Page 6 - WCMS1Q22

President’s Message
By John A. Hopper, MD, DFASAM, FAAAP, FACP
Just One in a Million
Imet Brian in 2014 when he became a patient of the Academic Internal Medicine Center at St. Joseph Mercy Hospital, Ann Arbor. His story was not unusu- al. He was 28, with hypertension, and he was a little overweight. He had struggled with depression since junior high school. He started smoking cannabis daily in his teen years to cope with isolation and loneliness.
Brian had to take a bus (maybe two) to get to his appointments, but he always arrived on time. He was polite and the staff liked him. His smile and affability hid the darkness inside: he was using heroin to cope with his depression. Our addiction medicine fellow at the time was Sarah Bur, MD. We evaluated Brian and started buprenorphine treatment. He was transformed. Brian stopped using heroin, his mood improved, he looked forward to getting back to work and returning to school.
Despite our reassurances, Brian’s biggest struggle was with the recommendation for continuing buprenorphine treatment. His dissonance was typical. He felt like he couldn’t tell his family, his friends, or his support group about this medication treatment. He did not want to be “on a crutch.” His struggle was compounded by a Medicaid authorization process that, at the time, was anything but patient centered. The process required for authorization and renewal was frequent and onerous. Gaps in treatment were inevitable. Sometimes patients would pay out of pocket for medication treatment, or just go back to heroin.
After one treatment gap, Brian did not keep his scheduled appointment with Dr. Bur. She called his cell phone and got the message that the number was “longer in service.” This is not unusual among patients recover- ing from drug use disorders; they may change phone
numbers frequently to avoid dealers and temptations. After several days we got a call from Brian’s dad. Brian had died from a heroin overdose, caught in one of the many fentanyl waves that have plagued heroin users since 2005.
Brian was just one – literally only one -- of the nearly one-million people have died from drug overdoses in the United States since 1999. On February 2, 2022, the Stanford-Lancet Commission on the North American Opioid Crisis published “Responding to the Opioid Crisis in North America and Beyond: Recommendations of the Stanford–Lancet Commission”. Modeling by the commis- sion (which includes University of Michigan Professor Amy Bohnert, PhD) estimates that 1.2 million people in North America will die in the next decade unless there is “substantial policy reform.”
As physicians in Washtenaw County, we can have an immediate and lasting impact on this public health crisis through education, treatment, and advocacy.
Here is a pop quiz to see what you can do turn the tide.
1. Do you know what CAGE stands for? Do you think CAGE is a good screening tool for an alcohol related problem? Do you still use the term “abuse” when referring to alcohol or drug related medical condi- tions? If so, it’s time to update your medical knowl- edge. Free online learning in addiction medicine is readily available through programs like the Providers Clinical Support System (PCSS) [pcssnow.org] and the Michigan Collaborative Addiction Resources & Education System (MICARES) [micaresed.org].
2. Do you, your office staff and even your family mem- bers carry naloxone for emergency use? If not, you
6 Washtenaw County Medical Society BULLETIN SPRING 2022