Sunday, March 12, 2006
Clinic wars could rekindle in Blacksburg
Elizabeth Strother
Recent columns
- Independent voice is silenced in merger
- TOP takes a hard knock
- Lagging on college access
- Alzheimer's drains minds and finances
From the RoundTable blog
Dr. Martha Wunsch told me last week she's "taking another run at it," trying again to establish a methadone clinic in Blacksburg.
Considering the intense opposition such a proposal so often meets in a community, I had to wonder: What's a nice pediatrician like Wunsch doing in a specialty like addiction medicine?
The answer, she says, lies in her original training in anthropology.
Wunsch, an associate professor and chairwoman in addiction medicine at the Edward Via Virginia College of Osteopathic Medicine, went from studying physical anthropology to entering medical school.
She got her M.D. from the Uniformed Services University of Health Sciences School of Medicine in Bethesda, Md., did a pediatric residency in Los Angeles, then became a public health officer for the Indian Health Service to repay the government for her education.
She went to work on an Indian reservation in Arizona, where she found both a high infant mortality rate and that "alcoholism was devastating the community."
"I looked at the problem as an anthropologist. I got interested in following up on every infant who died," she said. And she found a correlation between the high rate of infant deaths and the high rate of alcoholism among mothers. The babies weren't dying because of fetal alcohol syndrome, nothing so direct as that.
"The alcoholism had devastated the emotional capital of these families," she explained. "If I was to affect the infant mortality rate in the community, I needed to treat the women."
She founded the Pascua Alcohol Treatment Home in Tucson and earned a Medal of Commendation from the U.S. Public Health Service -- "because we really did make a difference."
Then, she said, "I thought I'd just be a plain old pediatrician." And for a while, she was, first in Boulder, Colo., then in Blacksburg, where her husband, Kent Nakamoto, is head of the marketing department at the R.B. Pamplin College of Business at Virginia Tech.
"But in 2000, the bug just bit me. I just wanted to do addiction medicine. I went back to school at age 45," to Virginia Commonwealth University in Richmond. Nakamoto and their two daughters stayed in Blacksburg, "and I commuted for two years."
Wunsch since has developed a four-year curriculum in addiction medicine at the Via college, where she teaches, is medical director for ARS Pantops Methadone Clinic in Charlottesville and is a substance abuse consultant for the New River Valley Community Service Board -- because, she said, she was raised in the Midwest and grew up learning "you help those with less than yourself."
Now ARS Pantops has applied for a state license to operate a methadone clinic in Blacksburg, and I hope the community will respond knowledgeably and with compassion. But I'm not counting on it.
The company's first attempt was derailed last year not by public opposition, but by a statewide ban against the treatment centers within a half-mile of schools or day care centers -- itself a product of public fears about a clinic proposal in Roanoke.
The Blacksburg plan had its vocal foes, too. "I stood in front of the public for 45 minutes and was berated for 45 minutes for 'bringing these people into the community,' " Wunsch recalled. "The thing is, they are in the community."
They are sick. And many doctors are reluctant to treat them.
I can understand that, I told her. Addicts can be so intransigent, so focused on undermining treatment rather than on controlling their disease.
And she agreed. When people are affected by an addiction, "you end up with someone who's not dealing with you rationally. All they're interested in is getting access to their drug."
Without training in treating addictions, she said, it's no wonder doctors back off.
"If, as a doctor, all you see is diabetics whose feet are falling off," you'll be reluctant to treat diabetics. But, like diabetes, addiction is a chronic illness that can be brought under control. "Once you see people, maybe someone in your family who does get better, you deal better with these patients."
They can be restored.
Methadone and another drug, Suboxone, are opiates that in low doses relieve addicts' incessant cravings without delivering the high that hijacks their higher brain functions and their lives.
By law, methadone cannot be prescribed from doctors' offices, which is why there are clinics and controversies over their location. A doctor with the proper training can prescribe Suboxone out of his or her office, though, for up to 30 patients, who must get the same kind of counseling and drug screens that methadone patients are required to receive.
"I've built a whole program around it at the CSB," Wunsch said.
But Suboxone won't end the clinic wars.
"I can't treat enough patients with that," she told me. And, at $2 to $4 a pill, Suboxone is too expensive for some methadone patients, whose dose costs pennies a day.
Wunsch also worries about Suboxone being diverted for illicit use. She gets advice from Larry Findley, a special agent with the drug diversion unit of the Virginia State Police, on how to prevent that.
Findley said the easiest way is just to learn to say no. He tells physicians: "Set your boundaries and say, 'Do not cross these boundaries or I'm gonna stop prescribing the drugs.' "
Wunsch is Midwest direct. She has no problem doing that.
"I have no secrets here," she told me. "I'm just practicing medicine." Her specialty is unusual, but as far as treatment practices, "there's nothing different about what I do. I take a patient history, I do an exam. ... There's no mystery to it."
The mystery would be why we would deny people life-saving care.
