In Rural Areas Without Pain Or Addiction Specialists, Family Doctors Fill In The Gaps
NPR | December 30, 20195:03 AM ET | Heard on Morning Edition
Dr. Angela Gatzke-Plamann didn't fully grasp her community's opioid crisis until one desperate patient called on a Friday afternoon in 2016.
"He was in complete crisis because he was admitting to me that he had lost control of his use of opioids," recalls Gatzke-Plamann.
The patient had used opioids for several years for what Gatzke-Plamann calls "a very painful condition." But a urine screening one week earlier had revealed heroin and morphine in his system as well. He denied any misuse that day. Now he was not only admitting it, but asking for help.
Gatzke-Plamann is the only full-time family physician in the central Wisconsin village of Necedah, population 916. She wanted to help but had no resources to offer. She and the patient started searching the Internet while still on the phone, trying to find somewhere nearby that could help. No luck.
Here was a patient with a family and job who spiraled into addiction because of doctor-prescribed pain pills, yet the community's bare-bones health system left him on his own to find treatment — which he later did, 65 miles away. If that situation was going to change in Necedah, it was up to Gatzke-Plamann.
"That weekend I went home and I said, 'I've got to do something different,' " she recalls.
In many ways, rural communities like Necedah have become the face of the nation's opioid epidemic. Drug overdose deaths are more common by population size in rural areas than in urban ones. And rural doctors prescribe opioids more often by far,despite a nationwide decline in prescribing rates since 2012. Meanwhile, rural Americans have fewer alternatives to treat their very real pain, and they disproportionately lack access to effective addiction medication such as buprenorphine.
It used to be rare for primary care physicians outside of big cities to take on the challenges of opioid misuse, according to Dr. Erin Krebs, a professor of medicine at the University of Minnesota who researches chronic pain management. Now, Krebs says it's becoming increasingly common "out of necessity."
"We just have a lot of people who need this kind of care and they need it where they are," Krebs says.
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