Amy Zipperer, AGNP-C, joined the medical staff of Regional Medical Center at Lubec in 2021. She is a nurse practitioner who specializes in primary care for adolescents, adults, and older adults. She completed her master’s degree in nursing at Duke University in 2021 and is board certified by the American Academy of Nurse Practitioners. Amy has a special interest in working with patients with substance use disorders.
What inspired you to practice medicine in rural Maine?
I moved to Washington County 20 years ago, before I became a nurse, so I practice here because I live here. I completed my nurse practitioner training away from here, but I was inspired to do it because I saw the need for medical providers who were interested in living and staying here for the long term.
What sparked your interest in caring for individuals with substance use disorders?
It didn’t really occur to me to opt out of treating substance use disorder. And there happened to be a need when I started my first job as a nurse practitioner, so it has grown from there.
Based on your experience in primary care, what are the challenges and opportunities in caring for individuals with substance use disorders in rural Maine?
When I listen to colleagues who have been practicing in this area for decades, it seems to me there is a sort of wound among clinicians who worked during the height of opioid prescribing and the tragic aftermath. I think the politicization of issues of addiction and substance dependence keeps many experienced clinicians with so much to offer from wanting to step into the fray, though there is really no way out of the fray. I think it is a place that could use a bit more of our attention and compassion, especially on a policy making level. I think it’s much easier for newer clinicians like me to say: “Sure, of course, addiction treatment is part of primary care,” because in the five years I’ve been practicing, it seems possible that could be true. I think I have the luxury of a less fraught relationship to it. The evidence that medication for opioid use disorder saves lives is clear. So, I think if we can prioritize this life saving thing, as we do with the vast majority of all other healthcare decision-making, that could help us clarify what we are doing. But the wounds need to be tended, too.
What do providers need in a rural setting?
Support, comradery, creativity. ME SUD Learning Community has been important for me. I started as a new NP practicing in Lubec five years ago without much mentorship on the ground for this work. The person who trained me passed away shortly after I started. So, as I’ve asked myself, “Is this the right thing? Is my decision making on track?” it’s made a huge difference to have access to experts in the field. I think the more clinicians feel supported, the more we can challenge ourselves to attempt to meet what is being asked of us.
What would you say to colleagues practicing in rural Maine to encourage them to address substance use concerns in their patients?
When I think about all the things I do in primary care, the part that involves prescribing medication for opioid use disorder feels like it has a huge impact on the lives of patients I see. I get to have wonderful conversations, learn from all sorts of people. I would encourage new clinicians to dive in, listen to their patients, and find supportive colleagues and mentors, and go for it. And I’d encourage clinicians who have been practicing for a long time to dive in, too, because we need their experience, we need their wisdom.
Are there particular substances, trends, or populations that you are seeing more frequently or have high needs?
I’m seeing a lot more methamphetamine use. It seems to be very available and causing a lot of trouble for people. Benzodiazepines, illicit and prescribed, are another big issue for people. Treatment is just more complicated. We don’t have medications, so it’s like, okay, what do you do? What does a person’s life allow for if they can’t necessarily go away and do an intensive treatment program? What’s possible? Telehealth IOP is available, but for some people it doesn’t fit. The illicit drug supply is becoming more unpredictable and dangerous. And best practices around benzodiazepine prescribing have shifted but often don’t match what patients believe to be true. So, we need more grounded-in-reality help in these areas, for sure.
Transportation is always a huge issue for patients, and connecting people to support and treatment, including MOUD, is critical. I think incentives for organizations to continue to support more robust services — substance use counselors, recovery coaches, peer support — could go a long way to making some of these vital needs available when the call arises. There are so many paths in recovery, so many paths to living. I guess I’d just love for us all to keep trying to collaborate, to find each other, and take care of each other.
How can the Maine SUD Learning Community best support ongoing learning and professional development in rural settings?
Accessible web-based learning is very practical because things are constantly changing and shifting and most busy clinicians can find the time for a Zoom meeting at lunch time here and there. The face-to-face gatherings are so beneficial because something special can happen when we’re together in real life that’s harder to find online. Your programs and support have really helped me feel connected to a wider community of wonderful clinicians across the country. More one-on-one mentorship and direct support would be wonderful as well.
Is there anything else you would like to share with members of the Maine SUD Learning Community or with other clinicians who provide care in rural Maine?
By incorporating substance use treatment into primary care, I appreciate that I can address medical issues as they arise, offer preventative care, and treat the whole person. To me, it is aligned with rural medical practice to address what is addressable with the tools and training available to us.