My Triple Aim of Medication Assisted Treatment for Opioid Addicted Patients

by HANS DUVEFELT, MD

My second foray into Suboxone treatment has evolved in a way I had not expected, but I think I have stumbled onto something profound:

Almost six months into our in-house clinic’s existence, I have found myself prescribing and adjusting treatment for about half of my MAT patients for co-occurring anxiety, depression, bipolar disease and ADHD as well as restless leg syndrome, asthma and various infectious diseases.

Years ago, working in a mental health clinic, we had strict rules to defer everything to each patient’s primary care provider that wasn’t strictly related to Suboxone treatment. One problem was that many of our patients there didn’t have a medical home or had difficulty accessing services. Another problem was that primary care providers unfamiliar with opioid addiction treatment were uncomfortable prescribing almost anything to patients on Suboxone.

This time around, the majority of my patients come to our clinic for all of their health care, or decide after being in our program to establish as primary care patients. I am the PCP for a good portion, and as the Medical Director for my clinic I not only have access to their medical records, but I am thoroughly familiar with my primary care colleagues’ preferences, practice styles and personal clinical strengths and weaknesses. That allows me to know when it works best to steer patients toward separate appointments for, say, their anxiety, and when it works better to establish a treatment plan right then and there as they become increasingly stable on their Suboxone.

Being involved in our group sessions, seeing clients on a weekly basis, even if briefly sometimes, and sharing impressions in post-group debriefings with my substance abuse counselor, Behavioral Health Director and our dedicated MAT coordinator has given me a profound insight into the personalities and circumstances of my Suboxone patients. The sheer depth of my insight from our comprehensive approach has allowed me to initiate life changing medication treatments for a large handful of patients beyond merely Suboxone.

Through a new grant we will soon also have a case manager, who will help our patients navigate their way back into mainstream society.

It’s funny: I had pictured Suboxone treatment as a carve-out niche in my practice, but it has become the most comprehensive, integrated thing that I do.

Hans Duvefelt is a family doctor in Maine. This piece was first published at his blog A Country Doctor Writes

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