“ I am pleased to say that most of the patients remain in my practice ” selling drugs – a discovery revealed with repeat negative urine screens . When they were told they were no longer going to be receiving prescriptions for opioids , many of these patients left her practice . But she has worked hard to keep the vast majority on as patients . “ I am pleased to say that most of the patients remain in my practice and they tell me that they are very thankful to have been either slowly tapered off entirely or to be now functioning on a lower dose .” What was the key to her success ? Slow opioid tapering using opioid rotation or weaning , supportive counselling , allied health professional support , regular appointments and a determination to never abandon her patients , she says . As she came to know her patients better , it was also common to identify a substance use disorder . As a result , she developed close alliances with local addiction medicine specialists who supported her . She added that a lot of credit also goes to her supportive clinic manager . “ He found some funding for massage therapy which really helped with the tapering process ,” she said . The best success story belongs to the patient who was on the 800 mg a day dose . He is now opioid free . He has lost more than 50 pounds and walks daily . His diabetes is now well controlled and he reports feeling better than he has in years . “ He has said that he lost a decade of his life to oxycontin and really regrets going on those meds in the first place . He was told they were not addictive ,” said Dr . Patel . In speaking to the patients and learning their stories , it was evident that many of them had experienced abuse and trauma , often as young children , she said . “ As we know , mental health issues can manifest with physical symptoms . Unless one takes the time to listen to patients and learn their story , mental health issues are too often inappropriately treated with opioids ,” said Dr . Patel . While Dr . Patel does prescribe opioids for some pain conditions , the list is not long . “ More than 90 % of chronic pain issues do not have any evidence of benefit from opioids ,” she said . She also refuses to prescribe oxycodone , a policy that all the doctors in her health centre have now adopted . “ I think it has too high a potential for addiction and does not add anything better when compared to traditional opioids like morphine ,” she said . Dr . Patel acknowledges that while the first year at the health centre was harrowing , she learned a few things about herself as a result of the experience . “ I learned that I am better able to tolerate a patient ’ s distress and I now feel that bearing witness can be a therapeutic technique on its own . Continuity of care and building trust with a compassionate family physician goes a long way ,” she said . She also has a deeper understanding of the impact of childhood adversity on one ’ s resilience . “ People who grow up with significant childhood adversity can have an extreme passivity and inability to make changes for themselves . Using a trauma informed care model can help these patients gain more control over their lives which then translates to improved mental and physical health ,” she said . More recently , she has taken on new patients who have an opioid use disorder . But she makes it clear at the outset that she does not pull out the prescription pad easily . “ I strongly believe that these medications cause harm when used long term at high doses and I will spend a long time explaining this to someone who wants to become my patient ,” she said . MD
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Dialogue Issue 1 , 2017