Physicians can choose not to be powerless against opioid addiction

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I didn’t become a primary care doctor to treat opioid addiction.

I wasn’t trained for it. To be honest, it scared me.

But when you work, like I do, at a clinic that serves a lot of people who have little money or who struggle with mental health and substance use issues, there comes a point when you have to step up.

When I started seeing patients in 2009, I knew that opioid use was a problem in the community. But I didn’t see many overdoses.

By 2015, that had changed. Patients turned up unconscious in our bathrooms after using drugs. I often saw people overdose from heroin and fentanyl.

I knew this was happening all over the country — not only in clinics, but in homes, in malls, and on the streets. People were dying in broad daylight.

Opioid use disorder is a chronic disease. And, like other chronic diseases, such as diabetes and hypertension, it is treatable.

But I didn’t know how to treat it.

Luckily, I found a way to learn what I needed to know, through the SUSTAIN Communities initiative managed by the Massachusetts League of Community Health Centers. This GE Foundation-funded program trains primary care providers like me to help patients struggling with opioid use disorder.

Through SUSTAIN Communities, I participated in Project ECHO, a weekly telementoring, and education program that provides remote coaching to primary care clinicians who want to treat patients with complex conditions. My colleagues and I learned from a team of specialists at Boston Medical Center (BMC) how to treat opioid use disorder with buprenorphine.

Buprenorphine is one of the best medication-assisted treatments for opioid use disorder and is often used in outpatient settings alongside counseling. It eliminates the daily hurdles to treatment: no commute, no waiting in line, and no fear of being seen seeking treatment, so no stigma. You can take buprenorphine in the privacy of your home and carry it with you.

In addition to training my team, the BMC specialists have virtually coached doctors at community health centers across Massachusetts and 17 other states.

As a new prescriber of buprenorphine, I quickly learned there’s no such thing as a “textbook example” of opioid use disorder. Yes, patients struggled with addiction, but they also had other complex health and social problems, like chronic illness, isolation, or a lack of stable housing. It was difficult to manage the health of a patient whose life teetered on the edge in all these ways, but I had the support of the specialists and providers in the ECHO community to guide me.

One of my patients, Joan, is a mother of two. If you met her, you would never guess she had an opioid problem. Polite and well-dressed, usually wearing a small cross around her neck, she showed no obvious signs of drug use. But she took oxycodone for her arthritic knees and began using heroin when the painkillers stopped working.

I found out about her addiction after she passed out behind the wheel of her car. The police found the car at the side of a road and couldn’t wake her up.

When Joan came to me for help, she was ashamed.

But the good news was: I could help her.

With buprenorphine, I’ve seen patients like Joan turn their lives around, regain employment and reunite with their families. For these patients, buprenorphine is a game-changer. It saves them.

Knowing how to treat and manage opioid addiction with buprenorphine has given me the privilege of helping patients change their lives.

Unfortunately, only 35,000 physicians in this country — a mere 3 percent — are certified to prescribe buprenorphine, even though 2.1 million Americans suffer from opioid use disorder.

As primary care doctors, our patients rely on us to deliver the care they so desperately need. We can choose not to be afraid. We can choose not to be powerless against opioid addiction. We can choose to be part of the solution.

I urge all primary care physicians to seek buprenorphine training and get certified to treat opioid addiction.

Joseph Panerio-Langer is an internal medicine physician and assistant medical director, Brockton Neighborhood Health Center, Brockton, MA.

Image credit: Shutterstock.com

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