Open Doors, Open Minds
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Maria Alvelo believes those who judge people with substance use disorders should consider themselves lucky. “People are dying left and right,” she says of the opioid crisis. It could just as easily be your mother, father or sibling struggling with addiction, she insists, “so count your blessings.”
Alvelo has been a nurse for Greater Lawrence Family Health Center’s Office-Based Addiction Treatment (OBAT) program since its humble beginnings over a decade ago. The health center was only able to see 100 OBAT patients at a time back then, Alvelo says, a far cry from where it stands today.
“We’re now in the range of 400 patients actively engaged in treatment,” she says. And the wait list? It no longer exists. GLFHC now has 40 doctors and two nurse practitioners licensed to prescribe medications for opioid use disorder, Alvelo says, meaning those struggling with addiction are now able to set up appointments quickly, often on the same day they put out the call for help.
Treatment with medications such as buprenorphine can be controversial in the popular opinion, with some confused or angry at the idea that health care providers would prescribe one opioid to “replace” another. Dr. Mia Sorcinelli, who’s leading the health center’s OBAT efforts, says she always makes it a point to dispel this myth.
GLFHC’s Dr. Mia Sorcinelli talks with patient Sasha Moeckel during a visit to the health center’s Office-Based Addiction Treatment (OBAT) program. Photo by Kevin Harkins.
“The thing that’s so fascinating is that really, when you look at the research, there is no controversy,” she says. “There’s no doubt that being on a medication — whether it’s methadone, Suboxone or Vivitrol — greatly increases a patient’s chance of sobriety, of not injecting drugs, of not getting Hepatitis C or HIV.”
Amy Bositis, GLFHC’s clinical services director, says a lot of this animosity comes down to a basic misconception people have about the medical condition.
“Substance use disorder is not a moral decision,” she says. “Nobody wants to be addicted to a substance. Nobody goes into this saying, ‘I think this is a great way to live.’ They make a choice at one point which introduces the opioid into their system, and their brain takes over in a way that they can no longer control.”
Because of this, Bositis says, the staff of the OBAT program approach relapse the same way they do challenges for patients with any other disease, like diabetes: by going back to the drawing board and trying a different method.
Of course, “diabetic patients” and “OBAT patients” are not always mutually exclusive groups. Because Greater Lawrence Family Health Center is a primary care provider, patients’ care teams are able to identify and address health problems they’re having beyond a substance use disorder. Perhaps unsurprisingly, these problems are numerous in OBAT patients, whose substance use is just one of many life challenges they have to contend with. When they’re addressed successfully, though, the results linger in the memories of both provider and patient. Bositis and Sorcinelli enthusiastically recall the story of an OBAT patient who finally got a Pap test after nearly two decades of avoiding them. Another patient, successful in her efforts to stay sober, then went on to quit smoking.
None of this would be possible, Alvelo says, without the team agreeing to leave their judgment at the door.
“These people come to us broken,” she says. “We don’t want them to feel like we’re going to judge them. I always tell the patients, ‘I’m here. I’m not going to go anywhere. The doors are open, so what do you need? What can we do for you?’”
Greater Lawrence Family Health Center
Lawrence, Haverhill and Methuen, Mass.
GLFHC.org
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