Doctor’s opioid work earns White House recognition

It wasn’t until 2013 that the opioid epidemic stopped Dr. Blake Fagan, a family medicine physician, in his tracks.

 “I had a patient of mine that I had been seeing for over a decade. I had delivered her two kids. [I] had what I thought was a really good relationship with her. And then she showed up in the emergency department dead from an overdose. It really did change my life, changed my career. I remember talking to the emergency room doctor. I was like ‘What happened?’ He said, ‘Duh, we’re in an opioid crisis. Where have you been?’ I don’t know where I had been, but I was just blown away that this person that I had taken care of for a long time …. that this can happen. So, I started reading a lot and became very passionate about trying to help people that have use disorders, but particularly opioid use disorder.”

That moment propelled Fagan on a journey that took him to a White House event early this year to celebrate the passage of the Mainstreaming Addiction Treatment Act. Passed the month before, the MAT Act makes it easier for physicians to provide lifesaving treatment for opioid use disorder, the new term for opiate addiction.

Specifically, the act removes the requirement that a physician obtain a waiver from the Drug Enforcement Administration to prescribe buprenorphine, a drug to treat those suffering from opioid use disorder. Fagan said, “It doesn’t work for everyone, but about 50% of people that get on the medicine, their lives stabilize, and they get jobs, go to school, get kids out of foster care. It can be life-changing for them.”

Buprenorphine is a Schedule III drug, indicating a chance of moderate to low dependence. According to the U.S. Substance Abuse and Mental Health Services Administration, it diminishes the effects of physical dependency on opioids, such as withdrawal symptoms and cravings. It also increases safety in cases of overdose and lowers the potential for misuse.

Fagan directs opioid treatment services provided at the Mountain Area Health Education Center. “There’s a lot of stigma and bias around prescribing buprenorphine,” he says. “I really enjoy the challenge of talking to other providers and educating them about buprenorphine, answering their questions, helping them get through their fears. Then that satisfaction once they started prescribing buprenorphine that I was doing a small part in helping their patients through that education.” MAHEC’s training and treatment of the disorder and Fagan’s work to educate lawmakers about the importance of buprenorphine led to his invitation to the White House event.

Xpress sat down with Fagan to discuss the MAT Act, how buprenorphine is used, and what it was like to go to a White House function.

This interview has been lightly condensed and edited.

Xpress: What called you to focus on opioid treatment?

Fagan: As I started doing more and more of that work within my family medicine practice, I realized that people with opiate use disorder are just like the rest of my patients. They just happen to have one additional chronic disease, and if you can stabilize it, they “do life” a lot like other people. It became very satisfying work to take care of the patients and also go out and teach other providers about opiate use disorder and about the medicine, buprenorphine.

Is buprenorphine a medication that is taken for a long time or just for emergencies?

The way that it works best is that you take it every day, and you should take it for as long as it benefits you. For some people, that may be a year; for other people, that might be the rest of their lives. Some people don’t like that because there’s so much stigma and bias around this medicine. If it’s not the patient that’s having a hesitancy, it’s one of their loved ones. It’s very rare that someone comes to me and says, “Hey, you’re prescribing this high blood pressure medicine for my dad or for my wife. I want them off that right now.” That’s just not a thing. They’re just like, “Yeah, I don’t want them to have a heart attack or a stroke or die either. Of course, they’re going to take this medicine for the rest of their life.”

What’s the significance of the Mainstreaming Addiction Treatment Act?

The (DEA waiver) was a big barrier to providers prescribing buprenorphine because even if they identified someone that had an opiate use disorder, what can they say? “Well, I don’t have my waiver. I can’t help you.” Maybe they would give a phone number or suggest an address of another clinic to go to. But they didn’t have the ability to treat the patient in front of them because they didn’t have the waiver. The medicine, buprenorphine, is actually really safe. By removing this waiver requirement, providers can write a prescription for buprenorphine just like a diabetes medicine or a high blood pressure medicine. They don’t need any extra paperwork and they don’t have to fill anything out on a federal website.

We believe that we went from having about 130,000 providers in the whole United States to now 1.8 million providers who can write a buprenorphine prescription, meaning all of us, whether you’re a certified nurse midwife, a nurse practitioner, a physician assistant. This literally means you could be seeing your cancer doctor or your heart doctor and disclose that you have an opioid use disorder, and they can now write this medicine. It’s a huge win for our society.

What was it like to attend the White House function?

It was an honor to go to the White House to celebrate the passing of the MAT Act into law. Thousands of people worked on this. I played a small part in educating some representatives at the federal level and some of the attorneys general from across the United States.

I’ve never been invited to the White House before. It was very exciting to be there for two reasons. One, to be at the White House. The other was to be there with all these people that literally spent three years helping to get this passed and feeling the sense of accomplishment. Hearing from Sen. Maggie Hassan from New Hampshire who was a big proponent of this bill and Rep. Mike Turner from Ohio, but then also meeting and hearing the push that happened from Dr. [Rahul] Gupta, the White House Office of National Drug Control Policy, Annie Milgram from the DEA, and the assistant secretary for mental health and substance abuse. It was just great. All of these folks had to come together.

I learned that it takes a lot to get bills passed, and you have to get a lot of coalitions together. There was a great sense of satisfaction with passing this bill. I felt very honored to be able to be there for the celebration.

What surprised and delighted you about this crowd?

That so many of the people in the audience were not physicians. There were a few physicians there, but the organizers made sure that they honored and celebrated this act with many people that are in the recovery community. There were social workers, pharmacists and people with lived experience that had lost loved ones to this terrible disease who had been big advocates and would jump on phone calls like I was doing when representatives or others had questions to help them become educated so that they would feel comfortable voting “yes” on this.

This was a huge step. But we know because of the stigma and bias associated with opiate use disorder, and the medicine in particular, buprenorphine, that we’re still going to have to do a lot of education.

I am just really proud that our state of North Carolina and the folks that work in North Carolina who have tried very hard to make sure that we’re teaching the providers out there about buprenorphine so that they can take care of folks with opiate use disorders.