By CALLIE DANIELS BRYANT
Nearly 20 years ago Dr. Brent Boyett established a medicine and dentistry practice in rural northwest Alabama. As years went by with countless patients Dr. Boyett realized he was in the middle of a catastrophic storm in rural South and across the nation: the opioid crisis.
Boyett changed his career path from dentistry to specialize in addiction medication. He then opened Pathway Healthcare in Madison, Ala. in October 2016. Since then Pathway Healthcare expanded to nine locations across the South with three in Mississippi: Jackson, Vicksburg and Columbus.
Boyett explains he chose Columbus because he was most familiar with the needs of that area.
“The original location that we opened was developed out of my private practice in Hamilton, Ala., and I’m a native of Sulligent, Ala. across the state line from Columbus – maybe a half-hour away. I know people in that area and consider that my hometown area, so I know the great need for addiction patients in Columbus. That was the outset of starting Pathway Healthcare. We wanted to establish a presence in Columbus to answer the need in that area,” said Boyett.
What makes his practice stand out is Boyett’s own experience in handling addictive patients in rural South. Where he once addressed addiction as a moral problem where he thought people could have simply said “no,” Boyett now sees and treats addiction successfully as a chronic disease that can be managed like diabetes or hypertension.
“In many of patients who are addicted to opioids are being treated for chronic pain syndromes and the cause of physical pain is the most common symptom of opioid dependency,” Boyett said, “and it looks and feels like a chronic pain syndrome when it’s actually a chronic brain condition and the pain is a symptom of the opioid dependency itself.”
The scale of opioid crisis is alarming. One statistic Boyett offered is that heroin overdose rates rose 300 percent between 2013 and 2016, a threefold increase in three years – and heroin and other illegal synthetic fentanyl is that it’s the tip of the iceberg with the massive scope of pill addiction in the South. Mississippi is the fifth highest number of opioid pain reliever prescriptions per person in 2015 as well as 563 reported overdoses from 2013 to 2016.
He noted that a nationwide problem in the opioid crisis is the scant access to qualified physicians and programs in addiction medicine. Though, the American Board of Medical Specialties addressed this in 2016 by recognizing addiction medicine as a subspecialty which led to a newly formed board in direction of preventative medicine against addiction. As a result there are 900 specially trained physicians in addiction medicine, and Dr. Boyett wants to use Pathway Healthcare to introduce more specialists to the rural South.
He said, “Our goal at Pathway is to increase the amount of physicians who are trained as addiction specialists and to integrate that in a hospital situation such as Baptist Medical Center in Jackson so patients can have access to addiction medicine care the same way they have access to cardiology, endocrinology and other specialists.”
Now serving as Chief Medical Officer, Boyett works with CEO Scott Olson to expand Pathway Healthcare across the rural South to help those most misunderstood and vulnerable in opioid addiction as well as other addictions such as alcoholism and smoking.
“The number one goal for this company is to build a culture that is really about helping people,” said Olson, “it sounds cliché but what we’re trying to do, the most important thing we can do every day, is helping our patients and helping the communities we serve.”
From a business angle Olson wants Pathway Healthcare to be known for providing highest quality care for addicts, and he wants to do it within healthcare system which is why it focuses on partnership with hospitals such as Baptist Medical Center where they are working on relocating its Jackson office to.
“We want to grow and expand, primarily in southeast United States in the near term,” Olson said, “providing access to this type of treatment where people don’t have it. The statistics are alarming: as few as one in 10 people suffer from addiction. (Working in hospitals) make sense in how historically people have received care through hospitalization or inpatient care. It serves very well for those who have a lot of money or those who have nothing. There’s a group of people that don’t have the ability, the time, and the money to be in an inpatient facility but can go to their doctor’s office near a hospital so we have a huge goal of expanding our network providing more and more access with the highest quality healthcare.”
A part of that goal is to take some of the burden off hospitals like Baptist by helping them treat addiction as a chronic disease instead of detoxing and having patients then leave against medical advice. Pathway Healthcare doesn’t yet have a formal arrangement with Baptist but they hope they will soon be able to assist Baptist in treating addictive patients by becoming its referral system in providing one on one care and outpatient treatment.
“(Our) relationships revolve around training their doctors by providing consultations and sometime treatment working with their case management workers and being that referral for outpatient care that can manage long-term cases. Hospitals aren’t set up to do that not because they don’t want to but just because (addiction is) something they weren’t focused on,” Olson said.
Pathway Healthcare’s first hospital partnership was with Ascension Hospital in Birmingham and it was through preferred provider agreement that they came to Baptist in Jackson where they eventually moved on hospital campus and became a referral system for its inpatient care and emergencies.
It also has a few partnerships with a few more in the works for hospitals in Tennessee and Louisiana.
Safe to say, Olson and Boyett have their hearts in rural Southeast where they feel the areas are underserved outside of cities and densely populated states.
“Combine that with the fact that across those states very few people get anyone who is offering medical treatment with behavioral counseling under a coordinated treatment plan in an office with an outpatient basis in the medical community – it really just doesn’t exist. We’re giving people an option to get evidence-based treatment and we’re just focused on a part of the country that’s underserved,” Olson said.
