Another Success Story

I see patients at our opioid treatment program at least once a year for an annual assessment. It’s when I sit with the patient and go over their medical history and discuss what has happened over the past year. I like to ask them about their goals in treatment and what they’d like to accomplish in the upcoming months/years.

These annual assessments are enjoyable, because nearly all the patients who’ve been in treatment more than a year are better off than when I first met them. Most have no ongoing illicit drug use, or if they do, it’s not causing devastation in their lives.

For the most part, patients tell me about how pleased they are that they haven’t used any illicit opioids, and how they are getting their work life and family life back on track.

Last week I saw Randy (not his real name), who was typical of patients getting annual assessments. I have changed some minor details so that his identity can’t be recognized.

Randy has been a patient for nearly five years. Just before he started treatment, he was injecting Opana. He started on methadone and gradually increased his dose until he was at 95mg, where he stayed for a few months. Due to late night withdrawal symptoms. I authorized a series of increases in his dose until he reached his present dose of methadone 115mg per day, where he’s stayed for over three years.

He took his last illicit opioid four and a half years ago.

That alone is an outstanding accomplishment, but he also settled into a steady job earning a good living. He and his wife reconciled just after he started treatment and are raising their two children together. With pride, he showed me a picture of his son in a baseball uniform. Randy told me how important it was that he was able to go to his son’s games to cheer for him and said he never could have been there for his son if he were still using Opana.

Though Randy earns enough money to support his family, he doesn’t have health insurance and doesn’t qualify for Medicaid. This past year he’s had his treatment paid for by the State Opioid Response grant. Randy’s doing so well that he only comes once per month to the opioid treatment program, getting take homes for the rest of the days.

Randy hasn’t seen any doctors besides me over the past five years, and I asked him how he felt about getting a primary care doctor who could do basic preventive care, which we do not offer at the opioid treatment program.

Randy’s answer was typical of my patients. “I didn’t think I was going to live this long, using drugs. I never thought about seeing a doctor for any of that.”

Many of my patients have what is called a sense of “foreshortened future.” This means they have an expectation that their life will be cut short. It’s a belief commonly seen in people who have experienced trauma in their lives.

We talked about how since it looks like he’s a survivor of the disease of opioid use disorder, he can now think about things like stopping smoking and getting treatment for the mild high blood pressure I found on exam.

I told him, “If you can make a few small changes and get your blood pressure down a bit, you can reduce your risk of stroke and heart attack ten years from now. And stopping smoking could add quality and length to your life. At this point, stopping smoking is the most important thing you could do for your health.”

I always ask about treatment goals, careful not to impose my views on my patients: “I’d like to ask how you feel about staying on your medication versus tapering down or off it. The best evidence shows you will do better if you stay on methadone, but I understand people have reasons for wanting to taper too. How do you feel about this?”

Randy said he was doing well and didn’t wish to taper at this time, though he’d like to be off methadone in the future. I told him that was just fine, and that I hoped he didn’t mind if I asked him about this from time to time, and he said that would be fine.

I’m always conflicted when I talk to patients about whether they should taper. I know the statistics say that relapses are frequent after a taper, and people die due to relapse. Randy’s doing so well now that I don’t want anything to happen to him. I felt relieved when he said he didn’t want to taper now.

It is his choice. Most people in long-term recovery using methadone would like to get off of it at some point, as they would with most medications for chronic illness. It’s inconvenient and can be expensive, and worst of all, there’s stigma. Friends and family, with the best of intentions, caution Randy that he needs to “get off that stuff.” That puts unfair pressure on him.

My approach is to tell my patients what I know about patient outcomes from the studies and tell them I serve as their consultant. If they want to taper off methadone, I will do anything in my power to help them be successful at it. If they want to stay on methadone indefinitely, I support their decision and congratulate them on their excellent recovery.

Randy is not unusual. In our opioid treatment program alone, we have hundreds of patients just like him. There are thousands across our state and maybe hundreds of thousands across the nation, but you will never hear about them. They keep quiet, trying to avoid unjust judgmental attitudes that people have against their form of treatment.

Even now, when so much of the country’s story about the opioid epidemic has been widely publicized, these successful patients remain hidden. That’s their right, and I understand their decisions because I’ve heard comments based on ignorance and misunderstanding.

Randy told me his parents think he’s already tapered off methadone because they were so opposed to this medication. He says he feels bad for misleading them, but he doesn’t want to have to hear them worry and criticize a treatment he feels has been life saving for him.

It is ironic. The medication and treatment that helped him return to family functions is the only topic he can’t discuss at the Thanksgiving dinner table this holiday.

