![]() ![]() ![]() Today, the hospital Gatzke-Plamann is affiliated with sends her a monthly report of how many of her patients have opioid prescriptions. That included joining the county's substance abuse prevention coalition and educating her peers. Gatzke-Plamann helped shape her community's wider discussion about opioids. "We don't need to have those pain medications sitting in their medicine cabinets." "Most of the time those patients really only have that much pain for a couple of days," Gatzke-Plamann says. Instead of defaulting to prescribing a month's worth of pills for a C-section patient, for example, she might prescribe only three to five pills. She weaned many off of opioids and tracked how many pills she prescribed for acute issues, like surgeries. Soon she, like many of her peers around the country, noticed a rise in overdose and misuse.Īround 2012, she stopped taking on new patients using chronic opioid medications to focus on current opioid patients. She estimates she inherited 25 to 30 patients with monthly opioid prescriptions. When Gatzke-Plamann came to Necedah in 2010, U.S. And for Gatzke-Plamann there was no question that she wanted to rise to the challenge. Alan Schwartzstein, speaker of the American Academy of Family Physicians Congress of Delegates, "so they're not as accessible."įor rural physicians, the burden of responding to the opioid epidemic falls squarely on their already-loaded shoulders. Specialists tend to practice in larger towns and cities, says Dr. "We just have a lot of people who need this kind of care and they need it where they are," Krebs says.īoth pain management and addiction treatment are specialties, calling for advanced training that many family physicians don't have. Now, Krebs says it's becoming increasingly common "out of necessity." Erin Krebs, a professor of medicine at the University of Minnesota who researches chronic pain management. It used to be rare for primary care physicians outside of big cities to take on the challenges of opioid misuse, according to Dr. Meanwhile, rural Americans have fewer alternatives to treat their very real pain, and they disproportionately lack access to effective addiction medication such as buprenorphine. And rural doctors prescribe opioids more often by far, despite a nationwide decline in prescribing rates since 2012. Drug overdose deaths are more common by population size in rural areas than in urban ones. In many ways, rural communities like Necedah have become the face of the nation's opioid epidemic. ![]() "That weekend I went home and I said, 'I've got to do something different,' " she recalls. If that situation was going to change in Necedah, it was up to Gatzke-Plamann. Here was a patient with a family and job who spiraled into addiction because of doctor-prescribed pain pills, yet the community's bare-bones health system left him on his own to find treatment - which he later did, 65 miles away. She and the patient started searching the Internet while still on the phone, trying to find somewhere nearby that could help. She wanted to help but had no resources to offer. Gatzke-Plamann is the only full-time family physician in the central Wisconsin village of Necedah, population 916. Now he was not only admitting it, but asking for help. The patient had used opioids for several years for what Gatzke-Plamann calls "a very painful condition." But a urine screening one week earlier had revealed heroin and morphine in his system as well. "He was in complete crisis because he was admitting to me that he had lost control of his use of opioids," recalls Gatzke-Plamann. Angela Gatzke-Plamann didn't fully grasp her community's opioid crisis until one desperate patient called on a Friday afternoon in 2016. ![]()
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