I prescribe Suboxone in Primary Care

There were 561 drug overdose deaths in Maryland during the first quarter of 2020.

I remember watching Panic in Needle Park in the 70's. It was a haunting depiction of heroin addicts living on the streets of NYC. I also remember my parents explaining that it was a movie about "junkies" in the city, and so it was of no concern to us out here in rural Maryland.

At the time, I thought it was odd my parents weren't more concerned about people in the city. Little did they know 30 years later, their own grandson would be an addict in rural Maryland. In the 1970's, overdose panic stayed in the cities. Now, however, overdose panic is in the backyard of every rural community throughout the country. Just one month after my son went into rehab in 2015, a neighbor just up the street found his daughter dead with a needle in her arm.

While urban areas have a significant amount of resources for people battling addiction, rural areas are often devoid of treatment. Because of the spread of opiate addiction into rural communities, primary care practices are now encouraged to provide medication assited treatment in the form of Suboxone in order to curb cravings for opiates and save lives of those battling opiate addiction.

For the past two years I have been prescribing Suboxone as a part of my primary care practice on the Eastern Shore. I currently have a panel of 75 patients, the physician I work with has about 100. Together we manage them as a team. The process is both challenging, and rewarding. While I've had to discharge a few patients who are not a good fit for Suboxone, I've also had the rewarding experience of providing much needed care to some of the most vulnerable members of my community.

All in all, most of our patients are hard-working men and women, who are happy to have a primary care provider who is able to prescribe their Suboxone as well as their lisinopril and lipitor. These people are not criminals, they are sick.

Croke, L. (2017). Management of chronic pain and opioid misuse: a position paper from the AAFP. American family physician, 95(7), 458–459. https://www.aafp.org/afp/2017/0401/p458.html

Dieperink, J., & DePaepe, C. (2019). AANP Forum: Nurse practitioners improving patient outcomes for opioid use disorder. The Journal for Nurse Practitioners, 15(9), A11–A15. https://doi.org/10.1016/j.nurpra.2019.09.006

Goldstein, P. J., Lipton, D. S., Preble, E., Sobel, I., Miller, T., Abbott, W., ... & Soto, F. (1984). The marketing of street heroin in New York City. Journal of Drug Issues, 14(3), 553-566.

Hancock, C., Mennenga, H., King, N., Andrilla, H., Larson, E., & Schou, P. (2017). Treating the rural opioid epidemic. National Rural Health Association.

Rigg, K. K., Monnat, S. M., & Chavez, M. N. (2018). Opioid-related mortality in rural America: Geographic heterogeneity and intervention strategies. International Journal of Drug Policy, 57, 119-129.