Doctors, drugs seen as vital on opioids

Most addicts don’t receive treatment

MARSHALLTOWN, Iowa — A newborn had arrived for his checkup, prompting Dr. Nicole Gastala to abandon her half-eaten lunch and brace for the afternoon crush. An older man with diabetes would follow, then a pregnant teenager, a possible case of pneumonia and someone with a rash.

There were also patients on her schedule with a problem most primary care doctors don’t treat: a former construction worker fighting an addiction to opioid painkillers, along with a tattooed millennial who had been injecting heroin four times a day.

Opioid overdoses are killing so many Americans that demographers say they are likely behind a striking drop in life expectancy. Yet most of the more than 2 million people addicted to opioid painkillers, heroin and synthetic fentanyl get no treatment.

Gastala, 33, is trying to help by folding addiction treatment into her everyday family medicine practice. She is one of a small group 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 going to curb the opioid epidemic, many public health experts say, it will need a lot more Gastalas.

Science says buprenorphine works: A substantial body of research has found that people who take it are less likely to die and more likely to stay in treatment. It is an opioid itself but relatively weak, activating the brain’s opioid receptors enough to ease cravings, yet not enough to provide a high in people accustomed to stronger drugs. But only about 5 percent of the nation’s doctors — 43,109 as of earlier this month — are licensed to prescribe it.

After a rocky start, the Trump administration has gotten on board with addiction medications. The nation’s top health official, Health and Human Services Secretary Alex Azar, said recently that trying to recover without them is “like trying to treat an infection without antibiotics.” Last year, Congress temporarily began allowing nurse practitioners and physician assistants to prescribe buprenorphine if they go through extra training, and more than 7,000 have gotten licensed.

Kathryn Gamble / New York Times Dr. Nicole Gastala (right), with nurse Andrea Storjohann in Marshalltown, Iowa, regularly prescribes buprenorphine, a medication for those addicted to opioids.