Primary Care Physicians Bench Themselves in Battle Over Opioid Crisis

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Of all the primary care doctors to have made the transition to treating opioid-addicted patients, Dr. Leslie Hayes is perhaps the most highly recognized.Earlier this year, Hayes won recognition from the White House as a “champion of change,” for her role in addressing the opioid-overdose crisis.

Her territory: Española, New Mexico.

When she started practicing here roughly 25 years ago, Hayes said she “didn’t realize there was actually stuff you could do, and how much you could do. So I did the best I could.”

That meant she practiced the standard approach to those with addiction disorders.

“The default was to say ‘You need to quit drinking and using drugs,’” she said. “Then refer them to NA. It’s a great option for some, but it doesn’t work for everybody.”

In 2003, Hayes heard about a new program in New Mexico, Project Echo, which trained primary care clinicians remotely in various medical specialties. She worked under the guidance of Dr. Miriam Komoromy, a professor at the University of New Mexico School of Medicine, and by the following year was trained to treat patients with substance abuse disorders and certified to prescribe buprenorphine.

“Leslie is my hero,” said Komaromy. Even though Hayes carries no board certifications in addiction management or OB/GYN medicine, Komaromy said, “she’s one of the state’s recognized experts in opioid addiction in pregnancy.”

Hayes is quick to point out that buprenorphine is not a cure-all. Some of her patients have learned that the hard way.

Bobby Delgado, 45, saw Hayes, who helped him get Suboxone for free because he couldn’t afford the $10 per-pill copay. Within three years, Delgado relapsed.

“Suboxone does work, but you have to do your share of the legwork,” he said. “Going to meetings, going to your appointments. All of this is a factor.”Of all the skills Hayes learned during training, she said the most valuable has been what is known in psychology circles as “motivational interviewing.”

“If you tell someone the reasons they need to stop, they’ll go the opposite way,” she said. “So the idea is to get the patients to voice the reasons they want to quit, so if they voice that, they’re much more likely to follow through with them.”

Hayes said she will ask patients to rate, on a scale of 1 to 10, the importance of quitting drugs, and then rate their confidence in their ability to do so.

“And I always ask what good things they get out of using. If you can figure out what those things are, and if they can figure out another way to achieve that, it can be very helpful.”Hayes said she sometimes remembers patients she saw before she received advanced training in the treatment of addiction. Among them was a young woman who was repeatedly turned away from busy rehab centers, until she was later convicted on drug charges and ordered by a judge to admit herself to inpatient care.

Years later, Hayes saw her in the local hospital.

“She’d aged so much — her memory was shot, and she was clearly still using and not doing well at all. She didn’t remember who I was, which made me kind of sad,” Hayes said.

If Hayes had been certified to treat the woman with buprenorphine during her early visits, she said, she likes to believe the woman’s outcome would have been different.

“I can’t say for sure, of course,” she said. “But she’d have had a much better shot.”

Kaiser Health News is a national health policy news service that is part of the nonpartisan Henry J. Kaiser Family Foundation.