Primary Care Pearls
Primary Care Pearls
"I no longer felt like I didn't have a choice." - Opioid Use Disorder (Part III)
In the third episode of our opioid use disorder series, we explore therapy, sponsors, and return to use with our patient TJ and Expert Dr. Chan. Share your reactions and questions with us at Speak Pipe. We might feature you on a future episode!
=== Outline ===
1. Introduction (0:00)
2. Chapter 9: Therapy (individual vs group) (3:29)
3. Chapter 10: Sponsors (17:33)
4. Chapter 11: Return to Use (21:40)
5. Conclusion: (34:39)
=== Learning Points ===
- While resources such as group therapy, NA, and other 12-step programs are not for everyone, they can be important tools to offer our patients.
- Sponsors can often relate to a patient’s struggles with opioid use disorder more authentically than we can as their providers. While a sponsor may not be for everyone, they can be invaluable to walk alongside some patients on their journey.
- Return to use is hard, both for patients and providers. We must accept that return to use is part of the disease of addiction, and this is not an excuse to pull back on medication treatment or to give up on our patients.
=== Our Expert(s) ===
Dr. Carolyn Chan is an academic hospitalist at Yale New-Haven Hospital with interests in medical humanities, quality improvement, and addiction medicine. You can reach her on twitter @CarolynAChan.
Dr. Lisa Sanders, MD, FACP, associate professor of medicine (general medicine) and author of the popular Diagnosis column for the New York Times Magazine offers her media expertise to the PCP team as a production consultant for the podcast.
=== References ===
- SAMHSA’s National Helpline: https://www.samhsa.gov/find-help/national-helpline
=== Recommended Reading ===
- Buresh M, Stern R, Rastegar D. Treatment of opioid use disorder in primary care. BMJ. 2021 May 19;373:n784. doi: 10.1136/bmj.n784. PMID: 34011512.
- Alexander GC, Stoller KB, Haffajee RL, Saloner B. An Epidemic in the Midst of a Pandemic: Opioid Use Disorder and COVID-19. Ann Intern Med. 2020 Jul 7;173(1):57-58. doi: 10.7326/M20-1141. Epub 2020 Apr 2. PMID: 32240283; PMCID: PMC7138407.
- Hoffman KA, Ponce Terashima J, McCarty D. Opioid use disorder and treatment: challenges and opportunities. BMC Health Serv Res. 2019 Nov 25;19(1):884. doi: 10.1186/s12913-019-4751-4. PMID: 31767011; PMCID: PMC6876068.
=== About Us ===
The Primary Care Pearls (PCP) Podcast is created in collaboration with faculty, residents, and students from the Department of Internal Medicine at the Yale School of Medicine. The project aims to create accessible and informative podcasts for furthering the medical education of residents and clinicians in early stages of their careers. Building on the work of other medical education podcasts, Primary Care Pearls includes contributions from patients themselves, who have the autonomy to share their own experiences of how their primary care physician directly impacted the quality of their care.
Hosts: Nate Wood, Maisie Orsillo, Addy Feibel
Logo and name: Eva Zimmerman
Theme music and Editing: Josh Onyango
Producers: Helen Cai, Addy Feibel
Other Background music: Slynk, Astron, Nathan Moore, Dream-Protocol, Emmit Fenn, and Arcadia
Instagram: @pcpearls
Twitter: @PCarePearls
Listen on most podcast platforms: linktr.ee/pcpearls
Addy: Hi everyone. My name’s Addy Feibel.
Nate: And my name’s Nate Wood.
Addy: welcome to primary care pearls. A podcast made by learners for learners. And most importantly led by our patients’ stories. Today,
TJ: [00:13:18] I know that, um, when I went to my first meeting, I never forget a young lady saying that, just listen.
[00:13:33] And if you don't get it, it'll get you. And that was at an NAA meeting and it got me, it did and got me
[00:14:06] And I found out that, that the meetings were basically just a bunch of us sitting around trying to live life on life's terms. So, so today they mean a lot to me.
Addy: we’ll be talking about therapy, sponsors, and return to use, part 3 in our OUD series.