11 responses to this post.

  1. Can I share your blog on our Facebook Jana?

    And awhile ago you talked about providers at a hospital just stopping someone’s methadone who was in your care at your OTP. I assume it was Frye, is that the case?

    Curious,

    And I hope you have a great Turkey Day!

    Matt

    >

    Reply

  2. Posted by David G. on November 22, 2022 at 3:37 am

    Great story, although this person is stiil compelled to hide the ongoing treatment from his family. Very sad. Decades of MAT and the stigma just will not go away. Nonetheless, he is a wonderful success story. Your skills, unheralded dedication and unmatched compassion for your patients has saved and/or extended so many lives. Never doubt the impact you make.

    Reply

  3. Posted by Shenita James on November 22, 2022 at 2:09 pm

    This is such an inspiring story! I am so proud of “Randy!”
    Thank you for sharing!

    Reply

  4. I also am gratified by such stories. We can’t help them all, but such successes keep me going 45 years after medical school.

    Reply

  5. Posted by Julie on November 22, 2022 at 6:21 pm

    Can I ask a question here. It’s medical in nature but I dont want a diagnosis. I have had panic and anxiety since 5. It was “childhood anxt” back the so nothing was done until I was confident enough to put my foot down with a doctor.
    I have tried everything from parnat4, to seroquel, to nardal, to 20x SS/NRIs prescribed amphetamines, mood stabilisers, brintelix, valdoxan, marijuana, TMS, EMDR, CBT and more than I can think.

    The only thing that gave me quality of life was 2 grams of heroin a day. Where I am you need to be a be a millionaire for life to afford that even though it takes cents to make. 2 grams has stabilised me 7 years. – i don’t keep going up. I work for y money, raise a family, and for all intents am normal.

    Why is it illegal for people like me to be prescribed opioids for tough cases. I beenin psych treatment for 28 yeears. I’m basically at the point of sourcing cyanide as I can’t take it without the relief of opioioids and to me one ie better than the other.

    Sorr for the emotional post. It’s just so ufair when phyisical pain is treated differently; and MAO, SSRI, an triyclics ae more dangerous but not addictive.

    Reply

    • Have you tried methadone? It can give some analgesia and can get rid of any withdrawal from heroin.

      Reply

    • Posted by Kim Smith on November 23, 2022 at 5:51 pm

      Julie I am also a chronic pain patient. Who was in pain management on a good protocol of opiates for pain. Unfortunately because of the opiate epidemic my Dr chose to decrease all his patients. I was in low dose of methadone plus a break through medication. I chose to go to methadone clinic and my pain is between a 1-2. I encourage you to try methadone. I mean what the worst thing that could happen you go back to heroin. The illicit fentanyl is everywhere and I don’t want you to overdose. Prayers are with you ❤️

      Reply

  6. Posted by MikeT on November 26, 2022 at 6:28 pm

    Thank you Jana for this post regarding ongoing stigma in our patients. Congratulations to “Randy” in this particular case. I have so many clients that fit this exact scenario & I am so proud of them. Many for well over 10+ years now. Some of them found the strength & courage to step forward a number of years ago to attend & speak at a state legislative meeting regarding proposed restrictions for MAT. The courage they demonstrated as they stood before a panel of legislators to share their stories just melted my heart. I was also a bit heartbroken as I observed several of the panelists obvious non- verbal averted behaviors as they remained completely unengaged, looking at cellphones, etc.

    It is so unfortunate when they cannot share their stories of success with those they love the most. After all what child doesn’t simply wish for a parent to be proud of them. I have come to find it absolutely amazing as I look back to review a clients initial ACE Score & how it correlates to current family dynamics. The higher scores seem to always relate to the present state of relationships within the family of origin, even after years of successful MAT. I have noticed a small increase in improved family dynamics with some that choose counseling, but not always by any means.

    The most heartbreaking cases I have seen are those that remain so successful in treatment, and after years on various different jobs they have a drug screen positive for buprenorphine. Most situations may have started without an initial requirement for a pre-employment screen (This alone indicates how long these clients have been in treatment), and numerous other situations too long to list such as those that begin with a surgery & progress to chronic pain med use, then OUD. In spite of any letter I write to attempt to explain the facts, outcomes, and a clients success & compliance in treatment, they end up terminated. I have provided patients with information regarding ADA rights, but they continue to think they are wrong somehow. Sadly, none that I am aware of have sought legal counsel as I also understand it is a bit higher on their immediate list to find employment.

    Where do we go from here?

    Happy Holidays Everyone!

    Reply

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