Pub. 3 2019 Issue 2

other incredible projects that almost always link back to primary care. She worked alongside other primary care doctors in rural Utah towns such as Moab, Price, Blanding, and Monticello. She hopes to help healthcare provid- ers become more comfortable treat- ing people with substance use disor- der. She also continues to perform outreach and training in Salt Lake City and has helped shape the medical school curriculum at the University of Utah. Up until recently, University of Utah medical students did not have any addiction medicine requirements in terms of formal didactic training. Dr. Howell and Dr. Cook helped add three hours of addiction medicine training in the brain and behavior module. Although they realize that three hours is insufficient, it is a start in the right direction toward more comprehensive education for students. Another innovative project Dr. Cook is involved with is the Bridge Program, where patients with opioid use dis- order seen in the emergency depart- ment are started on buprenorphine and are then moved to primary or behavioral care. This model is based on a study out of Yale University that showed by starting people with treatment in the ER, there is a greater likelihood of reducing overdose rates and continued addiction to opioids. Individuals come into the emergency department either seeking the project or present with an overdose, cellulitis, or an abscess. The program is funded by a grant through the Utah Division of Substance Abuse and Mental Health. Dr. Cook says it is a “three-legged pro- gram.” Patients are first treated in the ER and then sent to UNI for stabiliza- tion and 30 days of treatment, medica- tion, and doctor’s visits. While there, patients are connected with health insurance through Medicaid or, if eligi- ble, the Healthcare Marketplace. The final step is to connect patients with a partnering primary care clinic such as Health Clinics of Utah or the University of Utah Family Health Clinics where patients can continue their treat- ment. “Primary care was well-suited to partner in this program,” says Cook, “as they can treat other co-morbid conditions in addition to continuing treatment for addiction.” Since April of this year, they have seen over 400 patients come into the program. They have even had people come in from Idaho, Wyoming, and Nevada seeking treatment. They hope to expand the partnership with primary care clinics in Davis, Weber, and Utah Counties in the coming months. When asked about helping providers to feel more comfortable treating sub- stance use disorder as part of their primary care practice, Cook says, “It is important to try and move the bar to talk about addiction as a chronic con- dition.” She emphasizes that there are many things primary care doctors can do to make a difference in people’s lives. “Doctors can feel quite hopeless about actually helping their patients,” says Cook, “but treating addiction can be more similar to treating other ill- nesses than dissimilar. Take end-stage liver disease. A doctor can treat it is as someone who has end-stage renal disease due to diabetes.” Cook en- courages doctors to consider treating their patients with SUD rather than firing them. “Just keep one patient and treat them for addiction and see how the patient can turn their life around,” says Cook. “That patient can become a very rewarding patient.” In terms of helping patients avoid addiction to prescription medications, Dr. Cook stresses that doctors need to be alert and sensible when pre- scribing medications such as opioids and benzodiazepines to avoid putting patients in harm’s way. She recom- mends that doctors check the con- trolled substance database every time they write a prescription and watch for patients who are getting an effect from the medication other than what it is intended for, refilling early, losing prescriptions, or having a constant, steady increase in their dose. She also recommends the use of collateral in- formation, such as asking a patient to bring a support person to an appoint- ment so you can have a frank discus- sion about what’s going on at home. Dr. Cook emphasizes, “We already have a lot of the tools that we need to talk to our patients about substance use such as SBIRT (Screening, Brief In- tervention, and Referral to Treatment). Just by having a good therapeutic alliance with our patients, we can talk to them about what’s going on in their lives.” She hopes that physicians will stop thinking about substance abuse in black and white terms and look at what else is going on in a patient’s life. “Start talking to patients from a non- judgmental stance. Just talk to them about substance use like you talk to them about everything else. Ask them how much they drink, how they cope with stress, and what kinds of cop- ing mechanisms are acceptable to them. Having those conversations can change the narrative of what patients expect to talk to you about.” Dr. Cook lives in Salt Lake City with her hus- band, four kids, and two dogs. She is also a grandmother to two adorable grandba- bies and is an avid triathlete and outdoor enthusiast. By her early 20s, she already had three little girls at home. At age 30 she was accepted to the University of Utah Medical School. To say she had an interesting start in school would be an understatement as she gave birth to her son during finals week of her first year! Following medical school, Cook matched into St. Mark’s Family Medicine Residency in Salt Lake City. 11 |