My First Hole in One

My First Hole in One
People often ask me why I do addiction medicine, why do I want drug addicts at my practice. Let me now tell you why.

I first got into drug addiction medicine when a friend of mine introduced me to the provider of training in addiction medicine in the U.K. At that time, I was working as a GP partner in an established practice in South Wales. I was somewhat bored but resigned to the idea of clinical medicine taking time to create patient benefit. My diabetic clinics were full of people with persistently raised HBA1Cs, my hypertensive patients took at least thee months to get to some sort of appropriate range and usually only after two or three medications.

During my addiction training I learnt about buprenorphine. I learnt that patients could be stabilised on it after three days. Then, having completed my training I got a job working in a criminal justice funded drug clinic. It was designed to keep offenders with drug issues who had committed acquisitive crimes out of prison. I met my first patient for whom I felt that Suboxone was appropriate. Not his real name, but for the purposes of this story we shall call him Frank.

Frank was a twenty-six-year-old man who was at the last chance saloon. If he failed during treatment at this clinic he was heading straight for prison. He came with his mother who begged me for help. She offered to pay me private additional fees, just so I would work harder at helping her son. I assured her that the service I would give her son would be to my best ability even without any further financial inducements.

I decided to start him on buprenorphine, but then I realised I had no idea about how to do the prescription. It was all well and good learning the theory, but to write my first prescription: no one taught me how to do that. I phoned a friend and she very gently and calmly told me exactly what to write on the prescription. I will never forget her kindness. That is why I teach other doctors now, and I hope I do so with the same kindness that was shown to me all those years ago.

So, I started Frank on Suboxone. Within three days he had stopped using heroin. Within 6 months he was working and paying taxes. Within 12 months he was living back at home and helping his father work in their family business. During this time, we also provided him with wrap around holistic care. He saw dentists, psychologists, social workers and was vaccinated against hepatitis B. His alcohol consumption reduced almost to zero. He was happy again.

After one year of treatment Frank’s mother came back to see me again. She gave me a bottle of twenty-one-year-old whiskey as a present. With tears in her eyes she thanked me for giving her son back to her. I then realised just how rapidly and profoundly pharmacotherapy can positively help patients with addiction problems. It can literally be life-saving. I am not saying that every patient I now treat with pharmacotherapy responds as well as Frank did, but Frank keeps me going in this field of practice. He was my hole in one when I first picked up my addiction golf clubs.
Author: Ferghal Armstrong
Ferghal is an experienced medical educator and teaches the subject of pharmacotherapy to other doctors.
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