Confronting the Opioid Crisis Facing Rural Washington
How One Collaboration is Mobilizing a Comprehensive Community Response
Robin was living what many would consider an ideal life. He had a loving wife and family and a successful health care career. After a prescription for pain management following back surgery developed into an opioid addiction, the life he knew drastically changed.
“I didn’t stop at my doctor’s prescriptions,” says Robin. “I knew when to say ouch. I knew how to exaggerate it to get what I needed. I took Vicodin, Oxycodone, morphine and fentanyl, which led to other drugs. As a result, I lost my career, I got divorced, and I lost my family.”
As tragic as it is, Robin’s story is unfortunately all too common. In America1, 130 people lose the battle to opioid addiction every day. Family physicians are scrambling to treat opiate use disorder with limited resources and more treatment programs are desperately needed—especially in rural areas where patients like Robin have minimal access to care.
Barriers to treatment, such as the stigma surrounding the condition and lack of access to care, are what inspired Caleb Holtzer, M.D., MPH, a family medicine provider with Providence, to lead the Tri-County Opioid Treatment Network (TCOTN), a rural opioid treatment program in Washington’s northeast counties. The result for Robin and over 300 other patients has been nothing short of life changing.
A coordinated response to care
“There’s a great need in our community and a big burden of pain, and that falls to family physicians to manage that care,” says Dr. Holtzer. “There was a need for providers to take on the role of treating people with opiate use disorder and chronic pain. People don’t know how to ask for treatment. They feel marginalized.”
According to Dr. Holtzer, the interconnectedness of the Providence team makes all the difference. “We have a coordinated response and we’re all in agreement regarding medication and care thanks to our team working behind the scenes.”
In collaboration with partnering organizations in the Tri-County area, Providence care navigators, nurses and social workers support a group of wavered providers to expand access to treatment throughout the region. They do the hard work of calling patients to set up treatments, helping with transportation, and removing barriers to treatment. Most importantly, Dr. Holtzer notes, they get to personally know every patient, their families and their stories.
“I had a couple caregivers come check on me at my home when they were off duty,” Robin shared. “Who does that? They make sure you have anything you need, like a ride to your appointment. They really go above and beyond.”
Breaking down stigma
“I don’t think anyone wakes up and looks in the mirror and says ‘I want to get addicted and lose my family and my life’,” says Robin. “You lose hope. You get depressed a lot, because you know what people think about you. And your own self-imposed stigma – ‘I'm an addict, I’m no good’ — you allow that to dictate your life. Stigma kept me from telling people and getting help.”
“The hub and spoke model is aimed at increasing community awareness of the problem, normalizing it, and treating patients humanely with a caring attitude,” says Dr. Holtzer. “The biggest difference we’ve made is people start to understand opioid use disorder in context of the chronic disease model. It’s a disease of the brain and neurotransmitters in the brain. It needs medical attention just like any other disease. It can happen to anyone.”
“They didn’t see me as a human piece of garbage,” says Robin. “They saw me as human. The nurses were awesome. Dr Holtzer was completely awesome. They have a real program. They have patience. They cry with you. They laugh with you. It saved my life.”
“I'm really proud of our staff,” says Dr. Holtzer. “They have embraced seeing patients as important members of our community rather than someone who has a moral failing. They bring warmth and caring in a crisis and have developed therapeutic relationships with them. It really changes the patient’s belief that they can succeed in handling this problem when they see a kind face.”
Robin says the treatment program has “meant everything” to him. “If they didn’t have this program and doctor, I probably wouldn’t be talking to you right now. I’d be back in prison, dead, or on the streets dying somewhere.”
Today, Robin has been in recovery and opiate free for two years. “My relationship with my kids and my ex-wife are awesome now. If you saw me back then you would say it’s a God-given miracle. I don’t want it to sound like a wave of the wand. There’s no quick fix. But I’m telling you it works. If I can change, anyone can.”
“It’s a lot of work and also very gratifying,” says Dr. Holtzer. “It’s very rewarding to see people get better and decrease the burden of that disease on their lives.”
If you or your loved one is experiencing challenges with opioid use disorder and live in the north Tri-County area, call Monday – Friday 509-690-1303.
For help 24/7:
- Washington State Recovery Line 1-866-789-1511 or visit warecoveryhelpline.org.
- Idaho Treatment Line 1-800-922-3406 or visit healthandwelfare.idaho.gov.
*Name changed to protect patient identity.
1 “America’s Drug Overdose Epidemic” Cdc.gov 2017