Blog Anniversary and…. I Win an Award

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Eleven years ago, I started this blog to provide a dependable source of information for people seeking to learn more about opioid use disorder and its treatment with medication. Back in 2010, there wasn’t as much talk about the festering opioid use disorder epidemic in our country. Back then, pain pill mills still flourished in some parts of the country, pouring fuel on the fires of this illness.

Not many people outside the field of Addiction Medicine endorsed the use of buprenorphine products or methadone as a treatment choice back then, and I felt aggrieved by that. Here was this treatment with more evidence to support its benefits than practically anything else in all of medicine, yet there was much misinformation and stigma against it.

“If people just knew of the benefits,” I thought, “If they just knew and understood, they would feel differently about these medications and this treatment.”

I set out to educate as much of the world as I could.

My blog didn’t always get it right. When I read early blog posts now, I sometimes cringe. I use more person-centered language now, and I like to think I’ve become less judgmental towards critics. Trading insults doesn’t really help anyone and perpetuates bad feelings.

I’m an odd person to be writing such a blog. I did my medical residency in Internal Medicine. I didn’t get any training in Addiction Medicine during my residency, though I did learn about 12-step recovery in medical school. At The Ohio State University, every medical student was required to attend at least one Alcoholics Anonymous meeting.

After residency, I worked for seven years in primary care before I developed my own substance use disorder. I took time off work to seek treatment. Like most physicians, I was lucky to receive high-quality treatment with prolonged monitoring after acute treatment. As part of that treatment, I was asked to participate in 12-step recovery.

For me, it worked well. It filled a void in my life by forcing me to re-connect with people without the title of “physician.” During 12-step meetings, I was like all the others seeking help.

I found a great deal of benefit from the Twelve Steps and Twelve Traditions, and from my sponsor, who remains a dear friend these nearly twenty-three years later. I grew as a person and re-connected with a neglected spirituality.

After my treatment, I went back to work in primary care, and found it just as distasteful as before. I was looking for something different when a doctor friend asked me to work for him at a treatment center while he went on vacation.

I thought I’d be doing admission physicals on patients entering their inpatient (abstinence-based) program, which sounded like fun. I did NOT know I’d be seeing patients on methadone and starting patients on methadone. By the time I found this out, I’d already made a commitment to my friend so I couldn’t back out.

I felt like this methadone thing was shady, a “fringe” area of medicine, and decided that when my friend returned, I’d tell him I didn’t “believe” in putting addicts on drugs like methadone. My opinions were based on mistaken preconceptions, certainly not on science.

The patients I saw started my education process. They told me how methadone (buprenorphine was not yet available) had changed their lives for the better and helped them stabilize into the person they were always meant to be. “How can this be true?” I thought. What the patients were saying, and the positive changes I was seeing with my own eyes, contradicted what I thought I knew about treatment and recovery.

Intrigued, I started reading about opioid use disorders, called “opioid addiction” at that time. I went to local addiction medicine conferences and eventually joined the national American Society of Addiction Medicine and our state chapter. I discovered a ton of data clearly proving the benefits of methadone in the treatment of opioid use disorder. I was amazed to read that starting methadone dramatically reduces the risk of patient death.

Not dying…that alone makes this medication worthwhile.  How could I not have heard about this before? As we know now, medical school and residencies paid little attention to addiction and its treatment, so no wonder I had not learned about the use of medications for opioid use disorder.

I gradually transitioned from primary care to addiction medicine, and by 2004, I was working exclusively at opioid treatment programs.

Meanwhile in my own recovery, I continued to go to 12-step meetings. Of course I never spoke about my work at meetings, knowing how most people there felt. But gossip exists in those rooms as it does in every human organization. A few times I was approached after a meeting and told what I was doing professionally was wrong, and against the policies of that 12-step group. Fortunately, by then I knew no person could speak for the entire organization. I also knew these misguided people didn’t have all the facts. They were like I had been, which was uninformed.They didn’t know the science behind treatment. They were relying on opinion and not fact, so their opinions didn’t matter too much to me.

I knew what the science said, and I leaned on that. I also talked to other people in recovery who worked at opioid treatment programs. They also went to 12-step meetings and worked with patients being treated with methadone. They didn’t see any conflict. Those wise people didn’t see one form of treatment opposing another. They felt different treatments should be complementary. That is, rather than an “either/or” approach, recovery could be “both/and.”

That’s what I think now. I hear abstinence-only proponents criticize medications for opioid use disorder, and I think to myself, “If you only knew how much some people benefit from methadone/buprenorphine, you would change your mind.” When I hear people who support medications for opioid use disorder talk badly about 12-step recovery, I think the same thing. If you could only see the great benefits some people get from these recovery meetings, you wouldn’t be so harsh. Meetings aren’t perfect, and the people who attend them certainly aren’t, either, but they can be so helpful.

This year, I have the honor of receiving the Holden/Lane award for Patient Advocacy from the American Association for the Treatment of Opioid Dependence. I believe it is mostly for my efforts writing this blog, and for some other advocacy things I’ve done at a local level for my own patients.

I am thrilled to receive this honor, and a little embarrassed, too. I feel like there are hundreds of people like me working in our field, toiling to do our best job for the patient sitting in front of us, day after day, week after week, etc. My efforts seem puny when compared to professionals who lobby congress and work on changing laws in our nation.

But I do feel a fire to defend and promote adequate treatment for all patients with opioid use disorder, and it’s turned into kind of an obsession for me. I understand how medical professionals lack education about opioid use disorders. And when I offer information to other people including professionals, I expect them to care about the science. When they don’t…I can write snarky things about them in my blog, which is still kind of fun.

I get angry when my patients, mostly all nice people who happen to have a bad disease, are treated poorly. When they endue prejudice and stigma, I get a little obsessed with correcting mistaken impressions and assumptions. I’ve written letters and made phone calls to all sorts of medical and dental professionals, to judges and lawyers, and to law enforcement personnel.

I’ve given many talks locally and around my state about opioid use disorder and its treatment with medications. I’ve talked to probation and parole officers, to EMS workers, and other members of the community. I’ve spoken at churches, university conferences, to community groups, and with DSS workers. I’ve talked to groups of doctors and to nurses. I hate talking in front of people, but after I get started, I lose myself in trying to communicate the important message that medications used to treatment opioid use disorder do work.

I am deeply grateful to be chosen for this distinguished award. The winners in previous years are most impressive people, so these are big shoes to fill.

I plan to continue to advocate as I can, by letter writing, giving talks when asked, and…by continuing this blog.

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