Meet Nurse Practitioner Dorothy Moore, a key member of the Workit Health Team.
Workit Health offers innovative online addiction care, including medication like buprenorphine, after a single in-person visit to our Bay Area, California location. We recently caught up with Nurse Practitioner Dorothy Moore, a member of the Workit Health team providing care in Contra Costa County and beyond.
Thanks for taking the time to answer some questions with us today, Dorothy. It takes a specific type of waiver to be able to prescribe buprenorphine — what made you interested in receiving this extra training and offering this treatment?
I switched careers midlife from tech writing in Silicon Valley to nursing. First I worked in the ICU, but eventually ended up in an emergency department in Oakland. That was way before all of the awareness of the Opioid Epidemic. I saw so many people coming in for pain, but what they really wanted were pain pills, and they’d get them, basically just to get them out the door so that we could focus on “the real patients.” The chronic pain addiction patients were often treated horribly by some staff. Since I was brand new to the ER world, and maybe because I had this whole different background, I was really shocked. There was no effort to teach, or refer. Basically, it was treat the pain and get the person out of the ER.
I eventually did my doctoral project on nurse attitudes around these patients, because nurses felt caught in the middle. As a nurse practitioner, when I learned about the CARA Act and how NPs could prescribe Suboxone, getting a Suboxone waiver seemed like a natural progression. Suboxone isn’t magic, but it’s the best thing I’ve seen for really helping people with opioid addiction.
You have a background in emergency medicine, and at Workit we’ve noticed that many emergency medicine clinicians seem to be the most passionate about providing care to those struggling with opioid addiction. How do you think ER experience has influenced the work you do today?
Well, as I said, I’ve seen many kinds of people in the ER. If you are a good ER Nurse or Doctor, you have to really learn to embrace humanity and realize that we’re all really struggling with the same things in our lives. People come to the ER in crisis. It’s the place of last resort for many people. You’d have to be pretty arrogant or ignorant or just thick-headed not to eventually realize that you or a loved one could easily someday be in the same situation as your patient. I like to practice what I call radical empathy—where you try to see yourself in the patient’s shoes. At the end of the day, we all have the same desires and feelings.
Many, many people who present to the ER have some issue related to addiction—they’ve had an accident because they were under the influence; they’re in withdrawal but tell use they have the flu, and so on. But the ER is not the best place to treat addiction. If a person is lucky, he or she might get a good referral to outpatient treatment or someone might say something supportive and motivating, but all in all, it’s not the place where healing the chronic condition of addiction happens. Working in the ER has made me frustrated to want to do more to direct people to get better care and lead healthier lives.
You are not only a provider, but also a professor of nursing and researcher. Your recent research is looking into the role nurse practitioners can play in ending the opioid epidemic. Can you tell us a bit about what you’ve found?
So, I can’t really say I’m a researcher, but I’m learning! I am going to retire this summer from the ER, but continue working as a nursing professor at San Jose State University where I am trying to study addiction as best I can from a nursing perspective. Right now, I have a project going where we are interviewing Suboxone users and asking them about their experiences. We don’t use the word stigma in our questions, but we do find people bring up the fact that there’s stigma around addiction and even around Suboxone. Many patients aren’t really comfortable talking to their friends and even loved ones about it. I hope that changes over time and our society starts to look at addiction as a chronic disease. I might also add that most of the Suboxone patients we’ve interviewed say they feel normal now for the first time since their addiction process began. And normal is a good feeling.
I’m working on a project where we train Nurse Practitioners about addiction and Suboxone. What I find is that nurses get very little training on addiction in their regular curriculum and they can bring a boatload of prejudices and misconceptions into their practice. I’d like to see the waiver training get built into our NP curriculum.
Many of us in recovery have previously had negative experiences with clinicians and the medical field, often because we’ve had fear around disclosing our struggle with addiction to a medical community that isn’t very understanding of addiction in general. Do you have any tips on how those of us in recovery can begin to trust the clinicians providing our care?
There is a lot of prejudice and stigma around addiction disease, patients aren’t imagining that. I don’t know if it’s helpful, but of course, try to be as honest as you can about what is going on with you so that the provider doesn’t have to guess. A good therapeutic relationship is built on trust. Trust is really all we have at the end of the day. Try to remember, and it’s very hard because of all the shaming society does, that your condition is no different than diabetes or COPD in the sense that you didn’t choose to get sick. If you feel that the provider is belittling you are treating you as less than human, then move on because that is not right. That reaction from a provider says much more about the nurse or doctor than you. Trust your own instincts. There are many, many providers who view addiction as a chronic disease, not a lack of willpower or ability to “just say no,” and who will not pass judgment on you. One of the reasons I like WorkIt is that our medical team is on the same page about treating all patients with respect.
The Bay Area is unique in that it offers several unique initiatives such as the ED-Bridge program and the Hub and Spoke model to ensure access to buprenorphine. Also, fentanyl hasn’t seemed to make the impact in California that it has on the East Coast. How is the opioid crisis in California unique?
I really only know California. I’ve lived in Northern California for about thirty years. I think there is a lot of access to drugs and in a weird way, we’re pretty tolerant of drug use, but then when it gets out of hand, no one wants to talk about it or deal with it. I think that’s really obvious with our high schools and teenage access to pills, which is a huge issue no one wants to really confront. I see lots of people who started using prescription pills but then had trouble accessing them and maybe even moved on to heroin. But, like you said, we do have some good support for drug treatment in this state. The Hub and Spoke model is fantastic. So many people can qualify for free or very low-cost treatment through it. I hope it grows.