In this episode of Pain Matters, Shravani Durbhakula, MD, MPH, MBA, speaks with Maia Szalavitz, award-winning New York Times opinion writer and AAPM 2025 Featured Speaker. Recorded April 4, 2025, at the AAPM PainConnect 2025 meeting, their conversation explores themes from Szalavitz’s recent writing on addiction, harm reduction, and drug policy. Maia shares her personal journey through addiction and recovery, and offers insights into the critical distinction between dependence and addiction. They also discuss the effectiveness of harm reduction strategies when it comes to opioids, the potential of emerging treatments like Ozempic, and the role of media in shaping public understanding of addiction. Throughout, Szalavitz challenges traditional narratives and advocates for evidence-based, compassionate approaches to drug policy and treatment. She also offers tips for how medical professionals can make their voices heard.

*Views expressed by our guests are their own and do not necessarily reflect those of the hosts, their institutions, or the American Academy of Pain Medicine.

About the Guest:

Maia Szalavitz
Maia Szalavitz is an acclaimed journalist and author known for her expertise in addiction, harm reduction, and drug policy. Having personally experienced addiction, Szalavitz's work draws deeply from her own journey to recovery. Her celebrated books include "Unbroken Brain: A Revolutionary New Way of Understanding Addiction" and "Undoing Drugs: The Untold Story of Harm Reduction and the Future of Addiction." Szalavitz frequently contributes to major publications with opinion pieces that challenge traditional views on addiction and advocate for science-based approaches to drug policy.

Episode Summary:

🔑 Key Takeaways

• Addiction vs. Dependence: Szalavitz emphasizes the critical distinction between physical dependence and true addiction — a nuance often misunderstood in both policy and clinical settings.
• Harm Reduction Works: Szalavitz says that strategies like syringe exchange and safe use education are not just compassionate — they’re backed by evidence and save lives.
• Ozempic and New Treatments: The conversation touches on the potential of drugs like Ozempic in treating addiction, and what the early research suggests.
• Media’s Role: Fair and science-based journalism is essential — Szalavitz critiques the harm caused by sensationalized or "artificially balanced" reporting on drug use.
• Policy Reform: Current drug policies often criminalize rather than help — Szalavitz calls for systemic change rooted in public health, not punishment.

Resources:

• Maia Szalavitz: Personal Website
• Books by Maia Szalavitz: Undoing Drugs, Unbroken Brain

Join Executive Producer and Host Shravani Durbhakula, MD, MPH, MBA, and Co-Host Mustafa Broachwala, DO, for a pivotal episode of the Pain Matters Podcast where we address the recent BMJ publication, “Common interventional procedures for chronic non-cancer spine pain: a systematic review and network meta-analysis of randomized trials,” and the associated guideline. Steven Cohen, MD, Feinberg School of Medicine Northwestern University, Lynn R. Kohan, MD, University of VA Medical School, Zachary McCormick, MD, University of Utah, Nathaniel M. Schuster, MD, University of California, San Diego, Daniel Larach, MD, MS, MA, Vanderbilt University, Hance Clarke, MD, FRCPC, PhD, University of Toronto and President of the Canadian Pain Society, Hemant Kalia, MD, MPH, FIPP, Invision Health, and present diverse perspectives on the publication’s claims and the systematic review and meta-analysis methods behind it.

In this episode, you’ll learn:

• The podcast underlines the necessity for comprehensive, unbiased systematic reviews and meta-analyses to inform clinical guidelines effectively.
• Experts caution against the misinterpretation of studies and the potential consequences for policy and access to interventional pain procedures.
• Advocates call for unified efforts in the pain medicine community to pursue legislative and regulatory reforms that align with current evidence and patient needs.
• The conversation underscores the pivotal role of personalized patient care and clinically validated techniques in improving outcomes and preserving practice legitimacy.
• The podcast highlights the risk of reducing access to viable interventional pain treatments if skewed interpretations of data shape healthcare policies.

Tune in to discover how these leading experts address the controversies, advocate for robust clinical evidence, and highlight the urgent need for unified advocacy in shaping practical, patient-centered guidelines.

Be sure to subscribe so you don’t miss our next episode.

Reference:

Wang X, Martin G, Sadeghirad B, Chang Y, Florez I D, Couban R J et al. Common interventional procedures for chronic non-cancer spine pain: a systematic review and network meta-analysis of randomised trials BMJ 2025; 388 :e079971 doi:10.1136/bmj-2024-079971

Dr. Mark Wallace of UCSD joins hosts Shravani Durbhakula, MD, MPH, MBA and Mustafa Broachwala, DO and pick up where they left off on their discussion regarding the nuanced world of medical cannabis, understanding medical applications, appropriate dosing strategies, and advice for prescribing providers. Furthermore, they discuss the challenges of clinical trials, regulatory hurdles, and the implications for treating pain. Dr. Wallace offers insight into the complexities of cannabis research, dosage guidelines, and the controversial discourse surrounding its legalization. This enlightening discussion offers a deep dive into an oft misunderstood and stigmatized area of pain medicine.