This month at the AATOD meeting in Baltimore, Maryland, Spencer Clark won the prestigious Dole-Nyswander award for service to the field. Spencer is the director of North Carolina’s SOTA (State Opioid Treatment Authority).
I’m so pleased he got this award. He’s earned it, for all the hard work he’s done to improve the quality of care given to patients at OTPs in NC.
Being SOTA director can’t be an easy job. He’s had to lead doctors, legislators, OTP owners and managers to a better plan of care for those with opioid addiction.
Spencer has been able to get OTP physicians together, so that we can educate each other about the best standards of care. I don’t know about the other groups, but getting a group of physicians to gather in one place and agree on anything is like trying to herd cats
With the help of the North Carolina Governor’s Institute, Spencer started monthly telephone conferences for all the doctors who work in North Carolina opioid treatment programs. These phone calls, led by a knowledgeable physician moderator, usually start with the presentation of a difficult case, and participants give suggestions for how best to handle the clinical vignette. Then we discuss various timely topics that complicate care to our patients with opioid use disorders.
This sounds like such a simple thing, but it’s had such a beneficial effect for the doctors who participate. This is a very specialized field, and we frequently get difficult cases fraught with medical and ethical issues. Now physicians in North Carolina have access to other doctors with similar specialized knowledge, to discuss difficult and complex cases.
It can be lonely, working as a physician at an opioid treatment program. We don’t usually have a lot of contact with doctors sharing our common vision of how to treat opioid use disorder. More often, OTP doctors are criticized by other community physicians, usually behind our backs, out of ignorance of our work.
SOTA and the Governor’s Institute, along with the North Carolina chapter of ASAM (American Society of Addiction Medicine) also started sponsoring yearly meetings each spring. These several-day conferences have had excellent speakers from around the nation. I’ve learned so much at these meetings, and look forward to it every year.
Spencer Clark set up an unofficial physician mentoring program as well. I help out in the Western part of the state, and another physician is available in the Eastern part of the state. We are available at all times to answer any questions OTP physicians might have. It’s a state-wide version of the national program Providers Clinical Support System (PCSS), run by the American Association of Addiction Psychiatry, which provides guidance for physicians across the nation who treat opioid use disorders with buprenorphine, methadone, or naltrexone.
Since there can be regional variations in drug use problems, a physician in the same region can sometimes add complementary perspective to what a national expert provides.
Spencer Clark came to his office in 2007. At that time, I was pulling my hair out because I’d just become medical director of a large, multi-site opioid treatment program, and we had too many patient deaths. Even one is too many, and I remember we had three patients die in one weekend, over Easter weekend that year.
I analyzed data from all the decedents, and it was obvious we had to change some things about our treatment program. I told the administrators of this program that we had to start being open all days of the week, and that we could not give take homes to brand-new patients. We had to lower starting doses, and start scrutinizing benzodiazepine-using patients to see if they could be started safely in treatment, or needed inpatient detoxification first, to get off benzodiazepines. I had a few other things to recommend, and to their credit, the administrators began to implement some of my ideas.
But later that year, when Spencer Clark came to SOTA, he sent a letter to the president of the opioid treatment program, wanting to know – in essence – what in God’s name was going on with these overdose deaths??
I remember one administrator lamenting that Spencer had taken over as SOTA director. He said of Spencer’s letter, “This will blow over. This isn’t going to amount to much.” I remember thinking, “OK, you’re wrong. Now we appear to have a SOTA director who gives a damn about what’s going on in the methadone clinics.”
Spencer made my job easier. With that pressure from the SOTA, I believe administrators were more willing to implement needed changes. I still wasn’t able to get them to provide buprenorphine in addition to methadone, but other changes reduced our death rate.
Spencer helped the physicians who work at OTP become allies. We set a standard of care, giving individual doctors more clout with the OTP owners. We can now point to what other physicians are doing to improve patients care and safety. And if an OTP owner is intransigent, refusing to make a needed change, that’s information for the physician. She then had to decide what to do – keep working at that program, or look for a greener pasture.
Spencer’s efforts are always focused on making treatment for patients with opioid use disorder better and safer. He may disagree with individuals and agencies about what that looks like in actual practice, but his driving intent is always about the patients. I’ve heard he’s occasionally ruffled some feathers at the quarterly OTP managers meetings. Therefore, it’s a tribute to his tact that this same group nominated him for the Dole-Nyswander award. He’s able feather-ruffle in a way that’s respectful, and clearly motivated by a desire to improve the health of patients with opioid-use disorder.
Well done, Spencer! You richly deserve this award.