Pub. 3 2019 Issue 1

L ong before opioid addiction was making national headlines as a healthcare crisis, Dr. Mahana Fisher was seeing the devastation of substance use disor- der in his hometown community. A lifelong resident of Utah, Mahana Fisher graduated from the University of Utah School of Medicine and completed his residency in family practice at the University of North Dakota SW Campus in Bismarck, North Dakota. One of the primary reasons he chose family medicine as a specialty was that he hoped to return to a rural community like the one he had grown up in, Blanding, Utah, and practice the whole scope of medicine. Dr. Fisher returned to his hometown community that he knew and loved, where friends, family, and even his par- ents still lived. He worked for seven years for the San Juan County Health District and then Utah Navajo Health System from 2007 to 2017. As the area has a history of experiencing a shortage of healthcare providers, he was able to gain a wide range of medical experience in family practice, ER, and in-patient medicine. When members of his family began to move to the St. George area, he looked to move his practice to be closer to them and that’s when he met Lori Wright, CEO of Family Healthcare, a Community Health Center lo- cated in southwestern Utah. They both knew very quickly that Family Healthcare was going to be a good fit for the ambitious doctor. Problems in His Hometown When he began his medical career after residency, return- ing to the community with so many people he had grown up with in Blanding and Monticello, Dr. Fisher was surprised at the number of people who were struggling with substance use disorder (SUD). Even more alarming was the number of those addicted to prescription medications. People he had never treated before were coming in just for pain medica- tion and that trend continued to evolve and worsen over the next decade. He came across information about a training in Salt Lake City for medication-assisted treatment (MAT) and started reading up about the process and the medications involved. He be- came waiver-trained in 2002 and began providing MAT in his practice. Dr. Fisher struggled to convince other providers to join him, however, in the early days of providing the treatment of SUD, primarily due to a lack of understanding and diag- nosing, very limited resources, the difficult nature of treating, and the incredible amount of provider time consumed. It can also take many years of tremendous effort on the part of the healthcare team and the patient to see results. When asked why he continued to provide MAT despite the level of effort involved, Dr. Fisher says, “MAT gives people their lives back. You have a lot of failures and many patients just aren’t ready for it. But it’s the few who have struggled, and then finally break through and become productive after spending many years of their lives bound by their illness, that keep us motivated as providers.” Fortunately for Dr. Fisher, Lori Wright felt the same way he did. When Wright and Dr. Fisher met they discussed two of her pri- mary goals for Family Healthcare: to provide MAT to patients struggling with addiction to opioids and to practice integrated behavioral health. Dr. Fisher says what he was trying to de- velop for his practice in Blanding was integrated behavioral healthcare, he just did not know what it was called at the time. When working with his patients with SUD in Blanding, Dr. Fisher wanted to bring a counselor in at the point of care. At Family Healthcare, this kind of integrated care is now standard practice. Integrated Health Care and MAT When a patient comes in for an MAT initial consult at Fam- ily Healthcare, a behaviorist, Dr. Fisher, and a case manager all see the patient. Each meets individually with the patient and then all three conference before they go back in and see the patient together. Dr. Fisher says his part in treating SUD Dr. Mahana Fisher Membe r Spot ligh t By Barbara Muńoz www.UtahAFP.org | 18