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Letter from Dr Kornfeld

A Letter from Recovery Without Walls Founder and Medical Director Dr. Howard Kornfeld:

Dear Friends and Colleagues and Larger Community,

I have had the privilege of treating people who struggle with chronic pain conditions, alcohol misuse, drug dependence, or prescription medication problems.

In this advanced era, treatment of pain and drug dependency continues to be unfortunately neglected and stigmatized. Our team at Recovery Without Walls in Mill Valley works to overcome these limitations by combining compassion, science, spirit, and evidence-based medicine. We provide solutions to problems other clinicians have found difficult, if not impossible, to solve.

Recovery Without Walls has become a nationally recognized medical practice for innovations in the use of the partial opiate agonist buprenorphine in the treatment of chronic pain. Buprenorphine, better known as Suboxone, is FDA approved for opiate addiction and has been an analgesic (or pain drug) since its discovery over forty years ago in England. Recently, buprenorphine has also become available for chronic pain in the U.S. as an FDA approved transdermal patch called Butrans.

By carefully studying the successful use of buprenorphine in Europe for pain (which has been largely ignored by the pharmaceutical companies in the U.S.), we have stayed years ahead of other pain practitioners in making these medical breakthroughs available.

Buprenorphine used for pain is increasingly important now because:

• We are in the midst of an epidemic of chronic pain. The Institute of Medicine of the National Academy of Sciences reported that over 100 million adults in America suffer from this condition at an estimated cost to the nation of greater than $600 billion per year.

• Traditional opioids including OxyContin®, Vicodin®, methadone, Dilaudid®, and morphine can be ineffective and are associated with adverse consequences such as abnormal behavior, addiction, overdose, or death.

• Buprenorphine is often uniquely effective for severe forms of neuropathic pain, as well as pain in cancer patients and the elderly.

Buprenorphine can be substituted for more harmful opiates with far fewer side effects and dangers. After sufficient stabilization, it can be readily tapered –– in fact, many chronic pain patients can finally discontinue all opiates altogether.
Since few U.S. physicians are experienced in using buprenorphine, particularly for pain, patients often suffer needlessly. Recovery Without Walls stands to change this through a unique integration of cutting- edge pharmacology, exceptional psychotherapy, nutritional support, and the best of the alternative healing arts.

For over ten years as a member of the UCSF clinical faculty, I have educated medical colleagues about buprenorphine’s role in pain by delivering Grand Rounds at local hospitals, presenting at the Quarterly UCSF Challenges of Managing Pain lecture series, and teaching physician trainees in the UCSF Pain Fellowship Program on a monthly basis.

While continuing my private practice with our team in Mill Valley, two years ago I partnered with Alameda County Medical Center (ACMC) at Highland Hospital in Oakland, California as the Medical Director of the new Pain Management and Functional Restoration Clinic. The goal was to help address the county’s problem with escalating chronic pain and dysfunctional prescription drug use among their low income and medically indigent patients. We used the tools developed at Recovery Without Walls to specifically address these patients needs, and have been gratified by the success of the program. Enclosed is a short article written about the ACMC pain program by journalist Julia Landau in the influential California Health Report, a project of healthyCal.org.

I am also excited to announce the publication of our recent “Introductory Report,” describing our progress in treating pain in Alameda County, including patient testimonials and quantitative measures of improvement. This report and our other publications in peer reviewed medical journals, including the Annals of Internal Medicine, the Archives of Internal Medicine, the American Journal of Therapeutics, and Marin Medicine (the magazine of the Marin Medical Society) are available on our website, recoverywithoutwalls.com.

If you think we can be of help to any of your patients, friends, or colleagues, please feel free to call us at the office, 415-383-2949. We would be happy to discuss how to help you or a patient grapple with a pain, drug, or alcohol problem.

I am reminded that at some point in our life, all of us seem “broken” or our integrity “cracked.” Patients with chronic pain can experience a profound vulnerability to these feelings. We, at Recovery Without Walls, in this season of light, see promising options and new opportunities, bringing together science, method, and grace. In the words of singer-songwriter, Leonard Cohen, in his song “Anthem”:

“There is a crack, a crack in everything. That’s how the light gets in.”

With Warm Warm Regards,

Howard Kornfeld, M.D. Medical Director

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