Nate: During our discussion, we will be joined by TJ, a patient living with opioid use disorder.
[00:00:28] Hi, I'm TJ. I am one of the patients that the clinic arc and, um, I've been part of arc for about five years.
Nate: We’re also joined today by addiction medicine expert, internist, and medical education fellow at the Yale School of Medicine, Dr. Caroline Chan.
[00:00:32] Hey everybody. My name is Caroline Chan. I am so happy to be here and talk about one of my favorite topics, the treatment and care for patients with opioid use disorder. I am an internal medicine physician and an addiction medicine physician. And as Nate said, I am a medical educator.
Addy: With our conversation facilitated by resident interviewer, Dr. Mariah Everts.
[00:00:00] So I'm Mariah Everts, I'm a third year resident this year in the primary care program at Yale. I've been particularly interested in addiction medicine as a resident. Um, and so I've spent a bunch of time in our addiction recovery clinic. Which has been one of my favorite parts of residency
Introduction to hosts and to the episode
Addy: My name is Addy Feibel, and I’m a second-year medical school student at the Yale School of medicine.
Nate: And my name’s Nate Wood. I’m an internal medicine physician and medical education fellow at the Yale School of Medicine. Addy and I will be your hosts for today’s episode.
You’ll also hear one other familiar voice during today’s episode, my friend Dr. Maisie Orsillo.
[00:00:59] this is Maisie, a PGY two in the primary care program
Nate: Who you know as co-host of Primary Care Pearls. She also helped interview our expert for today’s episode, Dr. Carolyn Chan.
Addy: Before we get started, please know that this content is meant to be for learning and entertainment purposes only, and should not be used to serve as medical advice. If you or a loved one is suffering from anything covered in today's episode, be sure to discuss it with your medical provider. Now on to the show.
Chapter 9: Therapy (individual and group)
Addy: Last week, we talked about the three types of medications that are FDA-approved for treating opioid use disorder: naltrexone, buprenorphine, and methadone, and those have really become the first line treatment for opioid use disorders. But when we think of treatment for a substance use disorder, the first thing that comes to mind for many of us, and probably for many of our patients, isn’t going to be medication. It’s going to be group therapy.
Group therapy programs such as Alcoholics Anonymous and 12-step programs have become such mainstays of treating substance use disorders that I would say a great deal of the general public is at least familiar with the names of these programs. So how do these group therapy programs, or counseling more broadly, fit into the equation when it comes to treating opioid use disorder?
[00:28:58] So I think in terms of the counseling piece, um, that's really, that's really an important piece as well. I think in someone's recovery. I will say that I do not think counseling or 12 step programs should be mandatory for any of Our patients.
[00:29:16] Right? If a patient just wants medications from us, studies have shown time and time again, that medications are extraordinarily effective and adding counseling doesn't necessarily improve outcomes. Okay. But I will say that oftentimes there's benefits either from having an individual therapist from getting personalized cognitive behavioral therapy from doing an IOP, an intensive outpatient program, right.
[00:29:41] To really build up an individual's coping skills or manage something else that's going on, help manage the underlying depression, anxiety disorder. Bipolar disorder, right? There are so many things that come into play. I never make it mandatory for a patient. I often encourage it though. Cause I think it can be helpful for patients.
[00:30:01] And again, I give them options. Hey, what do you think would work best for you? Do you think you'd enjoy a one-on-one counselor? Are you somebody who would be in a group setting, you know, what do you think would work best for you and 12 steps? You know, aren't for everybody, but they are cheap. They're free.
[00:30:16] They're accessible. For some patients, it's a game changer. So I like to encourage people to try one of them, you know, or try a couple and see what works best for them, but I don't make it required.
Nate: [00:32:01] I know you've seen lots of patients. Who've probably had lots of different opinions on group therapy. Some folks really seem to love it. Others seem to shy away from it. So, uh, in your experience in, um, you know, engaging with folks in group therapy or referring them, what kind of value do patients get out of group therapy and what types of patients might benefit the most?
