Pub. 3 2019 Issue 1

with medication “is easy” with a limited choice of medications. He prescribes the medication to prevent withdrawals and cravings while allowing the patient to become functional and allow time for the brain to heal. The behaviorist works with the patient, developing skills and providing tools to cope with life’s challenges, which allows the patient to return to full functioning. The case manager works closely with the patient, providing additional resources, and also helps to track the patient’s pro- gress. The case manager also serves as a contact and resource for patients to access when they are struggling. Dr. Fisher emphasizes that co-morbid conditions are nearly always present in someone struggling with SUD. Many people have a psychological predis- position for addiction, but then some- thing in that person’s life sets it off. He also sees trauma as one of the primary underlying conditions that sets some- one on the path to SUD. Family Health- care also employs a full-time Psychiat- ric APRN, who does a comprehensive psychiatric evaluation to determine accurate diagnoses and specific treat- ments for the patient, with or without SUDs. The comorbid conditions fre- quently seen in SUD include illnesses such as having bipolar, experiencing treatment-resistant depression, ADHD, and many personality disorders. Having the mental health providers as part of the healthcare team has helped Dr. Fisher better recognize the mental health issues in other patients as well — particularly trauma. His experience is helping him and other providers to be more aware of, screen for, and treat trauma as well. He tells the story of a young women who has type I diabeties. She was frequenting the ER every week with blood sugar levels either soaring or crashing. After Dr. Fisher and his entire SUD team spent months delving into other underlying trauma and comorbid conditions, she is finally taking control of the diabetes. Uncontrolled diabetes with many ER visits and hospitalizations was her way of dealing with the other prob- lems. One treatment recommendation of a behaviorist was obtaining a service animal. As an only child with a history of trauma, she needed a “sibling.” And it has helped tremendously. Barriers to Treatment One of the things that has most drawn him to working within the Community Healthcare Center setting is the abil- ity to treat patients, including patients with SUD regardless of their ability to pay. The number one reason for not seeking care, according to a study done by the American Academy of Ad- diction Psychiatry, was funding,” ex- plains Dr. Fisher, “70 percent said they didn’t seek help because they could not afford it.” At Family Healthcare, they see a large number of uninsured patients who benefit from MAT. They continue to treat those patients, even though they are losing money on the program. Dr. Fisher emphasizes, “We, as a healthcare community need to find ways to funds patients who need treatment.” MAT and Managing Pain Differently The number of eligible providers re- ceiving MAT waiver training has grown significantly since Dr. Fisher started providing the treatment in 2002. “There are no longer other alternatives for patient seeking opioids,” Fisher says. “The door is being closed for pa- tients who are ‘Doctor shopping’ to go to other providers just to get an opioid prescription.” Dr. Fisher believes doc- tors are seeing the benefits of becom- ing waiver-trained and offering treat- ment. “After providers start treating patients with SUD and these patients stabilize, they are so much easier to work with and manage than they were before treatment.” Providing treatment for opioid addiction also means helping patients manage pain differently. Dr. Fisher says if those struggling with pain can try different alternatives, in many cases that is all it takes to prevent them from requiring opioid painmedication. Behaviorists can also help patients understand that near- ly everyone experiences some pain, and they help them live everyday life with realistic expectations with some pain. Sometimes simply working with the pa- tient to try a modality such as stretching and exercising is enough, but for the pa- tients they cannot help, they refer them to the pain management clinic to try to find nonaddictive alternatives. The Journey Continues Despite the funding issues, the time it takes to work with patients with SUD, and the setbacks they often face dur- ing treatment, Dr. Fisher is committed to MAT and integrated health care. “My whole journey — it’s been almost two decades now — was to help patients get the treatment they needed and to learn myself how to treat those pa- tients. That was the initial mission, and since I’ve been at Family Healthcare, the second half of my journey is to help providers understand substance use, the patients suffering from this illness, and offer appropriate medically-assist- ed, multidisciplinary-integrated care.” Mahana Fisher, MD, is the Associate Medical Di- rector of Family Healthcare, in St. George, Utah where he also lives with his family. Dr. Fisher was surprised at the number of people who were struggling with substance use disorder (SUD), and even more alarming was the number of those addicted to prescription medications. People he had never treated before were coming in just for pain medication and that trend continued to evolve and worsen over the next decade. 19 |