Vanderbilt pain specialist lost brother to possible drug overdose, now helps others

Dr. Dan Lonergan, a pain specialist who also focuses on addiction, left, treats patient Jeff McCoy at his practice in Franklin, Tenn., Monday, June 5, 2017. Back pain still bothers McCoy; he spends a chunk of each day flat on his back to rest it. Suboxone helps a little, and he worries about not being able to find a doctor to prescribe it, if he or Longeran were to move away. Special training is required to prescribe that medicine in an office-setting instead of the kind of treatment clinics where methadone, another opioid recovery medicine, is prescribed. (AP Photo/David Goldman)

NASHVILLE, Tenn. (AP) – Dr. Dan Lonergan says relapse is the biggest risk for patients recovering from opioid addiction. The drugs work by attaching to chemical receptors in the brain and sending signals that block pain and create pleasurable feelings.

Repeated use can lead to drug tolerance, meaning increasingly high doses are needed to produce the same effect. In recovery, patients lose that tolerance so resuming the drugs can be fatal.

Addiction medicine — buprenorphine and methadone — act on the same drug receptors but produce much milder effects, along with reducing cravings and withdrawal symptoms.

As a pain specialist, Lonergan sometimes prescribes opioids to patients with no history of drug abuse. But for patients taking medicine for their addiction he won’t, no matter how strenuous their pleas.

“Every day in my practice there are conflicts like that,” Lonergan said.

His double focus on pain and addiction is personal. When he was a second-year medical student, Lonergan got an early morning phone call from his distraught father with the news that his older brother was found dead on the couch.

The young man used powerful painkillers for severe headaches and other medical problems, and his death was considered a possible accidental overdose.

“There may be some therapy for me in treating patients with addiction, but you never recover from the loss,” Lonergan said softly. “There’s still a hole there that will never be filled.”

Lonergan says the opioid crisis is compounded by not enough specialists trained to treat it and a persistent stigma, especially in Bible Belt states like Tennessee. He says patients’ families can sabotage their recovery efforts by telling them church, not medicine, is the answer.

Many of Lonergan’s patients are on addiction medication long term, though some can be weaned off. What he has found though, is that most need other addiction fighting tools, too — counseling, group meetings, social support, learning to manage life’s problems “in more old-fashioned ways,” he said.

Even with all that, he said, “there’s still a lot within the patient that has to come from the heart.”