Give Thanks



OK, here is the column I was preparing before I became impaired by turkey tryptophan last week:

I have plenty of things to be thankful for in my personal life, but this column is about my gratitude for what’s happening in my professional life.

  1. I believe stigma against medication-assisted treatment of opioid use disorders has decreased over this past year. With the continued appalling mortality from opioid-related overdose deaths, people in positions of power have been forced to look for solutions. And when you look for solutions proven to help reduce opioid overdose death, there’s more evidence for maintenance use of methadone and buprenorphine for these patients than any other intervention. If you do any research at all, you can’t ignore this evidence. Well, unless you are Dr. Phil, but I digress.

In fact, some of my colleagues feel, and I agree, that abstinence-only treatment programs are committing malpractice if they fail to inform patients with opioid use disorder about the options of methadone and buprenorphine maintenance.

Policy makers and people who decide who gets grant money now look for grant proposals that include medication-assisted treatment of patients with opioid use disorder as necessary to get grant money. Money talks louder than any lecture, conference, or review article, and so some professionals who didn’t “believe” in MAT in the past are now becoming believers. I am fine with that, since patients benefit.

I’m excited to be involved with several grants, as a consultant in two and as a provider in another. This makes me happy, because all I have to do is what I always do – provide care and serve as a consultant if someone wants to pick my brain. I’m enthusiastic to see the final results of how we can improve care with better communication, too.

  1. More people know about naloxone for opioid overdose rescue. As a routine question when I admit new patients, I ask about past overdoses and I ask if they have a naloxone kit and if they know what they are used for. Most people know what the kits are for, and many already have kits. Some returning patients are reminded to tell me their kits have been used – usually on a friend or acquaintance.

Most of our patients got their kits, directly or indirectly, from Project Lazarus, the grass-roots program that started here in North Wilkesboro. It’s been copied in many other places, and does a wide variety of helpful services. This program provides education for law enforcement, physicians, community leaders, and any other interested parties on opioid use disorder, opioid overdose, and how each part of the community is needed to improve the lives and health of these patients.

As the founder of Project Lazarus, Fred Brason was given the Robert Wood Johnson award, and recognized for ground-breaking action in our community that can be duplicated in any interested community.

My state now has third-party prescribing, meaning I can write a prescription for naloxone to a worried parent or friend of someone with opioid use disorder. I did this twice yesterday, after two of my office-based buprenorphine patients, stable for years, talked about their fear a family member was going to die of an overdose from active opioid use disorder. My patients were very grateful, and I felt happy my state felt this was an important law to enact.

Naloxone kits aren’t treatment, but can help keep a person alive until they reach some sort of treatment. As I repeatedly say, dead addicts don’t recover.

  1. More physicians are willing to talk with me about the patients we share. Several months ago, a meeting was scheduled by one of our local OBs which included most of the obstetricians working in our area, all MAT providers in our county, the local health department, hospital representatives, and pregnancy care coordinators. DSS and anesthesiology were also invited but didn’t come. Our hospital’s new neonatologist was there, as was the head hospital pharmacist, who has always been an ally to me.

I was there along with the nurse manager and program manager of our opioid treatment program. We came armed with reams of information and recent studies to hand out to all participants, along with some of SAMHSA’s publications about medication-assisted treatment of opioid use disorder in general.

The meeting was ultimately productive, though it started poorly. In his opening statements, the head of the hospitals OB department accused me of “allowing” patients with opioid use disorders to get pregnant. I fired back at him, and accused him of being difficult to speak with because of his openly hostile stance on MAT.

A pregnant pause settled over the meeting, if you will pardon the pun, until cooler heads prevailed. Then we started talking about the actual mechanics of how we all could improve communication and treatment for these patients.

Aside from the opening of the meeting, it went well. We decided on ideas of how better to communicate with each other. Since that meeting, I have been sending updates to OBs of patients’ progress (with permission from our patients, obviously). I’ve been more diligent at asking patients to see their OB or the county health department for family planning if they aren’t on contraception and don’t desire a pregnancy.

The last pregnant patient who delivered at our local hospital was happy with her treatment there, and says she was treated courteously by hospital staff. She had a chance to meet with the neonatologist before delivery and felt comfortable with him, too.

  1. Now for the best of all…our opioid treatment program just moved into a new facility.

It’s great. It feels like a football field compared to the too-snug warren of offices we worked from before the move. Best of all, I am no longer located right beside the patient bathroom. My office smells gently of the scented candle I have on a shelf. And I have my own sink. I can wash my hands between patients without having to make a trip to the nearest bathroom!




I’ve worked over fifteen years in OTPs, at over fifteen separate sites. This is the best physical plant I’ve seen. The company, a for-profit hospital and mental health chain, spared no expense with renovations. All of our computers are new, as is our phone system, and all of our furniture. We have six dosing windows so that once we are up to speed, our patients will have short wait times. Patients waiting to see me have a separate waiting room. New patients, usually not feeling all that well, don’t have to be around the noisy interactions of the main waiting area.

What I like best is exactly what one patient said to me after looking at the facility: “You know, it looks just like any other medical practice.”

Yes. Because it is a medical practice. We provide life-saving, evidence-based medical care. The owners of this company sent an important message with this renovation – that our patients and our staff are deserving of a nice facility where we provide this important care.

I have great expectations for 2017.

3 responses to this post.

  1. You are awesome! I miss you!


  2. Are you familiar with the NC POEP’s toolkit? (

    It might help conversations your having with local OBs.


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