Dr. Dombrowski Interview

I’ve been practicing addiction medicine for the past five years. I’m also board certified in addiction medicine.

Unfortunately, I do not see any change with respect to the practice of addiction treatment. I do see a ramping up of aggressive use of buprenorphine in nurse practitioners primary care physicians and PAs. I’m not sure this is the right way of treating patients but the government seems to be supporting this type of practice.

I am a proponent of medication-assisted treatment. I do provide methadone treatment programs as well as buprenorphine. We also do provide intramuscular injections of blocking agents as well as implantation of naltrexone. Certainly, the best way to move forward, outside of a business model, would be a blocking agent. However, we’re still in a holding pattern given the fact there is no FDA approval. All of these other medications that have been mentioned that have active agents or partial agonist or antagonist agents can be abused and diverted.

As you’re aware I’ve been working with BioCorRx specifically. I have personal experience in use of naltrexone both for alcohol as well as opiate use disorder. Obviously, I would like to do more of this work.

From what I can tell normally the patients do exceptionally well. These patients are selected in that they have failed multiple rounds of addiction treatment. The implantation therapy offers the patient an insurance policy with respect to the possibility of relapse.

I personally am not aware of any side effects of implantation therapy.

Cognitive behavioral therapy recovery, coaching, etc. is exceptionally important.  Likely, no one will ever get better just with medication management. Patients need to change their lives fully and that is not all in a medication. It needs to include lifestyle changes, friend changes, job changes, etc. Addiction takes over the entire person and therefore all these factors must be treated in concert with medication management.

Greater support of implantation therapy, especially in the jail system. They are currently paying essentially $1200 for an intramuscular injection of naltrexone with no follow-up.  To me that is wasting taxpayer dollars.

I believe having communication out there is incredibly important especially with implantation therapy to move forward in other states especially border states where they have approval for Medicaid use of implantation therapy, for example, I believe the state of Ohio has approval.  Therefore a move should be made to let the Commonwealth of Kentucky know about this, the Commonwealth of Pennsylvania, the state of Indiana and the state of Michigan. All of these are border states and therefore we need to get the message forward.

This is an interesting question. Before, there would be a tremendous amount of stigma but now, a political point of view is that everyone is a victim. Everyone has some type of mental illness and addiction is certainly one of those factors. So perhaps now this is not a barrier for treatment.

I am currently a medical director of a rehab center. This is a good center, however, a majority of them essentially do not care very much about patient recovery. Actually, they are hoping that the patient fails and therefore they have another customer one or two months later. Essentially might gut feeling is these are revolving doors.

I initially suggest traditional treatment at least as a start. If the patient continues to fail or have continued relapse then I would clearly recommend implantation therapy.

Unfortunately, there such a thing as free will and consent. Nothing can be done for patients who are not willing to seek treatment or who do not offer consent for medical therapy. This goes against the Nuremberg laws that were promulgated in 1946 after the atrocities of the Nazis with medical experimentation. Patients must give the free will and consent to treatment and they also must understand risk and benefits to treatment. They also must be allowed to withdraw treatment. The patient has complete autonomy.