[Dr. Angela Gatzke-Plamann] I think I realized something was wrong when I got a phone call from one of my patients on a Friday afternoon. He was in complete crisis because he was admitting to me that he had lost control of his use of opioids. I didn’t have any resources to be able to give him. I was literally sitting in this office Googling while we were talking on the phone just to try to find some place where he could get help in the area, and he didn’t have it. We didn’t have it available to him. That was a really bad way to end a week. And that weekend I said, “I’ve got to do something different. I can’t ignore what the community needs at this point.” [Sheriff Brent Oleson] I’ve been sheriff now a little over 20 years, and um– you know, it’s just been a problem. Studies show that a high percentage start out as a doctor’s prescription, and then they become addicted, and when that prescription ends, they find other ways to feed their habit. [Dr. Gatzke-Plamann] Shortly after I came, you could see that we were starting to see this rise in overdose, kind of, nationally. We were worried about the use disorders. We were all seeing that in our practice, too. We were seeing that some patients were losing their control to use these, and that I think is when I realized that We shouldn’t be ramping up the number of patients we have on chronic opioids. We should be pulling back. So this is a patient I just delivered the other night. I was also much more careful with my prescribing practices for acute pain. So this is Jasmine and her newborn baby and her husband Nate. Just really thinking about well how many pain pills does a patient with a C-section need to go home with? Three to five, maybe. I’ll see you in six weeks. Call me though if you have any questions about the breastfeeding or if anything comes up. [Jasmine] Okay.
[Dr. Gatzke-Plamann] I’m around, okay? Take care. Congratulations. So I really sort of became responsible with just the amount that I felt like my, at that time, pen was writing out and going out into the community, because it became more of a community issue for me at that point. Morning! How are– Good! How are you? [Patient] I’m going to the MRI today.
[Dr. Gatzke-Plamann] Okay. Alright. Good luck. You’ll do okay.
[Patient laughs] We’re all so interconnected, and if one person is not healthy and not able to fulfill their role, then that affects all of us. It affects my other patients. It affects my family. I stopped taking on new patients who were on chronic opioids, so that I could focus on the ones that I already had. Some of those patients were very willing to come off of their opioids, which was wonderful. Some patients may not have necessarily agreed and would leave the practice and would find somebody else to take care of them, and that was fine. I don’t hear from those patients anymore, but that’s kind of the way of things. [Door knocks.]
[Dr. Gatzke-Plamann] Hello. [Patient] Hi.
[Dr. Gatzke-Plamann] Hi. Thanks for waiting. [Dr. Gatzke-Plamann] It’s really important for me that the treatment for chronic pain is not just opioids, that we have a full treatment plan which includes: physical therapy, exercise therapy. [Dr. Gatzke-Plamann] Do you ever not have pain? [Kruchten] No. I wish I could say ‘yes,’ but I can’t. [Dr. Gatzke-Plamann] We have to make sure that you’re having enough benefit from the medication, not just in terms of pain reduction, because you understand your pain will never go away, but in terms of your quality of life and how well you can function. That that benefit outweighs the potential risk of the medication to you, because we know that this medication has the potential to cause addiction. [Dr. Gatzke-Plamann] They have to agree to engage in an entire treatment program. So, I’m clear again that the medications are not their whole treatment. It’s one part of the process. You know you come in for your appointments regularly, and you’re always on time. You’re respectful with the staff, and if I ask for something, like if I ask to have a urine drug screen to make sure that you’re not using other substances, that you’ll do that. And if I ask for a pill count that you’ll come in, and we can count your pills at any point. [Dr. Gatzke-Plamann] A lot of that is keeping people accountable, but it shows them that I’m accountable to them, too. And I care, and I don’t want you to develop an opioid use disorder, so we’re gonna do these things to try to help mitigate that. [Dr. Gatzke-Plamann] We have issues with transportation, so some of my patients can’t engage in a full treatment plan just because they can’t drive to get physical therapy. Cognitive behavioral therapy and pain psychology can be really beneficial for patients with chronic pain, but we don’t have those sorts of resources necessarily right around here, even in the county. We’re working on decreasing the number of opioids that we’re prescribing, and working with patients to get off of opioids when appropriate, but the next step of this is that we’ve got to be able to take care of the patients that have developed an opioid use disorder. I started my waiver training to be able to prescribe buprenorphine. [Catina Stoflet] Okay, so my husband’s in the hole right now at Stanley. I was going and seeing my husband for visits, and he has gotten into some trouble, so he is now in the hole for— his sentence was 60 days. So I write him every day while he’s in the hole. It started out with I think Tylenol-3’s. Vicodin and Percocet, so then we started that. And then, like a year into that, it was Oxycodone. I started becoming addicted to the pain medication. Throughout time it’s gotten to hardcore more heavier drugs, A.) Street drugs, and then B.) when I’m the hospital, it’s gotten to stronger pain medication. And I knew— I could feel every ounce in my body being addicted. And I didn’t want to be prescribed pain medication for the rest of my life, ’cause that’s what I was afraid was gonna happen. [Stoflet] Go potty! Good girl, Bailey. It’s just snow, honey. Good girl! [Dr. Gatzke-Plamann] From my perspective, as the person prescribing her Suboxone, my big goal is that she doesn’t overdose. She was very motivated. She had some goals and she had things that she wanted to change about her life, and that’s what I see the buprenorphine is doing, is kind of helping the patient stabilize their brain, so thaat they have the time and the space to work on the true reason for their addiction. Every several months, we’ll drop the dose by a little bit, so if you drop the dose down, then maybe some of their depression issues start to come out or some of the anxiety issues, because the buprenorphine may mask some of that. [Stoflet] Yeah, sometimes it’s a lot of driving, but I want to be done. I want to just stay home with my husband and watch movies and play stupid Uno, ’cause when I go and see him at the prison I play Uno with him, and it’s amazing how much fun we have just playing Uno. I just want a simple life. That’s my hope. [Dr. Gatzke-Plamann] We don’t have as many resources here, so when I see that there’s a need for something, I have to respond to that, which means that my practice changes. So, to institute a buprenorphine practice in a busy family medicine practice is not an easy thing. But, as a family physician, I have to respond to what’s going on in the community, and if they have a need, and I can fulfill that need, I should do it.