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.

Join us for an enlightening episode of the Pain Matters Podcast, where we dive deep into the world of medical cannabis and its implications for pain management.

Hosts Shravani Durbhakula, MD, MPH, MBA, and Mustafa Broachwala, DO, are joined by Mark Steven Wallace, MD, a Pain Management Specialist and Professor of Anesthesiology at UC San Diego Health, who brings more than two decades of experience in cannabis research.

In this episode, you’ll discover:

• Biologics of Cannabis: Dr. Wallace dives deep into the pathophysiologic mechanism at play regarding endocannabinoid receptors and the mechanism of actions of cannabis in the body, especially as it relates to pain.
• Medical Cannabis vs. Opioids: Dr. Wallace shares his observations on the lack of tolerance development in patients using medical marijuana compared to traditional opioids.
• Regulatory and Dosage Challenges: Insights into the complexities of prescribing and dosing medical marijuana, and how these factors impact patient care.
• Therapeutic Potential: Discussion on the conditions that respond well to medical cannabis based on current research and clinical experience.
• Patient Stories and Outcomes: Real-world examples of how medical cannabis has impacted patients' lives, particularly in managing chronic pain.
• Future of Cannabis in Medicine: Dr. Wallace's thoughts on the evolving landscape of medical cannabis research and its future potential in healthcare going forward.

This episode is a must-listen for healthcare providers interested in understanding the nuanced role of cannabis in pain management and those looking to integrate evidence-based cannabinoid therapies into their practice.

Be sure to subscribe so you don’t miss Part 2 of this nuanced discussion and to find out what’s next for medical cannabis in pain medicine.

Join us for Part 2 of our engaging series on the necessary reforms in pain medicine training as we explore potential changes that could significantly enhance the quality and effectiveness of pain medicine education.

Hosts Shravani Durbhakula, MD, MPH, MBA, and Mustafa Broachwala, DO are joined once again by esteemed experts Scott Gregory Pritzlaff, MD, Associate Professor and Pain Medicine Fellowship Director at UC Davis Health, and Sayed Emal Wahezi, MD, Professor and Pain Medicine Fellowship Director at Montefiore Medical Center, to delve deeper into the structural adjustments and implications of extending training periods in pain medicine.

Tune in to hear:

• Structural Changes and Educational Enhancements: Discussing the risks & benefits of: extending fellowship duration, truncating baseline specialty training years, creating a pain residency, re-establishing graduation case numbers, and more. How do we make training comprehensive and attract a more dedicated cohort of trainees?
• Diversity and Accessibility: Examining how changes in training duration might impact the diversity of applicants and accessibility of pain medicine as a specialty.
• Mentorship and Peer Learning: Highlighting the importance of mentorship and peer learning that changes in training could facilitate, enhancing both professional growth and patient care.
• Controversies and Challenges: Addressing the potential challenges and controversies associated with implementing longer training periods, such as funding, accreditation, and acceptance within the broader medical community.
• The Need for Collaboration: Discussing the need for a unified voice in pain medicine and collaboration across specialities and societies to achieve mutual advocacy goals & better training.

This episode is critical for educators, trainees, and healthcare policymakers interested in understanding and shaping the future of pain medicine training.

Join us in a critical discussion on the urgent need for reform in pain medicine training programs.

In this enlightening episode of the Pain Matters Podcast, hosts Shravani Durbhakula, MD, MPH, MBA, and Mustafa Broachwala, DO, engage with experienced pain medicine program directors to delve deep into the current state, gaps, and proposed changes surrounding pain medicine fellowships.

Tune in as we’re joined by Scott Gregory Pritzlaff, MD, Associate Professor and Pain Medicine Fellowship Director at UC Davis Health, and Sayed E. Wahezi, MD, Professor and Pain Medicine Fellowship Director at Montefiore Medical Center as well as a board member of the Association of Pain Program Directors, to share unique insights into the complexities of pain medicine training.

In this episode, you'll hear about:

• The Current State of Pain Medicine Training: Insights into the existing structure of pain medicine training programs and their limitations.
• Challenges with Fellowship Durations: A detailed discussion on the implications of the current short durations of fellowships and how they may not adequately prepare physicians for the complexities of pain management.
• Interdisciplinary Education: The importance of integrating diverse medical disciplines within pain medicine training to enhance understanding and patient care.
• Potential Reforms: Proposals for extending fellowship durations and making pain medicine training more comprehensive and interdisciplinary.

This discussion is essential for anyone involved in medical education, particularly those in pain medicine, who seeks to understand the future directions of training that could better prepare physicians for the evolving challenges in patient care.

Please subscribe and turn on notifications to ensure you don’t miss part 2 of our Pain Medicine Training discussion.

• Overview of the FTC's Decision: What the FTC's ban on non-competes means in practice, and why it's not yet enforceable.
• Exceptions and Challenges: Discussion on specific exceptions to the rule, like the carveout for senior executives and how this might affect non-profit and for-profit healthcare entities differently.
• Implications for Physicians: How the ruling could change the dynamics of physician practice models, mobility, and employment negotiations
• Legal and Economic Perspectives: Insight into the broader economic and legal debates surrounding non-compete clauses and their enforceability.
• Future of Physician Employment: Speculations on how this could lead to greater autonomy, innovation, and potential shifts in the healthcare employment landscape.

Join us for a riveting exploration into the rapidly evolving world of artificial intelligence (AI) in interdisciplinary pain medicine. This episode of the Pain Matters Podcast features a thought-provoking discussion on the transformative potential of AI and the ethical challenges it introduces.

Hosts Shravani Durbhakula, MD, MPH, MBA, and Mustafa Broachwala, DO, are joined by two distinguished experts:

• Tinglong Dai, PhD, a Bernard T. Ferrari Professor at Johns Hopkins Carey Business School, co-chair of the Johns Hopkins Workgroup on AI and Healthcare, and a leading voice in the integration of AI within clinical settings. Dr. Dai's extensive media presence and recognition as one of the World's Best 40 Under 40 Business School Professors by Poets & Quants underline his profound impact on AI education and application.
• Nestoras Mathioudakis, M.D., M.H.S., an Associate Professor of Medicine at Johns Hopkins School of Medicine, where his work focuses on medical applications of generative AI. As Co-Director of the Diabetes Prevention & Education Program and a seasoned educator in clinical informatics, Dr. Mathioudakis brings critical insights into the practical and ethical dimensions of AI in medicine.

Tune in to discover:

• AI's Impact on Clinical Practices: Exploring how AI is currently being used to enhance clinical documentation, streamline insurance processes, and support decision-making in patient care.
• Ethical Considerations and Challenges: Discussing the complexities of data integrity, the potential biases in AI algorithms, and the ethical implications of AI in clinical decision support.
• The Future of AI in Medicine: Speculating on the future directions of AI in healthcare, including its role in personalized medicine and the ongoing need for rigorous validation and ethical oversight.
• Real-World Applications and Case Studies: Analyzing specific instances of AI application in healthcare, such as diagnostic support and predictive analytics, and evaluating their outcomes.
• Navigating the Regulatory Landscape: Understanding the implications of recent legal and regulatory developments affecting AI in healthcare.

Find out how AI is reshaping healthcare delivery, enhancing patient outcomes, and posing new questions about the intersection of technology and medical ethics.

This discussion is crucial for healthcare providers looking to stay informed about the latest developments in AI and its impact on the field of pain medicine.