In Case You Haven't Heard…

Mark Parrino, president of American Association for the Treatment of Opioid Dependence, should have been the final speaker at Coalition of Medication‐Assisted Treatment Providers and Advocates last week. His speech, which was the first, included one of his fabled anecdotes, this time to highlight why opioid treatment program (OTP) patients need to be listened to because they are smart. He talked about a patient of his program who was seen at the corner barking like a dog. He asked the security guard to bring the patient, who clearly needed medication, back into the program. The patient was not only barking like a dog but gnawing on a ham bone. “For some reason, the guard took the ham bone away,” said Parrino. “The patient, of course, bit him in the leg.” The next day, when the patient was stable, and the OTP medical director and security guard were present, Parrino was asked by the security guard, “Do I need a rabies shot?” Parrino responded that although the patient was acting like a dog, he was not in fact a dog, and that the guard would need a tetanus shot. The medical director then brought up lycanthropy. The patient, again who was stable by then, wondered if he was really a werewolf. The medical director was asked if he really believed in werewolves. The moral of the story: listen to your patients. They may be smarter than you. This was a very good beginning to a conference of OTPs, but at the end, the state Department of Health presented extremely depressing information about how to comply with Medicaid work reporting requirements. In some parts of the state, all OTP patients are covered by Medicaid. There's nothing that the state can do about this — it's federal law. But it's important to remember the real meaning of the work done: helping people, regardless of the law.