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Tackling the opioid epidemic in rural America

Tackling the opioid epidemic in rural America

I am always on the lookout for real-life physician heroes; they inspire me personally and professionally. Today I am sharing a compelling story about Dr. Nicole Gastala, a family physician in rural Iowa. Dr. Gastala is among a small cadre of primary care physicians prescribing buprenorphine to suppress cravings and withdrawal symptoms associated with opioid addiction. While buprenorphine is a key method to reducing the opioid epidemic, only five percent of the nation’s doctors are licensed to prescribe this drug. In rural communities, doctors who are certified to prescribe medications like buprenorphine are especially scarce.

pill bottle with a single pill inside.

Deaths from opioids have been rising sharply for years. There are now more than 100 deaths caused by opioids each day. It is estimated that the toll could spike to 500,000 deaths in the next decade. Most students and physicians are not prepared to treat addiction, or opioid use disorder. Despite this, Dr. Gastala is filling a void in her rural community. She is folding addiction treatment into an already busy family medicine practice. She engages patients, asks about their support system and helps plan long-term goals. She demonstrates empathy—meeting patients with an open mind and being okay with where they are in their recovery process. A recent New England Journal of Medicine perspective addresses the myths and realities of buprenorphine treatment in primary care and offers suggestions for responses from physicians and others.

The Texas A&M Health Science Center, through our Opioid Task Force, is taking up the challenge. Our multidisciplinary task force has representatives from all five health sciences colleges. The task force serves as a research, education and practice hub critical to address the opioid epidemic and its impact on persons, families, communities and the entire health care system.

Our task force is already gauging implications of the opioid epidemic in current medical practice. In a survey of Texas primary care physicians, the task force found that more than 70 percent of primary care doctors received too little or no training at all during medical school or residency on patient education of pain management or opioid prescriptions. Only 29 percent indicated they felt very confident in their ability to prescribe opioids safely. There is much work to be done to close the gaps that currently exist in opioid management and treatment knowledge. The task force is currently developing continuing education materials for physicians, dentists and pharmacists that will be shared widely. We want to deliver significant support for providers, like Dr. Nicole Gastala, who are making a profound difference in rural communities across the nation. This is a first step. There will be many more opportunities to advocate, educate, conduct research, and provide clinical care in an effort to stem the epidemic. If you are interested in contributing to the Opioid Task Force’s mission, I encourage you to apply to become a student ambassador. Membership is open to all health sciences students across our five colleges.

Dr. Gastala states in the New York Times piece that she had no interest in treating addiction until she arrived in rural Iowa. She felt the personal responsibility to step up and meet the medical needs of her patients. This is a reality of medicine, especially for those practicing on the front lines. In my career, I have seen physicians step up to care for those with HIV, Ebola, and other marginalized populations. The U.S. needs more providers like Dr. Gastala to effectively address the opioid epidemic plaguing our nation.

As a physician, will you do the work others might shy away from? Please share your experiences or thoughts on how primary care physicians can champion care and provide necessary treatment for those struggling with addiction.

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