Addiction Medicine in Rural Settings

When Jamie Pandey was working on a Master of Public Health degree in health services management at the University of Cincinnati in 2017, it was against the backdrop of an opioid epidemic roaring across the country. The director of the Hamilton County Health Department was an instructor for her management courses at the university, and he spoke often about the epidemic that was hitting southern Ohio particularly hard. 

She remembers one class when the Health Department director reported there had been numerous overdoses just that morning, all along the same street. “Later, they realized the overdoses were tied to a dealer who had sold heroin to people who didn’t know it was laced with fentanyl. It could have easily been any street in Ohio. It’s easy to think of how many people were in shock that morning and I thought of how terrifying it would be to find a loved one who had overdosed,” says Pandey.

“Addiction is a recognized mental health crisis by the health care community, but that’s not necessarily a perspective shared by everyone. Pursuing addiction medicine as a career is a way for me to ensure that when people come for care, they and their families know they will be treated without judgment and that their health is valued.”

Pandey has followed her interest in addiction medicine at the College of Medicine, where she is a second-year student. Soon after coming to NEOMED, Pandey discovered the Rural Medical Education Pathway Program and immediately applied. “I can’t speak highly enough of how supportive the RMED advisors are and how kind the students are. I’ve met some of my best friends through this program,” Pandey says.

Among other areas of special concern for rural medicine physicians, Pandey has found training in addiction medicine, both through the curriculum and extracurricular events.

Pandey describes a training session held by the American Medical Association student chapter on the topic of Narcan, the rescue medicine for opioid overdoses. “We went over the current state of the opioid crisis in Ohio, what to look for in someone who has overdosed on opioids, and how to administer Narcan,” she said.  Attendance was optional. She chose to attend because, she noted, “The point of becoming a physician is to help when you see someone in need. Giving someone Narcan is a lifesaving treatment, and to know how to use it could be the reason someone sees their friend, child, parent or sibling again.”

A Neurobiology of Addiction lecture (part of a psychology lecture series) provided statistics of substance use disorder, the etiology of addiction (that is, genetic predispositions for opioid dependency risks), discussion of some pharmacotherapies and non-pharmacologic treatments, and how opioids impact the rewards system of the brain. From another lecture, she gained a pharmacologic overview of abused substances and potential treatments. 

And in the summer of 2020, despite the constraints of the pandemic, Pandey was able to shadow a physician by participating in the Leroy Rodgers program offered through the American Academy of Family Physicians. Through her mentor, Pandey learned about the physicians must follow for opioid prescriptions: “She told me that many physicians are not comfortable prescribing opioids because of the epidemic, the restrictions, and worries about the addictive potential.”  

Pandey has found that the Rural Medicine Pathway Program is a good fit to prepare her for a challenging area of medicine – one where she believes she can make a difference.