Posts Tagged ‘third wave of opioid epidemic’

An Evening of Enlightenment

 

 

 

 

I had the great pleasure of going to a training held by Dr. Alan Wartenberg last week, at the Revida Recovery facility in in Johnson City, Tennessee.

His topic was opioid use disorder and its treatment with medication, but the talk was so much more than that. He covered all of that competently and easily, but his talk was funny, poignant, and encouraging. He reminded me of why I love my job.

I loved every minute of his talk, and I felt uplifted and enthusiastic afterward. I went with my long-term fiancé and chatted excitedly for about half of the long drive home. My fiancé, who is an addiction counseling professional specially trained as a Motivational Interviewing Network of Trainers also found the experience to be of great value.

The whole meeting was about four hours, with the first part being educational, then ended with a long question and answer session.

Dr Wartenberg has been around while. He lived through the ridiculous phase of twenty years ago when physicians practically threw opioids at patients for any type of pain. He used intravenous buprenorphine for patients in detox units as far back as 1992, which is kind of amazing.

I particularly absorbed his message about the importance of keeping all patients in treatment, barring specific dangerous situations.

It’s been a very long time, thankfully, since I’ve tapered patients out of treatment because they couldn’t or wouldn’t stop using marijuana. It hasn’t been all that long since I stopped tapering patients out of treatment for continued stimulant use disorder (methamphetamine, cocaine). This year, I’ve become more reticent to taper patients off methadone and buprenorphine because they continue to use benzodiazepine and/or alcohol.

After listening to Dr. Wartenberg, I’m convinced I must go farther in this direction.

In this third wave of the opioid epidemic, fentanyl use changes the decisional balance. Relapse back to heroin/fentanyl use presents such an increased risk of death that it dwarfs the risks of benzodiazepine, alcohol, and other sedative use in methadone patients…in many cases.

There will still be some cases where the risk of remaining on methadone will be too high; for example, if the patient comes to the opioid treatment facility impaired, or if the patient has accidents and continues to drive while on methadone and sedatives. We have a duty to our communities and to other patients to keep the OTP from becoming a negative influence.

But for patients with regular benzodiazepine use without factors that indicate imminent danger, I now feel like I need to work harder at increasing their counseling and contact with treatment staff, without asking them to leave treatment. And I need to push harder for the state ADATC to admit struggling patients to detox and rehab, while continuing their buprenorphine and methadone.

So I had a great evening. Besides what I gained from Dr. Wartenberg, I got to spend a few hours with the love of my life driving through beautiful mountains, I saw some old friends, and I met new friends, other providers working hard to help our patients.

I appreciate Dr. Wartenberg’s experience, passion, and for his ability to re-ignite my enthusiasm for working with our patients. He reminded me of the importance of doing my best for the patient sitting in front of me. And that’s really what’s most important.