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A Doctor’s Education in Opioid Addiction

With a brassy laugh and penchant for bringing her granddaughter to appointments, Ms. L had been a memorable patient for Dr. Audrey M. Provenzano. That’s why it was such a shock when Ms. L admitted that she had started using opioids again after decades in recovery – and an even greater shock when she learned that Ms. L had died of an overdose. In a powerful personal essay, Dr. Provenzano reflects on this experience and how it has changed her perspective on addiction treatment, and her practice of medicine as a whole (“Caring for Ms. L. – Overcoming My Fear of Treating Opioid Use Disorder,” The New England Journal of Medicine, February 15, 2018).

When Ms. L asked for a prescription of buprenorphine – a type of medication-assisted treatment to reduce or quit the use of opioids – Dr. Audrey M. Provenzano couldn’t write it. Dr. Provenzano couldn’t write it not only because she didn’t have the right kind of license to prescribe buprenorphine, but also because she simply didn’t want one. To be able to prescribe a drug like buprenorphine, clinicians must go through an 8-hour training course.

But Dr. Provenzano conceded that it wasn’t just the time commitment that dissuaded her from taking the course. She was also extremely reluctant to take on patients with opioid use disorders (OUD), as they sometimes present challenging behavior problems that she did not, admittedly, know how to meet.

Instead, Dr. Provenzano referred Ms. L to a trusted colleague with the appropriate licensure. Dr. Provenzano recounts the space this wedged between them – a space so large that Ms. L stopped showing up to their appointments.

A year went by without hearing from Ms. L. Dr. Provenzano ultimately learned that Ms. L. had died of an overdose. She first felt horror, then profound sadness, but it was the overwhelming feeling of shame that she could not shake.

“What if I had treated her myself, instead of referring her?” Dr. Provenzano asked herself. “Ms. L. and I had had a relationship. She had trusted me. And I’d turned her away.”

This experience highlights only one piece of the puzzle that stigma and lack of information around substance use disorders have on the treatment and outcomes of those affected.

The death of Ms. L was a pivotal moment for Dr. Provenzano – she has since earned her license to prescribe buprenorphine and now treats a small cohort of patients with OUD.

“Caring for these patients has become the most meaningful part of my practice,” said Dr. Provenzano. “Providing some sense of normalcy for patients whose lives are roiled by overdose and estrangement is the most profound therapeutic intervention I’ve engaged in as a caregiver.”

With more than 115 overdose deaths a day in America, the opioid epidemic is a crisis that affects everyone. Just as in Dr. Provenzano’s story, education is a key component of reducing the stigma associated with opioid addiction. To learn the signs and symptoms of someone who may be affected by a substance use disorder, take a Mental Health First Aid course today. By noticing and supporting someone who may be in crisis, you can #BeTheDifference in their life.