Carolyn Chan: [00:32:26] That's a good question. So there's a number I think of, there are a number of different types of groups. So I can think of a group in a formal medical setting, like intensive outpatient therapy, or I can think of something that's more 12 step based, like alcoholics anonymous or smart recovery. So I do think that patients have to feel comfortable in a group setting. Um, they have to sort of want to be there at least somewhat to, to engage. I do think thatThere's a variety of different philosophies. So I have had some patients say to me, my group doesn't believe in medications, even if the individual isn’t on a medication, which, which is.
[00:33:08] Which can be challenging for that person in that group environment. So I try and encourage people to just sort of reframe it, take what you think is helpful to you and leave what is not, you know, you don't have to buy in 100%, but just whatever resonates take it, use it, put it in your toolkit. And the same thing with groups.
[00:33:25] I do think that with 12 step programs. One nice thing is, is the first time you go, you don't have to talk to anybody. You can just sit there and listen. So I do let patients know that like, Hey, you can go, just check it out. And a lot of these groups, philosophies, or just to let that be okay, that's, that's an okay space to be.
[00:33:43] If you just want to check it out. And then some people also just really benefit from the formal IOP groups. They're like, I want to know what time I want to be there. I want to have the same group, the same counselor, the same therapist, and just having that regularity can be very helpful for a patient. So I just try and give them a little bit more information about the different settings to see what they think would be best for them.
Addy: I really like that mindset. You lay out all the options for patients and let them decide which one works best for them. And if they don’t want to do group therapy or counseling, that’s okay too.
Nate: Absolutely. And if they do want to do group therapy, thinking about what type of setting would be best for them. Do they just want to hang back and listen for a bit? Or are they gung ho, ready to share, and schedule-oriented? That was something I hadn’t really thought about before Dr. Chan brought it up.
Addy: As we will see with TJ, group therapy can really make a huge difference for patients with substance use disorders by showing them they’re not alone. There are other people going through the same struggles who can offer support.
TJ: [00:13:18] I know that, um, when I went to my first meeting, I never forget a young lady saying that, just listen.
[00:13:33] And if you don't get it, it'll get you. And that was at an NA meeting and it got me, it did and got me. I, when I, um, I sat and I listened and everyone, like I can remember, you know, listening to a young lady talk and she cried and, and, and talked about, um, You know her job and, and how things were going on the job.
[00:14:06] And I found out that, that the meetings were basically just a bunch of us sitting around trying to live life on life's terms. So, so today they mean a lot to me, because I know that I can go to the 12 o'clock meeting because I had some kind of altercation at the job.
[00:14:44] And, and I need to talk to someone that's gonna understand what I'm feeling. I know that I can go to, uh, the eight o'clock meeting. Because I've had a crazy day and they're going to know, you know, exactly what I'm feeling and, you know, and try to help me out, you know, uh, addiction with addiction. Um, It's it's it's it's it's, uh, I, I'm trying to think of how I can, how I can put it, you know, and, and not, you know, cause we call, We call them normals, right. People and there are normals and normals don't have you know, you know, because you don't look for a substance to take away the pain of losing a friend or a loved one. I think the normals just deal with it. Whereas, you know, in addiction, when something happens, we look for substance to help get through it.
[00:15:57] So when I go to meetings, I'm trying to learn. How to live life without a substance. So I think that's what I'm saying. Yeah. You know, it's, it's, it's different, you know, so, you know, if I go and I come and talk to me, if I go and I talk to my sister and I tell my sister who is not an addict that, you know, I want to use, you know, because today was such a hard day.
[00:16:25] And she'll, you know, she thinks I'm completely out of my mind, you know, she's no, she don't get it. You know, why would I want to do that? Why would you want to use a substance? Why would you want to use that drug or, or that drink, or, you know, just go home and go to bed. That's probably where she would tell me, you know, go home and go to bed, you know?
[00:16:49] And. You know, so she knows he can get it, but another attic, you know, or another person, another person that's struggling with addiction. I'll just say that, you know, um, we have a, uh, uh, a woman that at arc that tells us not to, not to call ourselves that, but, but they have to call it to say that we're struggling with substances, you know?
