Dr. Angela Gatzke-Plamann is the only full-time family physician in the tiny Wisconsin town of Necedah – population 916. She always thought she would be able to help patients in her small county. But when a man came in to ask for addiction treatment because of doctor-prescribed pain-pills, she realized her resources were far too limited. She had to turn the patient away, sending him to get help 65 miles away. As she told Kaiser Health News, Gatzke-Plamann went home that night only to toss and turn and thought to herself, “I have to do something different.”
In this article, we will take a close look at illicit drug use statistics and pain management in rural areas, as well as the innovative actions Dr. Gatzke-Plamann took to change the way her hospital and community deal with pain management and addiction.
According to the Centers for Disease Control and Prevention (CDC), since 2015, the drug overdose death rate in rural areas is higher than in urban areas. CDC Director Brenda Fitzgerald states, “We need to understand why this is happening so that our work with states and communities can help stop illicit drug use and overdose deaths in America.” Even with the decline in prescribing opioids for pain management, the rates at which rural doctors prescribe pain pills are still high. One CDC study analyzing patient prescription data revealed that “patients in non-core counties [rural areas] had an 87% higher chance of receiving an opioid prescription than did patients in large central metropolitan areas during the study period.”
What are the reasons behind this statistic? Rural Americans have fewer alternatives to treat pain, and they lack access to effective addiction treatment and medication. Additionally, pain management and addiction treatment are specialties, calling for advanced training that many small-town family physicians lack.
To deal with the growing opioid crisis in Necedah, Dr. Angela Gatzke-Plamann realized it would take ingenuity, community involvement, additional training, and a lot of patience. To tackle the issues of addiction and pain management, she developed the following protocols:
Gatzke-Plamann stopped taking on new patients who use chronic opioid medications to focus on current opioid patients. She took on the task of weaning many patients off opioids and tracks how many pills she prescribes for serious issues, like surgeries.
She helped create a wider discussion within the community about opioids, including joining the county’s substance abuse prevention coalition, educating her peers, and working with a hospital she is affiliated with (Mile Bluff Medical Center) to get monthly reports of how many of her patients have opioid prescriptions.
According to Kaiser Health News, rural communities “disproportionately deal with painful conditions related to aging, such as arthritis. Injuries also appear to be more common in communities more dependent on physically demanding jobs, such as mining, construction, and logging.” Keeping this in mind, Gatzke-Plamann tries to avoid prescription opioids when she can, asking patients to try alternative therapies for pain such as exercise, cognitive therapy, and physical therapy treatments. When these techniques are out of reach for some patients, she tries different combinations of non-opioid medicines until she finds the right mixture to help bring relief to pain sufferers.
Gatzke-Plamann, along with the Mile Bluff Medical Center, created a medication treatment agreement for their patients. Patients must agree to certain terms before getting a new opioid prescription, such as getting pills from only one doctor, filling prescriptions at just one pharmacy, and submitting to random pill counts and urine screenings. The main objective of the contract is to keep the lines of communication open with patients. By reviewing the contract with them, Gatzke-Plamann can also discuss the risks and warning signs of addiction.
After seeing how scarce the resources were for addiction treatment medications in her county, Gatzke-Plamann decided to take matters into her own hands and got the training required to prescribe the addiction medicine buprenorphine. As Kaiser Health News reports, “In Wisconsin, 18 of 72 counties lack a buprenorphine provider, and 14 of those unserved counties are rural.” Gatzke-Plamann is now one of only two people in her county who is licensed to prescribe buprenorphine. Just like her opioid patients, anyone taking buprenorphine must sign a contract that includes agreeing to addiction counseling.
Gatzke-Plamann realizes that solving the problem only starts with her. “I am just one part of their treatment plan. They need counseling. They need psychosocial support. They need group meetings,” she says. It is our hope that other healthcare professionals will follow her lead and show the same dedication and tenacity in treating patients wherever they live.
At The Kimberly Center, we want to help you heal from addiction and are committed to putting you and your recovery first. We offer a comprehensive range of services including outpatient treatment, post-rehab services, continuing care, and long-term treatment. Call us now at 855-4-KCENTER (855-452-3683) for more information.