On opioid addiction treatment in small-town Iowa

Abby Goodnough reports today from Marshalltown, Iowa, population 27,552, on one how one young physician is responding to the opioid crisis.  The headline is "When an Iowa Family Doctor Takes on the Opioid Epidemic."

Goodnough explains what Dr. Nicole Gastala, 33, is doing in Marshalltown:

She is one of a small cadre of primary care doctors who regularly prescribe buprenorphine, a medication that helps suppress the cravings and withdrawal symptoms that plague people addicted to opioids. If the country is really going to curb the opioid epidemic, many public health experts say, it will need a lot more Dr. Gastalas.

Just 43,109 physicians--about 5% of those in the nation--are licensed to prescribe buprenorphine, though science says it is effective. With the license to prescribe comes more oversight from the DEA. Half of U.S. counties have no buprenorphine prescriber.

 

Gastala, is not from Marshalltown, but her trusty companion--nurse case manager Andrea Storjohann--is:

Ms. Storjohann keeps the buprenorphine program running while the doctor multitasks. She gauges each patient’s progress, asking about their highs and lows since their last appointment. She also tests their urine to check for other drugs and that they’re not misusing or diverting the medication. And she makes sure they’re going to therapy, which the program requires. 

Goodnough observes the lack of judgment in Storjohann's manner, even as she asks how many times in the last year a patient has used drugs for nonmedical reasons.  This helps her win patients' trust.

This story features several profiles of Gastala's patients, those succeeding and those failing, all struggling. 

Also of interest:  Gastala is in Marshalltown as a beneficiary of a federal program that helps pay off her student loans from medical school.  The small city qualifies as an underserved community.

Marshalltown is also one of this places that figured in this fall, 2015 op-ed by Alec McGillis, which I blogged about here.

A two-part NPR series from this spring regarding opioid addiction and overdose deaths in Indiana is here and here.  The angle there is the devastating toll on families of addicts, as well as on their financial situation. 

Here is a story from last fall about meth's resurgence in rural Iowa.