[00:17:13] And, um, So I am, I'm struggling with substances and sometimes I feel like I need a substance to get through my day. And if I go to a meeting, I find out that I can get through it without it.
Nate: Such a constructive and insightful discussion here. TJ really sets up this dichotomy that is powerful and real to her. TJ sees people like her sister, who don’t suffer from substance use disorders, as dealing with the curve-balls of life via healthy coping mechanisms, like self-care and sleep. And she contrasts this with people like her, who do have substance use disorders, how she can almost feel this hard-wiring in her brain driving her to reach out for those substances to help her cope with the ups and downs of life.
And there’s almost this undertone of jealousy, too, right? Like, “Why is my sister able to just go home and go to bed when life gets tough, but I need a substance?” I just think this so strongly speaks to the neurobiology of this disease and really refutes this past rationale of some moral failing that we held on to for far too long in medicine. Opioid Use Disorder, is a disease. And we keep driving home that the treatment for this disease is multifaceted and patient-specific
TJ: When we have those, we have those group meetings, um, you know, when someone comes in and they’re new it’s hard, it's hard because you're trying to figure out, um, you know, where do you fit in? And is everybody going to understand you feel like you're different? A lot of times I tell people that, you know, you know what I was told, you know, that stick around, make sure you listen.
Uh, if you need to talk, just be honest, say whatever you need to say, you know, Um, if, you know, if things are shitty, things are shitty, you know, people look for you to, um, you know, to, to be happy, go lucky. And sometimes it's just not like that, you know? And, um, I know that, um, that if you take one day at a time, You know, like you learn, like you learn to meetings and I know it sounds corny.
It really does. It sounds really corny when someone tells you just 24 hours, that's all you have is this 24 hours. And you're like, and they're telling you that one day at a time, and they're telling you easy does it. And they're telling you, you know, um, think, think, think, you know, and all that. And you're like what the hell are they talking about, you know?
And, but. When a crisis comes and you've written that stuff down, it's it's really, really helps
Mariah: that's really powerful. How have those meetings changed over the pandemic
Patient: wow the pandemic really. That threw me for a loop.
And I guess a lot of people that I know that was struggling with them struggling with addiction and substances, we had to adjust to, how are we going to get together? We can't, you know, get together.
We just six feet apart in these mask and all this stuff, so we couldn't figure it out. So, and then zoom came. You had to have a computer. So, some people didn't have computers. So that was a, that was a thing. And, um, then we found out that you could use your phones. We finally, you know, it finally came together, but it just wasn't enough.
It just wasn't enough, you know? The meetings are very personable, you know, Seeing your sister or your brother, you know, as far as I'm talking about my sister and brothers and NA and AA, but seeing them and, um, and talking with them, you know, person to person, you know, is a lot different than seeing them on a computer it didn’t feel it just it's, it felt so mechanical. A lot of people fell off the wagon during that time, you know, it was hard
Nate: So far, we’ve talked about medications, support from the primary care provider, and group therapy. Many patients also choose to engage with a sponsor.
Chapter 10: Sponsors
Nate: Take a listen.
[00:23:35] I don't call Michelle like I used to, but when I first, when I first got got together with her, I, um, I called her every day and she told me to, no matter what, just call. Just say hi, because a lot of times. You lose that they lose it and using, you know, they talk about hitting bottom.
[00:24:08] I didn't talk to anybody except for my dealer. You know what I interacted with him. That was, that was it. And I went home and that's where I was for the rest of the day. You know? So you kind of lose that. So coming in and getting a sponsor, um, someone to, you know, you know, to, you know, to guide you through, um, you know, the steps. Someone to call when you're having a bad day.
[00:24:38] Someone they call, when you're having a good day, you know, and tell us, you know, just to be able to tell somebody that this is happening or that's happening or, or, um, I got a raise or I didn't get the raise, I'm having a craving. And could you help me get through? And I'm telling you, Jay will help you get through.
[00:25:00] They will, she'll talk to you, you know, your sponsor will talk to you and help you get through, you know, and that's, that's important, you know, and at the same time I'm helping her. You know, that's why he said, you know, there's no big, big, you know, big I’s and, you know, a little you’s, you know, it's not about that.
