Chris Smith: In Utah, we need compassionate, immediate care for opioid use disorder

People struggling with opioid use disorder should have easier access to buprenorphine.

(Ted S. Warren | AP photo) In this Nov. 14, 2019, photo, Jon Combes holds his bottle of buprenorphine, a medicine that prevents withdrawal sickness in people trying to stop using opiates, as he prepares to take a dose in a clinic in Olympia, Wash.

As a mental and behavioral health care provider, I frequently face the realities of providing care for those with opioid use disorder (OUD). Buprenorphine, a medication used to effectively treat this disorder, is often difficult for patients to access, delaying treatment. The Mainstreaming Addiction Treatment (MAT) Act, now before Congress, proposes to increase access to this medication, and to promote education on integrating treatment for OUD into practice.

I urge all our support of this lifesaving legislation.

Like opioid medications used to treat pain, buprenorphine activates opioid receptors in the body, but without producing the same “high” as heroin, fentanyl or other opioids. Once a person transitions onto buprenorphine, it can reduce cravings and prevent painful withdrawal symptoms. It remains the preferred treatment for OUD and is safe and effective.

Currently, only providers who take a special training and obtain an “X-waiver” may prescribe buprenorphine. This stigmatizes both the medication and the individuals who might benefit from it, suggesting both are too complicated to address.

As a waivered provider, I find it more useful to view buprenorphine as simply a medication for a specific condition, like any other. People with OUD deserve the same compassionate treatment as those with other complex conditions that involve behavior, physical symptoms, and environmental factors.

The X-waiver requirement creates unnecessary delays in a provider’s ability to address patient needs, placing excess strain on the health care system by funneling a widespread need through a limited number of providers. Treatment access may be delayed or prohibited through the practical limitations of a waivered provider’s location or workload.

Community programs emphasizing a buprenorphine-first approach have limited options for referral to long-term management. Passing the MAT Act would broaden access to life-saving treatment. It might also lessen the stigma around buprenorphine.

Providing care over the past six years at the Fourth Street Clinic in Salt Lake City, which focuses on health care for individuals experiencing homelessness, has taught me that time is of the utmost importance in treating OUD. Anytime someone uses opioids, there is risk for overdose death.

My patients exist along an ever-changing spectrum of willingness to discuss this issue, motivation to stop using or ability to access resources to do so, so it is critical that I respond to their desire to seek treatment as quickly as possible. But for many in Utah and across the U.S., the X-waiver has created a reality where requests for treatment are unmet.

In removing the requirement for the X-waiver, the MAT Act would restore a sense of timeliness in the provider-patient relationship.

At Fourth Street Clinic, we strive for a “no wrong door” approach to meeting patient needs and helping them find the treatment that works best. Some individuals access traditional support resources throughout their lives, while others find recovery by reconnecting to work, important relationships and meaningful activities that take up the bulk of their time. Some may simply find a path to a less harmful place than they were before – progress, nonetheless.

By first addressing opioid cravings and withdrawals with buprenorphine, we may free a person to engage in making other positive changes in their life, improving physical and mental health and the overall stability of their lives. But such changes may occur only gradually.

I sometimes get questions about my patients — ”What kind of people are they?” The answer is simply that they are people, with hopes and dreams, fears and sorrows. Like all of us, they are complex, with needs that extend beyond medical care. Because of opioid use disorder, they may experience a great deal of chaos and suffering at any given time. But their disease does not define their story.

Opioid use disorder destroys lives, while increased access to buprenorphine may save them. In my interactions with patients, I am offered countless moments of grace and kindness despite their suffering. It is my honor to share this time with them.

Passing the MAT Act, increasing access to buprenorphine, and facilitating a meaningful discussion of opioid use between patients and healthcare providers would be a great kindness – one that anyone deserves.

Chris Smith

Chris Smith is a psychiatric/mental health nurse practitioner who provides treatment for substance use disorder to patients in the Salt Lake City area.