I never aspired to be any heroin addict’s personal doctor. I just wanted to be able to give a dose of bupe and use the “warm handoff” to pass that patient to another doctor for long-term treatment while I “cleaned up” the emergency department.

After all, from my ED experience, I only knew opioid addicts at their worst: apneic with an overdose; altered; sick and feverish with intravenous drug abuse–associated infections; vomiting and writhing in opioid withdrawal; or manipulative, angry, or agitated trying to get an opioid prescription to treat the pain of withdrawal. I never intended to be handing off those patients to myself.

So How Did I Come to Enjoy This Work So Much?

It didn’t take long for me to see that my clinic was making a profound difference in people’s lives. At the time of induction (when patients receive their first dose of methadone or buprenorphine), many of the patients in my clinic look a lot like our patients in the emergency department in acute opioid withdrawal. In addition to constantly wiping their noses, fidgeting, writhing, and holding a trash can while trying to contain their nausea, they look exhausted, disheveled, and frustrated. Personal hygiene is usually lacking, and they haven’t slept in three or more days.

This is when I obtain the history of their opioid use. Most began being prescribed opioids after an injury or surgery; experimenting with a family member’s medication; or just trying to find something to treat their anxiety, depression, or social phobia. Other patients tell heartbreaking stories of being introduced to heroin as teenagers by a close, older relative. There is often a history of ensuing years of family conflict, job loss, incarceration, prostitution, etc. Other patients are still very high-functioning, with good educations, professional licenses, and enviable jobs. They have come to the clinic because they realize that their addiction has put them on the verge of losing their families and their careers.

All the patients in the clinic want to be free from the yoke of opioid addiction. They only continue to seek and use opioids to keep from experiencing the terrible misery of opioid withdrawal. They are tired of continually feeling sick and having so much of their time and money consumed with securing their next “fix.”

However, often when I see the patients we’ve inducted a few weeks later, they are unrecognizable to me because they look great. They look clean and well-rested, and they are smiling and cheerful. They have begun the road to recovery and have rekindled relationships with their families. Many have returned to work or school or are simply meeting their family obligations, which they failed to do frequently before.