Pathway Healthcare is also reaching out to local doctors and outpatient clinics where patients seek treatment for substance abuse across Mississippi.
“We’ve partnered with some great doctors like Dr. (William) Aron in Jackson and Dr. (Sterling) Easterling in Vicksburg,” Boyett said. “We also partnered with Dr. Mike Turner and Dr. (Duke) Wood in Columbus. We are developing a network of clinics where patients come in to an outpatient setting to be treated for substance abuse of various kinds: tobacco, alcohol dependence as well as opiate dependency. Our goal is to establish a network of addiction medicine clinics in Mississippi that increases access to this kind of care.”
So far, Pathway Healthcare is treating 1,500 patients on a regular basis with a full-service platform that provides counseling for mental illnesses which can be one of many roots of addiction. Due to its dynamic counseling group, Olson said that Pathway Healthcare is qualified to give quality evidence-based care for addictions from alcoholism to cocaine and methamphetamine to opioid dependency. Pathway Healthcare also offers cognitive behavioral therapy where medication falls short. The organization keeps in stride with latest evidence-based healthcare and medication coming up on markets that can treat addiction and underlying mental issues into a manageable condition.
Pathway Healthcare focuses on the administration of evidence-based medicine in an outpatient setting, which makes it not a rehabilitation facility, but rather a doctor’s office with trained addiction specialists that can provide counseling and medication to help patients manage their addictions.
“What kind of impact we’ve had,” Boyett said, “I think you’ll see patients can access care more readily and being able to do so in offices that feel like doctor’s offices. That’s intentional to reduce the stigma with disease of addiction and also to treat this disease like a chronic condition.”
Dr. Boyett credits advancements in neuroscience that helps him understand that addiction is a chronic disease that cannot be cured.
“The idea of detox discharge has been shown to not be very effective, I would think,” Boyett said, “and most experts agree, detoxing a patient off opioids or benzodiazepine and say they’re cured is the same as bringing in a diabetic then controlling their blood sugar only to say they’re cured. It doesn’t work that way. It’s a chronic relapsing condition and addiction in its various forms has periods of exacerbation and periods of remission. That’s a better way of thinking about the disease of addiction. We find patients do much better when they’re managed through a long-term outpatient care that may sometime include medicative assistance, but the patients are never disease-free. They have to be vigilant to protect their recovery.”
The medical approach to addiction is dynamic but it needs to be on a national scale.
“The crisis has definitely gotten worse, and it’s getting worse as we speak,” Boyett said. “Legislators in all 50 states are scrambling to figure out how to deal with this, and if you do approach it (medically) people do get better. But if you look at the drug issues in the last few decades there are two schools of thought.”
There is the supply reduction approach which policy makers propose incarceration, regulation, and border control to cut off supply – the premise of the War on Drugs. The other approach is to provide education, early prevention and long-term disease management also known as treatment.
“Education is important,” Boyett said. “Doctors and healthcare providers understand how dangerous opioids and benzodiazepine are. The cavalier attitude since the 1990s has been a big part of what’s resulting in this epidemic. We need to reeducate dentists, physicians and other prescribers as well as educating the public that narcos, percocets, vicodins given by their physicians do have a risk of forming dependency. Doctors and providers need to be trained to identify all types of substance abuse and be comfortable with having a conversation with that patient about ways in scientific and evidence-based ways how they can reduce harmful use and remedy it altogether. And finally, the doctors and the public need to realize that when people become dependent on that substance is a medical condition and that there are treatments, but no cures. People can live a normal, healthy life. Especially in opioid use disorder they’ll have periods of their lives where they’ll go into remission and periods where they’ll have their disease exacerbated again.”
To grapple with the sprawling reach of addiction nationwide, Olson said the states need to address the crisis from all angles especially on public awareness.
“I’m still shocked at how many people don’t understand that addiction is a disease and should be treated as such,” Olson said. “There’s so much shame and stigma around it and people still don’t apply proper standard of care across different states and regions within. Continuing to educate doctors and medical professions educating the community, our youth, and college campuses, will help. People need to understand the dangers of prescription pain medication. While the issue is in press more and more I’m surprised that people don’t understand that taking opioids for more than 30 days can make you addicted.”
Prevention is another component of what states could do to address the crisis. Olson said the doctors should not prescribe pain medication when unnecessary but rather find alternative pain management practices such as physical therapy.
“And last we need treatment available,” Olson said, “(we) have to treat it as a disease and remove that shame and stigma. The medical community has to work and collaborate and we want to be a part of the healthcare system. This effort shouldn’t be done outside the community in a strip mall. The medical community will help alleviate the stigma and provide collaboration and cohesive treatment.”
Education, prevention and treatment are the best ways in tackling the ongoing crisis, Olson said. And it takes all levels of the government and society’s focus to remedy it.
While the public addresses the issue Pathway Healthcare offers cost-effective way to get treatment for addiction no matter the patients’ time and financial restraints.
“If you can’t afford it or don’t have time, you’re wrong,” Olson said, “you can’t afford to not get help. We can fit your schedule, and we won’t judge you. We’re here to help you, serve you and care for you and we hope that you leave there knowing someone is on your side.”
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