Primary care doctors train to take on opioid addiction

EVERETT — Dr. Tom Tocher wants primary care physicians to play a bigger role in opioid addiction treatment.

Last summer, about 40 health care providers at Community Health Center of Snohomish County completed training to prescribe Suboxone, a medication that alleviates opioid withdrawal symptoms and cravings.

The trainees included every doctor who sees adult patients at CHC’s seven clinics, said Tocher, chief clinical director of the nonprofit.

“It’s something I’ve wanted to do for a very long time,” he said.

People shouldn’t have to go out of their way to get treatment for opioid addiction, he said. Equipping primary care physicians with the ability to prescribe Suboxone gives patients more comfort, convenience and privacy.

“It’s just like a regular doctor’s visit and nobody needs to know,” Tocher said.

Snohomish County is in the middle of a crisis. In the past decade, hundreds of people have died from overdoses caused by opioids, a category that includes heroin and fentanyl as well as common painkillers, according to the Snohomish Health District.

Tocher said he was one of the first doctors in the state to start prescribing Suboxone, back in 2003. Because of the scarcity of providers at the time, he said, he had patients show up to his office from as far as Seattle and Lynden.

He’s been on the Suboxone bandwagon ever since. Throughout the years, he has seen people’s lives perform 180-degree turns as a result of the medication, he said.

Want stories? “How much time do you have?” he asked.

An Army veteran got addicted to opiates after he injured discs in his neck and back. He said his life went into ruins. Then he started Suboxone treatment and things got better. He went from living in his mother’s basement to managing a grocery store.

One woman Tocher saw was swiping buprenorphine, the generic version of Suboxone, from a friend because she was scared to see a doctor for her addiction. Tocher said he got her on a prescription and she has led a more stable life.

He wants everyone to know they can get help.

So far, CHC is prescribing Suboxone to about 190 patients. That should ramp up, Tocher said, especially when doctors transition from their first year, when they can only see 30 patients, to seeing up to 100 patients in their second year. Those caps are set by federal laws.

He said he wanted to give his doctors a gradual start, but that he expects them to eventually take on a full load of patients. That means the nonprofit could see a total of 4,000 patients after the first year.

Still, Tocher said, CHC can only do so much by itself. If everyone suffering from addiction in the county is going to get treatment, more doctors will need to sign up, he said.

The training isn’t hard. It’s eight hours for doctors, and 24 hours for nurse practitioners and physician assistants.

But there’s still stigma in the medical community about treating addiction with medications like Suboxone or methadone, Tocher said. Some doctors tell him that it’s just replacing one drug with another.

He hopes that perspective changes and that more providers see addiction like any other disease. Doctors wouldn’t deny insulin to someone with diabetes, he said.

“We don’t apply these kinds of judgments to other ailments people have,” he said.

Zachariah Bryan: 425-339-3431; zbryan @heraldnet.com. Twitter: @zachariahtb.