The new outpatient substance abuse treatment facility is designed to diagnose and treat patients in a holistic and comprehensive way, reversing the county’s worsening trend of addiction due to illicit drugs, alcohol and – most recently – prescription drugs.
“The substance abuse in Pinellas County is of epic proportions,” Dr. Friedman said.
The doctors come from different backgrounds. Bagenski has practiced internal medicine for more than a decade and, earlier in his career, had a personal struggle with addiction. Friedman has practiced pain management since opening his practice in 1992 and saw firsthand how the proliferation of pain clinics and pharmaceutical companies turned pain medicine into an addiction for many patients.
Friedman and Bagenski met while training in addiction medicine though a unique, year-long fellowship at the University of Florida’s College of Medicine. During that fellowship, they recognized a shared goal to return to Pinellas and have an impact on a community struggling with addiction.
“There’s a lot of tragedy and sadness that goes along with addiction,” Bagenski said. “A lot of people die. Kids end up in situations they should not be in. We hope to be able to change some of that.”
The new pain patient
When Friedman began his practice, Pain Relief Centers, in 1992, pain medication had just become a sub-specialty. In the 1990s, it was controversial to prescribe opiates such as morphine and methadone, and doctors were hesitant to approve pain medications for long-term use for anything other than cancer pain, Friedman explained.
But in the early 2000s, there was a significant increase in the use of opioids, which include semi-synthetic drugs such as oxycodone. The medical community “essentially turned the tables and decided to have a war on pain,” Friedman said.
This coincided with an explosion of pharmaceutical companies marketing long-acting pain medications to physicians, he added. Education on these medications was often limited to the information the drug representatives provided.
“We had a proliferation of doctors who were writing for pain medications that were not trained in pain management, resulting in a huge increase in deaths and inappropriate prescribing,” Friedman said.
Between 2000 and 2006, retail sales of oxycodone increased 732 percent and sales of methadone increased 1,200 percent. From 1990 to 2001, the diagnosis of substance abuse rose from 628,000 to more than 2.4 million while emergency room visits for adverse reactions to controlled substances increased 152 percent.
“This is when we started to become very aware that our efforts to control pain with higher doses was becoming a huge problem,” Friedman said.
Especially in Pinellas, Hillsborough, Dade and Broward counties, more and more pain clinics were prescribing high doses of oxycodone and alprazolam, or Xanax. In 2009, death rates in Florida for prescription medication was four times higher than illicit drugs, making it the No. 1 cause of death after car crashes.
The face of pain patients Friedman was seeing in his practice dramatically changed. They were younger, and their reasons for pain were more convoluted than the patients he had been seeing.
“We were the epicenter of inappropriate prescriptions,” he said. “It was at that point that I decided that I lacked enough education to be able to handle this change of environment and patients.”
Eight university medical centers across the country began offering an addiction medical fellowship in 2012. Friedman jumped at the chance.
A personal struggle
Bagenski came to the fellowship six months after Friedman. They met on Bagenski’s first day working in detox unit. For Bagenski, the reasons for wanting specialized training came from his personal experiences with the damaging effects of addiction.
Though he knew better as a practicing doctor, Bagenski turned to a habit of drinking amidst a pending divorce and family problems. The disease of addiction eventually involved cocaine.
With the help of friends and family, Bagenski went into treatment in 2007 to sober up. When he returned to the practice of medicine, he was inspired to share his own experiences with those who were struggling as he had.
“I just felt like there was this area that I needed to explore,” he said. “It was … why I had gone into medicine for in the first place, in a way that had a much deeper meaning to me now because of my own history.”
During the fellowship, Bagenski said he saw how addiction affected people from every walk of life, from movie stars, professional athletes and Fortune 500 company executives to “mom and pop and grandma and little kids.”
“There’s no difference in the devastation that’s caused,” he said. “People can buy more time … when they have money, but ultimately, the end result is the same: devastation, ruined relationships, ruined lives, death, destruction, horrific disease, illness. It’s horrible.”
Bagenski said treatment at Recovery Resources begins with getting a good history by collecting as much information on the patient as possible. It’s this approach that allows the practice to provide more support than Bagenski said he could do in “five-minute meetings” as a family doctor.
Patients who will be most successful with the outpatient services that Recovery Resources provides are those who can be accountable for their actions as the staff seeks to add better structure and coping skills to their lives.
“Ongoing success and ongoing recovery is directly proportional to the effort they put into the program,” Bagenski said. “It’s a fragile time, early in the recovery. It’s our goal to hang on to folks long enough to get them the recovery tools that they need.”
The doctors treat patients through detoxification, counseling, motivational interviews and cognitive behavioral therapy. They also are able to recognize patients who need a higher level of care and refer them accordingly.
Patients at Recovery Resources benefit from Friedman’s long experience in pain management as well as Bagenski’s experience treating chronic diseases that are caused or exacerbated by long-term abuse of alcohol or drugs.
The vision the doctors have for their new practice is ambitious. They want to reverse the epidemic of abuse in Pinellas by helping patients toward abstinence instead of more drugs to treat their addiction.
“We see a need for more clinics, but clinics manned by doctors with the appropriate training,” Friedman said.
They’ve reached out to local drug courts, to offer their expertise in evaluating those struggling with addiction and in suggesting alternative treatments that don’t involve medicines with an abuse or an addiction potential to them.
“Many people in the court system are prescribed the very same drugs that they’re addicted to,” Bagenski said.
For now, their goal is to treat one patient at a time and fight for the miracles that are possible in spite of the widespread tragedy.
“It’d be nice to have a clean county. We want to reach as many patients as we can,” Friedman said.
His colleague agreed.
“I think in my own life, I’ve been blessed in so many ways,” he said. “I’m happy to try to pay this forward, and I plan to spend the rest of my career doing this.”
Recovery Resources of Florida is in Suite 215 of the Bardmoor Outpatient Center, at 8839 Bryan Dairy Road in Largo. For more information, visit www.recoveryresourcesofflorida.com or call 851-9528.