Saturday, April 23, 2016

On the Road Again

After some months of not going anywhere, I drove to DC and back, then to Asheville and back this week.  1150-odd miles, all told. courtesy of the Dwight D. Eisenhower National System of Interstate and Defense Highways, numbers 40, 85, and 95 (and tributaries thereof).

It was good to get out, I had some good meals, saw some friends, met with some clients, as well as some prospects.

It was all capped a visit to the Addiction Medicine Conference sponsored by the Governor's Institute on Substance Abuse, of which I am now a board member, thanks to Matthew Sullivan of the Chapel Hill Police Department and now running the Fire Department, who had the good sense to throw my drunk ass in jail back in 1991, nudging me in the direction of recovery, eventually.

This was a good conference, as conferences go. It was pretty awesome to be in the company of doctors almost exclusively, to observe them trying to figure out how to do best by their patients. Mostly there was talk of heroin and other opioids, which are the things killing the most Americans these days. It was pretty amazing to dig into the complexity of it all.

Take Buprenorphine, for example. On the one hand, Bupe, as it is known in the field, is a promising tool in the treatment of opioid addiction, and there's a desire to expand its use in general. Unlike methadone, addicts don't have to go into the clinic every day to get a dose, you can write a month's prescription, making everyone's life easier. On the other hand, addicts have figured out that if you grind up certain types of Bupe (the generic, for instance), you can inject it and get really high. In some sense, it's not even the addicts doing the figuring out, it's the disease of addiction driving the process, using the addicts as slaves.

At about 6 yesterday, at the end of a long day, maybe 150 doctors were sitting there arguing the fine points of what type of Bupe should be given to pregnant women addicts: the straight variety, or mixed with Naloxone (long story).  They dug pretty deep into the discussion for 15 minutes. It was impressive, because they really cared.

Overall, that was the impression of the conference. A bunch of doctors who really cared about their patients trying to figure out how the heck to make their lives better. Full stop. I'll go back next year, if I can swing it.

One codicil: most of the doctors seemed to be Republicans, at least the older ones. I know that they work in a heavily regulated domain and resent the extent to which the government makes it hard for them to do their jobs and earn the livings they thought they would earn when they gave up years of their earning lives to med school and residency. But they also work closely with lower-income populations and people of color all day, and overall care deeply about these people's lives, you can see it and hear it when you talk to them. I would like to get to know more of them better to get a sense of what they think the right policy approaches are to our most vexing problems but, like all things, those are long and complicated conversations, and time is the most precious of all commodities in most contexts.

No comments: