SAN FRANCISCOMEDICINE - California Society of Addiction ...

President’s Message
Michael Rokeach, MD, and Steve Heilig, MPH
Attorneys for the Afflicted
Drug addiction—and let’s be clear from the start that we
are talking about drugs both legal and illegal—has been
likened to a form of slavery. A strong choice of words,
yes, but not too strong for the impact severe addiction can have
on a person’s life: helplessness, destruction, and despair are all
common. To all that, add denial, both in the addicted person and
among friends, colleagues, and our broader culture as a whole,
and it’s not so surprising that the AMA years ago identified drug
abuse, including that of alcohol and tobacco, as our nation’s biggest
public health problem.
San Francisco has long been known as a hard-drinking,
hard-drugging town. This has been true from the Gold Rush
onward through Prohibition and the 1960s Haight-Ashbury
“hippie” explosion. Our city’s rates for abuse of substances
from tobacco to heroin have historically been among the highest
anywhere. Clearly there are many serious health and other
consequences as a result.
Thus it’s perhaps not surprising that San Francisco’s
medical and public health leaders have long been pioneers in
addressing addiction issues. SFMS advocates were movers and
shakers in getting the AMA to make the statement referred to
above; in the initiation, growth, and acceptance of addiction
medicine as a legitimate specialty; in recognizing addiction as
a disease with identifiable etiology, symptoms, and treatment;
in the banning of smoking in restaurants (before the rest of the
state and nation); in the acceptance of needle-exchange programs
as a means of both interrupting transmission of HIV and
as a bridge to treatment; in recognizing and treating physicians
who themselves experience problems with drugs or alcohol; in
developing sound approaches to the ongoing “medical cannabis”
controversies; in raising awareness about emerging new drugs
such as MDMA or “ecstasy” and others; in removing tobacco
products from pharmacies; in advocating for justifiable alcohol
tax increases to help compensate for the real costs of drinking;
and more. It’s a long and, we feel justified in saying, impressive
list of contributions.
Sometimes this work has been local; sometimes it has
involved taking our approaches statewide and beyond via our
representatives to the CMA and AMA, as well as undertaking
advocacy efforts with our elected officials and other authorities.
As in other arenas, we have learned that physicians can be the
most effective advocates of all. As the evidence base increases
for the disease model of addiction and effective treatment and
prevention, this becomes even more true.
Addiction can strike people of all walks of life. But we will
note that when physicians argue for better approaches and resources
on behalf of some of their most afflicted patients, many
of whom have been left with nothing other than hope, those physicians
truly take on the role the legendary nineteenth-century
physician and “father of modern pathology” Rudolph Virchow
defined as “the natural attorneys of the poor.”
We have been pleased and proud to turn over this issue of
our journal to two local guest editors who embody all that is
impressive about the rise and success of addiction medicine.
David E. Smith, MD, and David Pating, MD—”Big Dave and Little
Dave,” as they have referred to themselves during this editorial
process—are beyond renown in their specialty and community.
Smith we should all know as the founder of the landmark
Haight-Ashbury Free Medical Clinic, which he started right out
of UCSF medical school. Pating is head of addiction medicine at
San Francisco’s Kaiser Permanente. Both have been tireless advocates
for their field, presidents of addiction medicine specialty
societies, and holders of a dizzying array of positions wherever
drug and alcohol policy, prevention, practice, and funding are
debated. They exemplify the ideal role of the physician and
clinician, researcher, and, yes, “natural attorney” for their own
patients and those of others.
There is already an official David E. Smith, MD, Day in San
Francisco, and someday there is likely to be a Pating Day as well.
We all owe these two Daves a lot.
They’ve assembled for us here an impressive monograph
of addiction medicine. The authors herein, from the SFMS and
beyond, pull few punches in describing what has been accomplished
to date and what still needs to be done. The challenges
remain, and some are daunting. But many of those who have
experienced addiction, and beaten it, have identified hope as the
single most important element in their recoveries. And what do
effective treatment and more humane approaches to any lifethreatening
malady offer, if not hope
www.sfms.org June 2010 San Francisco Medicine 7