[00:25:22] It's about each one of us helping each other, you know, your sponsor just guides you and that's all, it's not better than you. Not bigger than you. She's just a person that maybe who's been clean longer than you, you know, unless, you know, you know, I'm trying to show you how to do this how to do this.
[00:25:44] It's not easy. It's not easy. So that's basically what, you know, what a sponsor's role is to kind of just help guide you through that's all.
[00:25:54] What are some of the things that Michelle says to sort of help you in that process?
[00:26:00] Not to not to beat myself up over things that you know, that you can't, that you can't control, you know, the, let things go, let stuff go because you know that that's, that's, uh, you know, and I, and I'm pretty sure that everybody has problems with that of just letting stuff go, you know, not holding on to things, not holding resentments.
Nate: Right, I think we can all relate to that. It’s definitely easier said than done sometimes to just let things go. Great advice from Michelle.
[00:51:25] So Carolyn, can you help us understand outside of the role of group therapy of medications, of support from their physician or primary provider? What role does the sponsor play and how important is that person?
[00:51:53] Okay.
[00:51:55] It's so person-dependent when patients connect with a sponsor, I love it. I Love hearing about it. I love people telling me about their sponsor about like their special connection. Whatever works for a patient, you know, there's no one size fits all in addiction. And that's part of why I love it. It's like so radically patient-centered and I'm here for it.
[00:52:14] Um, for some patients they don't find that person to connect with, or it just isn't a good fit for them. And that's okay too. Generally, I like to support and affirm whatever is working for that individual. And it can look like many different things. But I will say it's nice to have additional support, you know, or someone and folks often have lived experiences, which many people benefit from.
**music transition**
Chapter 11: Return to Use
Addy: Even with all the right support systems in place, because of the nature of this chronic disease, substance use disorders often involves return to use.
[00:44:20] So I imagine that for folks, whether or not they're engaging with treatment for opioid use disorder, this road to achieving abstinence, abstinence, or even harm reduction, depending on what their goals are, is rarely straightforward.
[00:44:41] And so what I've noticed in clinic is that when I have patients coming back in, um, with return to use that can often be a really difficult time for them and a very challenging interaction for the provider, because we clearly so much want to empathize with the patient and support them in a way that doesn't make them feel like they failed.
[00:45:23] So thinking about how many times you've probably approached this situation, how do you kind of deconstruct that situation in clinic with them in a really patient.
[00:45:36] Um,
[00:45:37] I think of it as two kind of different buckets of scenarios that I commonly see. So one, a patient just discloses to me. Hey, you know, I had a slip-up so I often actually thank them. So thank you for being so open with me. I really appreciate that. How can I support you? Let's think about what led to this slip up.
[00:45:56] Um, so I really tried identify what the triggers were for the return to use for the substance. So we can help come up with more effective coping mechanisms. I want to sort of minimize this, feeling, this feeling of like guilt or shame, because it is part of the process. You know, this, this is likely to happen to most of your patients at, at some point.
[00:46:16] So I really just tried to strengthen coping mechanisms around that piece. And sometimes patients don't feel comfortable disclosing and I get it right. The healthcare system generally is punitive of patients, unfortunately, who use substances. Right? Sometimes I, sometimes patients just don't have the trust or the comfort to share that, you know, yet.
[00:46:36] So. That often comes up in the form of like an unexpected urine drug screen where something was present that wasn't disclosed or I'm just curious about, so the way I approach it is, Hey, you know, last time you came in, it looks like that you're urine showed fentanyl. Can you, can you tell me a little bit about that, uh, this isn't to punish you or to blame you or anything?
[00:46:57] I'm just like, I'm just curious and I want you to stay safe. So sometimes the patient.
[00:47:02] will disclose and. And we sort of follow the same process, like what led to this slip up, or sometimes we don't, we don't know for sure where something came from, but that matters too, right? Like there's so much fentanyl everywhere.
[00:47:15] Um, there's counterfeit, Xanax, tabs out there, counterfeit all sorts of things. So I also think it's important to discuss with patients like, so they know what they were possibly exposed to. Um,
[00:47:29] that's important. So we try and figure that out as well.
