Dr. Donald Fay

These patients have families, they have all the pluses and minuses that anybody else has and when they’re treated in a family practice environment, the stigma of addiction is mitigated

Ending the stigma of addiction

For family doctor Donald Fay, the waiting room is a place that breaks down barriers.

“When it comes to caring for a patient with opioid addiction, I don’t think there’s anyone better suited than that patient’s family physician,” said Dr. Fay, who has been treating patients with opioid use disorder (OUD) in his Halifax family practice since 1997.

Over the last 15 years, Dr. Fay has had about 140 OUD patients on his roster, in addition to the 1,500 other patients in his care.

He is passionate about ending the stigma that surrounds addiction. “People see opioid abuse as a weakness in a person’s character, not as an illness,” he said. “They’re more willing to recognize alcoholism as an illness – it doesn’t have the same negativity that opioid abuse has.”

The complexity of treating patients with OUD in a family practice setting is what drew Dr. Fay to the work. He originally trained as an engineer, and has a doctorate in electrical control systems. “It’s not that different,” he said. “Understanding a system with many interconnected parts that all work together – that’s what family practice is all about.”

Methadone was introduced as an addiction treatment option in Nova Scotia in 1997. “Before that, we didn’t really have a treatment for OUD that worked,” he said.

Used as a replacement for opioids, methadone blocks receptors in the brain so there’s no high and no cravings when a patient takes it. “The benefit is that you can start working on getting your life back together,” said Dr. Fay.

But methadone isn’t a one-size-fits-all solution to treat addictions “We can’t use it as a Band-Aid,” says Dr. Fay. “When I’m treating patients, I’m not just treating their OUD – I’m also treating all the problems that come along with OUD.”

“People with addictions have all kinds of other health issues. I can use that visit to ensure they receive the primary care they need.”

Requiring a long-term commitment, the treatment is a natural fit for the scope of care provided by primary care physicians. “It helps to look at alcoholism,” Dr. Fay said. “Some people fight that issue for their entire lives. It can take four, five or six years for patients on methadone to get to the point where they’ve got their OUD under control.”

For some patients, success might be going from being an active drug user to not using methadone, opiates or any other drugs at all. Other patients might scale down to 10% of their original dosage, or work toward tapering their methadone use over seven or eight years.

“I work with each patient to optimize their treatment on an individual basis – what works for one person doesn’t necessarily work for another,” said Dr. Fay. “This is a very diverse group of patients – people of all ages, from all different socio-economic backgrounds and levels of education.”

Satroya Clayton has been working with Dr. Fay to help beat an opioid dependency that started six years ago. Introduced to opioids by her boyfriend at the time, in the span of a few months her life turned upside down. “I lost everything – my job, my car, my apartment,” she recalled. “I kept my drug use a secret from my friends and family. I was so ashamed of the path I was on.”

Nervous about going to a clinic specializing in addictions, Ms. Clayton liked being treated by a family doctor. “It’s more one-on-one,” she said. “The plan is customized to you. You feel like an individual, not a drug addict.”

She’s thrilled to be building her life afresh. “I don’t know who I’d be if I didn’t have this program,” she said, adding that she now has a career, owns her own house and is engaged to be married. “I’ve gained back my confidence and I want to stay clean. This program is part of my sobriety.”

Dr. Fay’s goal is also to promote trust and mutual respect for his patients in a non-judgmental, non-stigmatising environment. He’s done that by integrating his OUD patients into his full-service family practice.

He reserves one day a week – Friday – for his OUD patients. But patient demand is so great that there is some spill over, which means his OUD patients are sharing the waiting room with young families and elderly patients.

“It’s educational for everyone,” Dr. Fay said. “Interactions in the waiting room can go a long way to show my patients that people with OUD are people with issues just like everyone else.”

Helping his OUD patients conquer their addictions and resolve their health issues isn’t easy and it isn’t fast – but it is intensely rewarding for Dr. Fay. He hopes that more family physicians in Nova Scotia will start treating OUD patients in their practices.

“Holistic addiction treatment is a natural fit for a full-service family practice,” he said. “These patients have families, they have all the pluses and minuses that anybody else has. When they’re treated in a family practice environment, the stigma of addiction is mitigated.”