A View of the Epidemic: Medical Needs, and Recovery

  • Dr. Ellamarie Russo-DeMara talks with Cathy Johnson, a methadone dosing nurse, foreground, and her husband Dr. Gary DeMara following an addiction recovery forum at the Twin River Health Center in White River Junction, Vt., Thursday, Nov. 16, 2017. The forum brought addiction treatment professionals together to talk about their work. At right is Verona Pushee, of Wilder of the Celebrate Recovery support group at the Riverbank Church. (Valley News - James M. Patterson) Copyright Valley News. May not be reprinted or used online without permission. Send requests to permission@vnews.com.

Valley News Staff Writer
Saturday, December 09, 2017

It’s not just families who are coping with the consequences of the opioid epidemic, although they undoubtedly are paying the highest personal price. Many others encounter the crisis in the course of their work – physicians, child welfare workers, police officers and prosecutors, to name a few. Once a month for the coming year or so, the Valley News will focus on some of those people to get their perspective on the crisis and how it has changed both their work and their understanding of the epidemic.

White River Junction — As a physician who provides medication-assisted treatment to people suffering from opioid addiction, Dr. Ellamarie Russo-DeMara has seen her fair share of tough cases. One of the most challenging, though, also stands out in her mind as one of her greatest success stories.

The patient, who was in her 40s, “was struggling with addiction to the point that she even was dealing,” recalled Russo-DeMara, 58, who works out of Gifford Health Care’s Twin River Health Center in White River Junction. The patient had “so many health issues that she was not addressing. All she could do was get by day to day trying to get her drugs.”

As it turned out, the patient also suffered from liver disease caused by heavy alcohol consumption and breast cancer. Several of her family members were also struggling with addiction. She had an abusive husband, and her children were stealing from her.

But, with counseling and treatment, the patient “got really, really strong.”

She threw out her husband and moved away from the children who had been stealing from her. And, there was a marked difference in her appearance.

“She’d come walking in here, she looked like a whole different person,” she said.

Though the patient has moved away and no longer sees Russo-DeMara, “Last I heard she was doing wonderfully,” the doctor said. “I hope and pray that she’s still doing well.”

Treating substance abuse disorders with Suboxone was hardly what Russo-DeMara had in mind when she entered medicine as a doctor of osteopathic medicine. She trained as an obstetrician/gynecologist in New York and operated a private practice with her husband, Gary DeMara, before they moved with their four children to Vermont in 2004, so that Russo-DeMara could join Gifford’s Randolph practice. The family has lived in Sharon since 2007.

“It was the last thing I thought I’d be doing at this point in my career,” said Russo-DeMara, in an interview in one of the clinic’s exam rooms last month.

Two factors account for her change in direction: Treatment for breast cancer in 2011 left her with numbness in her hands, leading her to stop delivering babies and performing surgery.

At that point, though, she had heard enough stories from her obstetrical patients to identify a gaping health care need she could help address.

“(I) started to hear more and more about the addiction issues and how the accessibility was very difficult, especially for women,” Russo-DeMara said.

As it turned out, a skill she developed in her years of practice as gynecologist has proved critical in helping treat patients in recovery — lending an empathetic ear.

“I guess I’m fortunate that as a woman’s doctor or any doctor I have an easier time talking to patients; some docs don’t,” she said. “Even from medical school, treating patients holistically has been an approach for me. … So when I sit down with patients ... I want to know how are you doing, period.”

Once she realized there was a need, Russo-DeMara said that as an office-based provider she had the time to sit down with her patients, discuss their medical and addiction histories and be there for them through the ups and downs of their recovery.

She received a waiver required by the Drug Enforcement Administration to prescribe Suboxone, which helps curb the cravings of those addicted to opioids. In 2012, she began offering the treatment to women. She now provides medication-assisted treatment to 50 female patients and has recently begun treating males. DeMara, Russo-DeMara’s husband, has also begun providing medication-assisted treatment in recent years. He serves patients in upstate New York.

By offering the treatment, Russo-DeMara said she aimed to help address access challenges that some of her patients faced.

“When I first started, it was difficult for some to get into counseling that made sense for their schedules. Or travel — some of them didn’t have cars ... We’re not like New York City where you can hop on a bus or a train. ...it’s not that easy here.”

Part of Russo-DeMara’s job has become connecting patients to the resources needed for recovery. In addition to the medication she prescribes, Russo-DeMara’s patients also receive counseling and the services of a social worker. Some patients qualify for rides covered by Medicaid, and some get help finding employment and housing — “which is big,” she said.

Russo-DeMara’s youngest Suboxone patient is in her early 20s and the oldest is in her 60s. What her patients tend to have in common, she said, is “that they have not had access to good health care.”

High blood pressure, depression and dental problems are among the health issues Russo-DeMara attributes to her patients’ inadequate access. Unplanned pregnancy is another.

“A lot of them did not have reliable contraception, and pregnancy was the last thing they needed,” Russo-DeMara said.

When patients are considering pregnancy, Russo-DeMara said she talks with them about their health and medications they may be taking, some of which may not be compatible with pregnancy. She also speaks with patients in their childbearing years about the importance of caring for their teeth prior to pregnancy because poor dental health can contribute to a preterm delivery, she said.

More than half of Russo-DeMara’s 50 female patients have had babies while under her care, she said. While she no longer delivers babies, she is able to help assist them through the ups and downs of pregnancy.

“What worries a lot of the women is what’s going to happen to my baby?” she said. “… Most children or infants born to addicted mothers who are on maintenance therapies, not on heroin, do well at birth. If the mom has been actively using, babies are addicted at the time of delivery and unfortunately go through a horrible withdrawal, so they have to be treated.”

Russo-DeMara said hormonal changes during the course of a woman’s life — pregnancy, delivery, menopause — can exacerbate underlying conditions such as depression.

“Hormonal changes are really difficult,” said Russo-DeMara, who was one of the first doctors in the state to become a North American Menopause Society-certified practitioner.

If an underlying condition such as depression isn’t addressed, hormonal changes may “lead them to the point of despair,” she said. “Unfortunately, that’s going to affect their recovery. That leads to relapse. I find it’s really nice to have that medical conversation with them and to help them along the way.”

Of course, not all of her patients are success stories. She has also had a couple of patients overdose after they moved away or were transferred to a higher level of care.

“One of them in particular breaks our heart because she was seven months pregnant at the time,” Russo-DeMara said. “The last time I had seen her she was really doing well. She had just become pregnant. She was like, you know, really, really happy. She had a couple other children. She was getting her life back together. When I found she had transferred to somewhere else it was for a good reason, you know, closer to home and whatever. I was shocked when I found out later, a couple months down the road (that she had overdosed).”

The contrast between that case and the 40-year-old who turned her life around are telling.

“Those are the two that really stick with me as far as how devastating the disease can be or how rewarding it can be. They do hard work. It’s really work every day.”

Valley News Staff Writer Nora Doyle-Burr can be reached at ndoyleburr@vnews.com or 603-727-3213.