Nate: Awesome advice here from our expert. First, thank the patient for disclosing. Then, be clear that you’re asking for clarification out of curiosity and in the patient’s best-interest, not to judge or to punish them. And then work together to find root causes of the return to use, to craft practical solutions, and to reinforce healthy coping mechanisms.
[00:47:48] When we're thinking about creating an open environment, it's starting with open-ended questions so that people feel comfortable, the patients feel comfortable going through their history with us. You know, I've had some interactions where even with.
[00:48:05] Uh, establishing that basis, uh, patients really struggle, with the, with the trust, maybe in the healthcare system or with being open and honest or just, um, I'm sure there's a number of things that channel into that. And, um, you know, to kind of piggyback off of what you had said earlier, you find something on a utox that's not consistent and you just want to have a conversation, not
[00:48:28] Punishing the patient or anything like that to better understand. And also I think in some ways to more safely prescribe, uh, some of the medications we were talking about earlier, um, can you just comment a little bit more about that when you're struggling to have someone be open with you and, and secondarily, how you manage, uh, continuing to prescribe medications, if you're concerned a patient, maybe isn't using them appropriately
[00:48:59] Yeah, those are they're tough scenarios there. They can be challenging. Um, but again, I often really feel for our patients because again, the healthcare system generally is punitive. Right. So I can easily understand why people wouldn't feel comfortable disclosing everything. And oftentimes, honestly, that's okay.
[00:49:18] Uh, because often it doesn't change my management. Right. So I will frame things in terms of, Hey, you know, I did see this, how's the medication going, you know, what do you think? Um, sometimes patients need a little higher dose. I wonder if you think that could be helpful for you, you know, so I will often offer a medication adjustment if there's an unexpected finding if assuming there's room to go on the medications, the max dose of buprenorphine that we often use is 24 milligrams. Uh, so I check in with that and sometimes patients say, yeah, you know, I would like to try a little higher dose and we're like, okay, great. Let's try it. You know, you know, if a person continues to use substances substances while they're on, you know, buprenorphine or methadone, I'm not going to stop the buprenorphine or methadone.
[00:50:26] I'm just not going to do it because we know it still prevents them. It minimizes and decreases where someone's risk of overdose. You know, it still gives them protection. It's um, keeps their, their opioid tolerance. They may not have withdrawal. So they're likely less likely to use in a risky or dangerous situation.
[00:50:44] Right. Because they don't have that need to stop feeling sick immediately. So. From my point of view, as long as somebody is benefiting and taking their medication, you know, even if there's unexpected findings, as long as it's safe. And there are very few circumstances where I would consider stopping like buprenorphine or methadone, there are some, but, um, like using substances generally is often not one of them.
Addy: which if you think about it, just goes to show how differently society views opioid use disorder. You’d never stop prescribing diuretics when someone with heart failure strays from their low salt diet and decompensates. That would be ridiculous. And society should have the same attitude to treating individuals with opioid use disorder.
Nate: That’s exactly right. And I think at least some of that temptation to scale back medication therapy can sometimes come from an internal tension. Any internal tension that we have as the provider is nothing compared to the internal tension of trying to maintain sobriety.
Our patient TJ graciously gives us a window into the reality of that day-to-day tension.
[00:26:25] I was on a bus. I was on my way home. And, uh, and I wanted to use so bad. I had chose to use that day. She said, okay. She said, now you can either get off where you usually get off to cop. She said, or you can stay on. As she said to go all the way home. And she said, it's up to you. And she said that, you know what things are going to be like she said, if you use, she said, you need to play.
[00:27:04] That's one thing, play the tape, play it out. What's going to happen. Who's going to get hurt, you know? Uh, do you have the money to do it? Is your rent gonna get paid this month. I already had it in my head though. So that was, that was mine. That, that, that was my, that was the time that I slept in June. I didn't stay, I didn't stay sober that day, but I had a chance to, I had a chance to, and I chose when you, when you stay clean.
