Jamelia Hand MHS CADC CODP is the CEO of Vantage Clinical Consulting LLC. In a recent episode of The Rehab Podcast, I interviewed Jamelia on the topic of Medication-Assisted Treatment of opioid use disorder and how to make this proven treatment more accessible and standardized. The following is a transcript of our interview. You can listen to the entire interview here. Or, you can download it here.
Mark Leeds: And for the patients, when they go to a program and they get started, I guess there’s not a lot of standardization across the industry of how doctors do their treatments. Maybe doctors have the idea that, I know this one local doctor that I’ve read his writings online and some patients have told me that his theory is that no one should be on buprenorphine for more than, I think it’s six weeks. That beyond that it becomes very difficult to come off of it.
Jamelia Hand: Yeah.
Mark Leeds: Which is completely against what I believe that the current thinking is that it’s probably people should plan on somewhere around a year and a half at least and maybe longer.
Jamelia Hand: Right. Absolutely. We need time to stabilize a patient so that we can actually support them in the treatment goals that they have. I think, as clinicians, it’s really important. I’ll share with you the first physician that I ever worked with. He had been treating and this was maybe back in 2003/2004. So this was still very early after the launch of Suboxone.
Jamelia Hand: And I came in his office very early in the morning. He was one of the few physicians that did both methadone and buprenorphine [treatment]. And he did them within the same setting. And he actually did a very good job at being able to provide those in one setting. But anyways, I was there, it was very early in the morning. I was sitting in the waiting room. His office staff had not arrived. He had a patient in an exam room and the door was open.
Jamelia Hand: So, he didn’t know that I could hear, but I was really excited about the opportunity to hear a little bit about the patient experience and what type of things happen in that appointment. So, one of the things that I heard him say that stuck with me throughout my work, he’d asked the patient, “How do you feel when you feel healthy?” And that question resonated with me.
Jamelia Hand: It told me that he had no intention of setting the treatment goals for the patient. That he wanted the patient to take control of their own recovery, he wanted them to do their recovery planning. He wanted them to do the work, he wanted them to ask themselves those questions so that he could know where to start. So, they said, “Well doc, I don’t understand. It’s been a long time since I felt good about anything.”
Jamelia Hand: And he said, “Well, tell me about a time where there were things happening in your life that you felt good about?” And the patient started to reflect. He reflected on a time when he was in college. He reflected on time where his marriage was intact. He reflected on a time where he was able to spend quality time with his children. So, what I was able to take from that is that maybe his treatment goals are to reconnect his family. Maybe he wants to go back to school. Maybe he wants to repair his marriage or even find a relationship that he can feel good about. But those were his goals. The doctor did not impose his goals onto his patient. And that really stood out to me.
Mark Leeds: That’s a good point. This sort of treatment medication-assisted treatment for opioid use disorder, it should be patient-directed. Where the patient’s at and what their goals are should determine where the treatment is going. If a patient is not ready to start tapering or reducing their medication, it’s not really the doctor’s place to say, “Today is the day, this is the day of your plan that I’ve set for you that you will be reducing by this much.”
Jamelia Hand: Right.
Mark Leeds: But on the other hand if the patient really, really wants to start tapering and they have a specific goal, we can work with them. I mean, I can still advise them, “Well, if you get to a point where you have cravings all the time or you feel sick all the time, maybe it’s not the right thing. Maybe we should rethink it and we should look at what you’re doing besides taking medication are you getting the proper support?”
Mark Leeds: And of course, if the patient comes in and says, “My goal is to be off of this in two weeks or four weeks,” then we should step in and say, “Well, your goals maybe unrealistic. Let’s talk about it more.” And there maybe those situations where a patient comes in and says, “I’ve been clean and Narcotics Anonymous for 20 years and everything was great. I have a sponsor. I have a great support network and I just want to get off of this heroin I had a slip and I want to get back to my program.
Mark Leeds: And as you probably know Narcotics Anonymous is not really MAT-friendly, they disapprove, as official policy, they disapprove of the use of what they call replacement medications, methadone and buprenorphine. So maybe that patient really does want to quickly get back to where they were, and to be clean in the eyes of their sponsor and their support network. And it still might be a bad idea.
Mark Leeds: But maybe in those cases you work with them, you say, “Well, maybe we can plan for three months or six months or something like that. Instead of keeping you on medication indefinitely or for more than that time.”
Jamelia Hand: Absolutely. And that’s what you ought to do. You’re morally and professionally obligated to have those conversations, to educate your patients, tell them what their options might be, tell them about the science and the evidence to support the recommendations that you’re making for them.
Please stay tuned for the continuation of this transcript of an incredible interview.