Posted by: notdeaddinosaur | November 12, 2016

A Few Days Later

It was a bad week. I know a lot of other people who felt the same. I happen to be fortunate enough to live in an area where the vast majority of the population shared my dismay, but it was still difficult. Not much sleep. No appetite. Hard to concentrate. Anhedonia.

Calls for “healing” and “moving on” didn’t help. I feel assaulted, and it’s just too soon to try forgiving my attackers.

I had to keep going, though, so this morning I went downtown to work at one of my side gigs. Actually, I was there last week, but someone called out so they asked me to fill in this week as well. So I went.

It’s a Suboxone clinic*. A crazy-busy place where people struggling with addiction come to get a prescription medication that allows them to lead a normal life — their words — in conjunction with psychotherapy and close drug monitoring. They are probably the only buprenorphone prescribers in Pennsylvania who take insurance**. They average 200 patients per session, but because of the SEPTA transit strike last week, there were lots of folks who had to re-schedule.

I’ve been working there since June, and I love it. Don’t get me wrong: I love my practice, but reassuring yuppies that their back pain will go away in a few weeks and trying to explain why they don’t need antibiotics for their bronchitis doesn’t exactly feel like the cutting edge of saving lives and easing suffering. But this place does. These are people who have struggled with demons more malignant than I can imagine. They have seen loved ones murdered, lost others to overdoses, suffered rape and abuse; the entire gamut of human suffering. Yet they are the ones who have chosen to fight. To come and ask for help.

Many doctors don’t like addicts, an understandable attitude given many of the experiences we’ve had with them. The manipulation, the lying, the untrustworthiness; we’ve heard it all, and we’ve all been burned. But this is an extremely structured and protocol-driven setting. Every patient must have a urine drug screen after every visit. Dirty urines prompt a Probation program, with increased therapy and more intense followup. As long as a patient is working the program, we’ll write their refills.

It’s downright inspiring. There’s a real sense of making a difference in someone’s life; one that could literally be the difference between life and death. I don’t think there’s a single patient in that clinic who hasn’t lost someone to drugs. They know all too well how important this medication is to them. And I feel privileged to have the opportunity to help them.

And you know what? Thirty patients and four hours later, I felt better. Still worried sick about the future, but not quite so down. An unexpected benefit of helping others.


*Suboxone is the brand name for buprenorphine/naloxone, a “replacement” drug for opiate addiction that doesn’t produce the high of heroin (actually blocks its effects) but blocks the symptoms of opiate withdrawal. Whether someone on Suboxone instead of heroin is really “clean” or not is a matter of semantics. Medication-assisted treatment of opiate addiction has been shown over and over to be more effective than “total abstinence.”

** Many if not most doctors who prescribe Suboxone privately charge cash for the visit, often exorbitant amounts, including monthly returns.



  1. Hi Dr. Lucy,
    I had a similar experience last week. I fought and was told to move to Canada and was lectured to grieve for something more important, so I unfriended several people and went to work in Upper Darby where I teach students who cannot understand what they read. I’m not getting through to all, but there are several who make my travel time there gratifying. I love it when I see the spark of understanding and know I am helping them to read between the lines and question everything. I hope I am making a positive difference in their young lives.

  2. This is the best way to get through what has happened to our country. Do the best you can, be the person who holds others up instead of holding them down.

  3. You were saving them, just as they were saving you. That’s beautiful. (And nicely said in your comment, gardenqueen.)

  4. You have been unnaturally quiet for quite awhile. Are you OK?

  5. I was just thinking the same thing as JPB. It’s been a depressing month, but I tried to follow your example and did some charitable work.

  6. I don’t doubt that you are a dedicated physician or that you do your best to help.

    But how much help can you be providing if you have to see 30 patients every four hours? That breaks down to 7.5 patients/hour, which equals 8 mins per patient at absolute most with no contingencies for delays, bathroom breaks, charting, phone calls, interruptions, etc.

    If these folks are so troubled and ill, they need more time than an average patient, not less. As a physician, I know not much can be accomplished in 8 minutes flat.

  7. I am not providing primary care to these people. Nor am I providing the structured psychotherapy they all need and are required to participate in. There is no exam involved except a very cursory one for new patients. Essentially all I am doing is writing the prescription.

    There is a significant subset of patients who are doing very well, remaining abstinent, attending therapy, and are no longer what you would call acutely ill. It takes literally 2 minutes to confirm that all is still well and to write the prescription.

    Remember too these are people who want help, who by and large are no longer in denial about their addiction. Cutting through all that crap is what takes a great deal of time. I guess in a way I’m glorifying the experience of being an Rx machine. But it still feels good.

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