[00:27:52] Using becomes a choice once you're clean, once you’re clean using becomes a choice. Now I'm not saying that it's easy, cause it's not, it's not, it's not, it's, it's, it's hard. It is. But you do have to play that tape out. And you have to use all your tools, every tool that you have in your toolbox, all of them, because if you don't, if you don't, you'll use you'll use.
[00:28:35] And that day, that day I could have stayed on the bus, and continued home. I didn't have to get off. What I like about that is that I had a choice. I no longer felt like I didn't have a choice though. Though I chose to use, I still feel triumphant because I had a choice because when you're in the grips of addiction, there is no choice.
[00:29:05] Every day, every day is. I'm sick. I have to use, Ugh. I feel terrible. I have to use, I want to go to, you know, to go to work, you have to use, so once your clean. From then on it's a choice. It's a choice. And that's, that's a beautiful thing, man. That is wow. That is awesome. That's what I really dig about. That, that's what I really dig about that one, because once you are clean, you have a choice and you could say, you know what, today?
[00:29:50] You know, and like shell says maybe tomorrow, But, you know, so you know, this 24 hours here, you know, that I have, I'm going to use it to work. See my grandkids, go to the doctor, watch movies. Go to the park windows shop, go to Joann fabrics, pick up some crafts, you know, I mean just choices, all these choices, man. Now you tell me that ain’t awesome. That’s awesome.
Addy: That was really inspiring. It takes a ton of courage and strength to be that vulnerable and talk so openly and honestly about something as sensitive as return to use. With medicine, we often think scientifically. We depend on objective findings that we can see and measure. But opioid use disorder is a dynamic, chronic, extremely complex medical condition. Tendency to return to use is part of the nature of the disease, and many of our patients will continue taking medications for the rest of their lives. As a result, recovery cannot be measured simply by how many days our patient has been sober or whether their urine drug screen is positive or negative.
TJ has shown us that there are far better measures of recovery that are much harder to observe in the confines of a doctor’s office. It’s the hours of a day you get back. It’s the new relationships you form at group and the old relationships you rebuild, too. It’s the infinite number of choices you can now make now that you have regained control over your life.
As physicians, we should be more expansive when we think about successful outcomes for our patients with opioid use disorders. We should celebrate all the victories that you cannot quantify because these are the measurements that really matter in the lives of our patients.
Nate: What a great note to end on. Thanks Addy, and a huge thank you to TJ for sharing her story with us.
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Nate: Here are some key takeaways that I took from today’s episode and hope you can too:
- Group therapy, AA, and other 12-step programs are powerful resources that we should discuss with all of our patients who have opioid use disorder. Although they’re not for everyone, they can be important tools for patients to stock their tool belts with, and serve as a source of ongoing support outside of the provider’s office.
- Sponsors can be another impactful resource for patients. Sponsors can often relate to the patient’s struggles more authentically than we can as their providers. Sponsors are available, knowledgeable, and caring people who give practical advice and walk alongside patients on their journey. Again, a sponsor may not be for everyone, but for some patients, they can make all the difference.
- Return to use is not an excuse to pull back on medication treatment or to give up on our patients. It’s rather an opportunity to meet them in their vulnerability, to build rapport, and to help them get back on track by using sensitive, patient-centered language. And when they succeed, take a moment to celebrate with them.
Addy: And that concludes our episode for today, as well as our opioid use disorder series.
Addy: We hope you enjoyed this episode which was made possible by contributions from our patient TJ, our resident interviewer, Dr. Mariah Everts, and Dr. Carolyn Chan, who provided faculty peer-review for the project and served as our expert. Special thanks to our producers Dr. Joshua Onyango, Helen Cai, and Dr. Mariah Evarts as well as our faculty advisor Dr. Katie Gielissen.
Be sure to follow us @pcpearls on instagram where you can expect to get sneak-peeks, additional learning content, and the most up-to-date details on show release times. And if you enjoyed today’s episode, please share it with a friend or colleague who would be interested to learn about the health issue we discussed today.
Thanks again for joining us today. Farewell from all of here us at the Primary Care Pearls podcast, and we’ll catch you in the next one.
Nate: Thanks, everyone!