Exercising my buprenorphine waiver but going back to Alaska


I wonder if this is the way

With all the things I could say

I’m away and I’m off, To the Island Metkoff.  

I’m taking vacation today

SYNOPSIS:  I’m a family doctor from Sioux City, Iowa who danced back from the brink of burnout in 2010.   Honoring a 1-year noncompete clause, I did short term medical work in Keosauqua, Iowa, Grand Island, Nebraska, Barrow, Alaska and New Zealand.  I came back to work in a part-time position with a Community Health Center, and I’m now down to 40 hours a week.  I’m taking a month to work in Petersburg, Alaska, 

For the last week I’ve warned my patients  that I’ll take a month of vacation for March.  I’ll work in the same clinic in Southeast Alaska where I worked for 2 weeks in August.

My addictionology practice has grown by leaps and bounds in the last month, and the news of my upcoming time off has been particularly hard on my opiate addicted patients.

The narcotic or opiate group of drugs includes morphine, opium, heroin, hydrocodone, hydromorphone, meperidine, fentanyl, codeine, and others.   The epidemic of addiction to these drugs has started to strangle the country, until deaths from overdoses of legal narcotics surpassed deaths from motor vehicles in 2012.  Already, the US uses more narcotic pain killers than the rest of the world put together.

Some attribute this surge in dependency to a government agency’s decision to make pain the 5th vital sign, and to sanction doctors who failed to address a patient’s pain level that exceeded 5 on a 10 point scale.  In fact the opiate use started to grow logarithmically that year.

The problem usually starts when a person has a legitimate injury, such as a broken leg, and gets a prescription for a pain reliever, then gets hooked by taking a friend’s leftover pills.  Abuse escalates in short order, many start onto heroin because it’s cheaper than the prescription stuff, they lose their job/house/spouse/car/assets/family and when they find themselves with absolutely nothing they realize they have a problem.  Then they come to see me.

If I wait till they’re in full-blown withdrawal (yawning, tearing,  diarrhea, insomnia, aching) I can prescribe buprenorphine, but only because I have a special license to do so.

The requisite education, done online, only cost me 9 hours; I got the waiver last summer  to back up one of my partners while he had medical problems.  I didn’t write my first prescription for it for 6 months.

The medication blocks them from getting high, and can stop a lot of pain.  Success demands close monitoring and frequent blood tests.

Patients don’t seek help until chaos dominates their lives.  I don’t get to retell the dramatic , ironic stories because of confidentiality.  The temptation to judgementalism runs strong in my business, but especially in addictionology, yet I know I will finish my day with more energy if I approach each patient with an attitude that acknowledges the mistakes of the past and emphasizes the need to move on.  And really, the patients do the best when they take control of their lives.

But they have a lot of emotional needs and tend to bond tightly to people who listen without judging.

Fortunately I have a partner with more experience with that drug than I have.

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