs under the supervision of medical staff, often with access to sterile supplies and emergency care.
• Fentanyl: A powerful synthetic opioid, similar to morphine but 50 to 100 times more potent, often illicitly manufactured and a significant contributor to overdose deaths.
• Vacate Sentences: The act of nullifying or setting aside a previous legal judgment or conviction, often due to new evidence or a change in legal interpretation.