It took the patient two years to work up the nerve to tell his primary care doctor he’d been abusing his prescription pain medication. In response, the physician cancelled his prescription, gave him the phone number of a recovery center that was no longer open, and instructed him to return in six months to report on his progress.
Eventually, the man sought treatment from Merideth Norris, DO, an addiction medicine specialist in Kennebunk, Maine, who was horrified to hear his story. “This man had previously been diagnosed with colon cancer. When that happened, his doctor didn’t give him a nonfunctioning phone number and tell him he needed to figure out his own treatment plan,” she says. “Addiction is a medical condition, and as physicians, we need to treat it as such and guide patients toward appropriate treatment.”
Caring for the uninsured
Dr. Norris recently made headlines for announcing she will provide affordable care for uninsured patients who have opioid substance abuse disorders at her Kennebunk practice, Graceful Recovery. It’s a much-needed offer in Maine, where the nation’s opioid abuse epidemic has been especially acute. Between 2011 and 2014, the state saw a 530% increase in deaths involving heroin and morphine, according to Maine’s State Epidemiological Outcomes Workgroup.
Dr. Norris’ uninsured patients must cover the cost of any medications, but they’re charged only $40 for appointments with her, which includes a new patient consult, followup calls, connections with support and resources and medication management. “I’ve had patients drive from 180 miles away because they couldn’t find treatment in their area,” she says. Because she also serves as medical director at a methadone clinic in Westbrook and a recovery center with sites in Lewiston and Portland, Dr. Norris is familiar with addiction resources throughout the state.
Treatment options for opioid abuse
Specific treatment plans are tailored to the patient’s situation and goals, Dr. Norris says. Some patients opt to detox without using medication, while others pursue medication-assisted treatment, which combines counseling with medications such as Suboxone or naltrexone that block opioids’ pleasurable effects.
Whatever the treatment plan, connecting patients with support is an essential element, Dr. Norris says. She requires patients to bring a support person to their appointment, and this person signs an agreement pledging to help the patient avoid using drugs and work toward recovery goals. Depending on the patient, further support may come in the form of counseling, a 12-step program or peers who are also in recovery.
“I had one patient who was a lobsterman, so he worked really irregular hours—seeing a therapist or going to 12-step meetings was going to be difficult for him,” Dr. Norris says. Instead, she reached out to colleagues in the area who also work with patients in recovery. “That same day, I was able to connect the patient with another sober fisherman who was in the same situation he was. My patients tend to be scared, isolated, and overwhelmed, so just giving them evidence-based information and getting them started with treatment is a huge first step.”