Philly doctor: I'm one of 4% of physicians nationwide to provide office-based opioid treatment | Perspective
Despite a pretty common misperception that substance misuse is a choice, none of these patients would have chosen this medical illness, much in the same way that they would have not chosen the events that contributed to it.
One of my medical assistants looks forward to Thursdays. She says, "I just feel like we're saving lives." "That's what we do here," I tell her.
But mostly, I think of it as restoring hope.
I'm a family physician, and on Thursdays, my team spends time providing care for individuals struggling with opioid use disorder (OUD) through the provision of buprenorphine, a form of medication-assisted treatment (MAT).
This makes me unique. According to recent statistics, just 4 percent of physicians nationwide — and 5.7 percent of primary care physicians — possess the waiver required to deliver office-based opioid treatment (OBOT).
This is certainly not promising data at a time when the news is full of stories on the consequences of prescription and illicit opioids in our communities nationwide. Despite this opportunity for physicians to play a role in the multidisciplinary, multifocal strategy needed to address the crisis, I am still asked by colleagues: "How can you do this?"
While my answers are many, I can tell you with certainty it is largely because of whom I choose to spend these afternoons with.
A couple struggling with the loss of their newborn son, a young woman struggling with pain issues after work-related injury, and an elderly gentleman who struggled as a teenager with racial bias in his neighborhood are just some of the individuals I have encountered. Each with a personal story and a unique perspective, and each suffers from OUD.
Despite a common misperception that substance misuse is a choice, none of these patients would have chosen this medical illness, much in the same way that they would have not chosen the events that contributed to it.
While many people question why an individual struggling cannot see the damage that opioid use is doing to both the individual and the family, the psychopathology of OUD is such that it alters individuals' ability to clearly see the negative consequences of what they're doing.
We cannot simply make judgment on anyone's story based on the chapter we happened to enter into. Instead, we must be supportive — particularly because the major choice that faces those who struggle with substance-use disorders is the one they must make about seeking help.
A common story for the individual who enter our buprenorphine program is one of fear and lost hope.
My students regularly comment on the emotional reaction patients have at the end of their first visit with us: "Thank you for being so nice to me."
But why wouldn't we be? Sadly, many of my patients are all too familiar with a society, a health-care system, and a world that disenfranchises them.
Buprenorphine is used as a form of maintenance therapy in the treatment of opioid-use disorder and has strong evidence for effectiveness in treatment. In fact, its use in pregnant women has been shown to be more cost-effective in reducing Neonatal Intensive Care Unit stays for babies born with neonatal abstinence syndrome compared with methadone.
There's nothing about the medication or the ability to prescribe it that particularly excites me. But many physicians don't like it, for reasons that include a perceived lack of behavioral health support, low confidence, time commitments, and questions about reimbursement.
But for me, seeing that couple raise their children with the husband holding a steady job and the mother obtaining her GED, and watching that young woman successfully working two jobs and enjoying her life, and witnessing that elderly man change lives around him, are the reasons to do this.
As a family physician, it's probably one of the easiest things that I do, and certainly sharing in the recovery experience of these individuals is inspirational and hugely rewarding.
And so, I look forward to Thursdays too. In recovery, there is hope. After all, that's what we do here.
David T. O'Gurek, M.D., FAAFP, is a family physician and assistant professor in the department of family and community medicine at the Lewis Katz School of Medicine at Temple University.