The residents of Charlestown, Massachusetts have been sharply impacted by the devastating opioid crisis. According to the Boston Globe, Charlestown has seen annual rates of drug-related deaths reach a high of 22% more than Boston. Intravenous drug-related infections in Charlestown reached six times higher than the city average, the greatest impact out of any other Boston neighborhood (MacQuarrie 2015). Medication for Addiction Treatment (MAT) is a treatment model for patients suffering from opioid use disorder (OUD). To assist community health centers in communities like Charlestown with supporting patients with OUD, the Harvard Medical School Center for Primary Care (CPC) created an Innovation Pilot to increase patient access to MAT. This program aimed to support and encourage community health centers to increase the percent of providers who prescribe MAT, increase the number of patients on MAT, and increase the confidence of providers who care for patients with substance use disorder (SUD).
Sara Astarita Callahan is a Nurse Practitioner (NP) at the Mass General Hospital Charlestown Health Center. Seeking to impact this pervasive community issue, Sara merged SUD and women’s health care, a specialty she carved out for herself. Sara has been working to achieve her project goal of increasing the rates of pap smears and general women’s health check-ups among women suffering from SUD. Sara explains that her vision for this project was to see the same value placed on women’s health as is placed on substance use in adult medicine. Sara suggests, “We need to do a better job with keeping an extra eye out for this population, especially because they’re vulnerable and they may not be good advocates for themselves…just because they have a lot going on in their lives”.
When starting the new role at MGH Charlestown, Sara found that of 144 women with SUD, nearly 40% of the women were overdue for pap smears. In order to complete the examination, Sara would utilize appointments made on the day patients were due for Suboxone, which they need to be present for, by using part of the appointment for a women’s health check-up. Sara anticipated challenges in getting patients to agree to pap smears, or even getting them to show up to appointments. “A lot of these women who suffer from SUD have a history of severe sexual trauma, and they have a hard time trusting providers, so sometimes it takes a few visits before they’re willing and ready to do a women’s health exam”. Building trusting relationships with her patients by offering repeat visits to her patients, explaining that she will offer to do the procedure during the next appointment, respecting their autonomy, but also educating them on why the assessment is important, enables her to achieve her project goal.
Sara described the anxiety she feels when trying to convince patients to get pap smears done, especially for women who have a history of abnormal pap smears. Her greatest lesson has been understanding that it will only happen when and if the patient feels comfortable enough to agree to it. Sara has completed 22 of 37 overdue pap smears, but the biggest barrier has been realizing that there is still a large group of women who are prescribed Suboxone in psychiatry but have not been seen in primary care in years. So far, 7 women who have fallen out of care were removed from the initial list of women who were overdue.
Sara reflected on her positive experience with the CPC MAT program: “Having the mentor was the biggest help for me…in getting waivered and questions about prescribing…and the in-group check-ins and the phone calls, having regular check-ins and bringing up issues…in my practice or [surrounding] other providers”. Additionally, Sara and two colleagues from the MAT program were able to start a mentorship network for NPs to become waivered to prescribe. These NPs meet to discuss issues like not having their own panel of patients, and ways to make it easier for NPs to become waivered.
In her work, Sara is not only improving women’s health, but she’s also positively impacting the social realm of patient’s lives. One example she gives is of a 50-year-old mother who has been struggling with OUD for years. The patient has a history of IV heroin use and sadly had her son taken from her and put into the system. Since being prescribed Suboxone, she has experienced intermittent relapses with other substances. Harm reduction through Sara’s prescription of MAT allows this patient to return to parts of her life, including motherhood. She is now able to visit her son, a major accomplishment.
*Ja’Dana J. Ellcock-Crayton is a fourth year at the University of Virginia, pursuing Psychology and Sociology. She aspires to become a clinical psychologist with her own private practice, working with clients who suffer from adverse mental health disorders. Ja’Dana is an advocate for the prioritization of behavioral and mental health.
MacQuarrie, Brian. “As Charlestown Opioid Crisis Deepens, a New Clinic Opens - The Boston Globe.” BostonGlobe.com, The Boston Globe, 14 Dec. 2015, www.bostonglobe.com/metro/2015/12/13/opioid-problem-grips-charlestown/a2EUdE6PMmtCLXYgx3SlWO/story.html.
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