What supported your interest in working in addictions after 18 years in family medicine?
In 2016 I was practicing family medicine in a rural town in Maine. I had a thriving, overflowing panel of patients I looked forward to seeing and caring for daily. A local pain clinic closed its doors abruptly, and the practice was affected by this. I was challenged by the number of people who were being treated for chronic pain who also likely had substance use disorder. It was within this dynamic that two colleagues and I became X waivered to prescribe buprenorphine because we recognized an unmet need in our county. The response to this was positive, and we quickly grew to become a bustling IMAT practice that helped hundreds of patients over the years. This happened when the infrastructure for supporting such practices was being built, so we quickly transitioned from a “hub” to an “intermediate” status per MaineHealth nomenclature, as we were doing inductions frequently. For me personally, in the back of my mind, I knew I loved studying the field of addiction, given my research in the neurobiology of pain; however, I didn’t think I would also love practicing it until it became the best part of my days. l found joy in hearing and dissecting patients’ stories to try to understand what led them down the path of unhealthy substance use; conversely, I loved watching their paths toward recovery. Though these paths are different for everyone; and sometimes can be bumpy, it has always been an honor to walk them with the patients. I am constantly amazed at the courage patients in recovery show in the face of tremendous obstacles; I respect and want to help them fight this battle.
What helped you to decide to stay in Maine to practice after the addiction fellowship?
Staying in Maine was a given. I grew up here (in the small town I currently practice in,) and Maine is home to myself, my family, and the community I want to live in and serve. My husband is also from Western Maine, and we love living, working, and raising our children here.
How did the Addiction Fellowship prepare you for this work? What is the most important thing(s) to know when working with individuals who have addictions?
Completing the addiction medicine fellowship through Maine Medical Center and the VA hospital at Togus was the best professional move I have ever made. I learned so much beyond how to study again. I learned how to present data and information to a wide variety of learners and skill sets. Through this work, I found a joy in teaching that I never had before. I also learned that the key to healing burnout and moral injury is to find something you love and go after it in full force. It rejuvenated a passion I once had for practicing medicine and made me grateful that I found this field.
What have you found most fulfilling working with this population?
The most fulfilling aspect of working with this population is looking people directly in the eye and convincing them that I care for them just as deeply as I do any of my other patients that I have cared for throughout my years as a primary care physician. I love working against the tide of the stigma that fights them every day as they attempt to go about their lives despite struggling with this debilitating disease. I also enjoy being that voice of reason in a chaotic world where this issue often gets swept under the rug; it is just as pervasive as any other chronic health condition that takes lives every day and deserves the same energy and fight to combat it. I love this work.
Any suggestions or thoughts to share with PCPs across Maine whose practice no doubt has individuals who have addiction issues?
My first thought would be not to be afraid to work with this population. I was amazed at how quickly I realized that this population was no different from the population I had worked with for years, with many overlaps. This disease does not discriminate and affects all walks of life. It affects all of us, and I believe this to be truer in rural Maine. I had to declare my intention to leave primary care and attend fellowship almost a year in advance of my leaving my primary care panel. That left a year for me to discuss the plan with my patients, some of whom I had taken care of for over 14 years. By and large, everyone was supportive and understanding of this change. However, it also gave us lots of chances to discuss how they were affected, even if indirectly, by the consequences of addiction. This experience led me to see that no one is immune. Whomever you talk to has been affected in some way by addiction, whether directly or through friends or family. This realization was eye-opening to me.
How do you envision the addiction services in Norway and Stephen’s Memorial Hospital developing?
Currently, my team is accepting referrals for outpatient consults and, in six weeks, has completed over fifty of these referrals. We see all ages and all types of substance use disorders in addition to hepatitis C and perinatal substance use disorder. I envision the practice expanding to include inpatient and ED consults over the next few months. We hope to offer even more harm reduction measures than we already do and plan to watch practice grow.
Any thoughts/tips to share with others who may be hesitant to embrace addiction treatment, etc.?
I would say just jump in. Taking the half-and-half buprenorphine training course that is offered twice a year through The MaineHealth Substance Use Education Committee is a great way to get your feet wet. To obtain the waiver to prescribe to more than 30 patients, physicians are required to take 8 hours of training. This course is 4 hours of face-to-face training with an instructor followed by 4 hours of on-your-own online training. NPs and PAs can also take this course and receive credit for 8 hours. This will then apply to their 24-hour training requirement. (Please note that no training is required to apply for the waiver as of 2021 as long as the prescriber treats less than 30 patients; however, most experts would argue that some training is a good idea. The half-and-half course is a very thorough introduction to the treatment of opioid use disorder and the ins and outs of prescribing buprenorphine. By taking the course, you are under no obligation to apply for the waiver, but it will give you a good solid bank of information to see if this interests you. In addition, the American Society for Addiction Medicine offers a one-hour course called the ASAM Buprenorphine mini course. This is less of a time commitment and may be just what you need to see if this would augment your current practice. Both of these courses can be accessed at www.mainehealth.org/SUD-resources.
Any else I haven’t asked that you would like to share?
In addition to being the medical director of the Western Maine Addiction Medicine Program, I am also currently conducting harm reduction research. More specifically, I am investigating injection drug use patterns and practices as well as syringe service usage and needs in rural Maine. If anyone is interested in this work, please reach out.