Iowa Family Doctor: Taking on the Opioid Epidemic

Dr. Nicole Gastala moved to Marshalltown, Iowa straight out of residency at the University of Iowa as part of a federal program that would help her pay off medical school loans while working in an underserved community for three years. The small city of 27,000 appealed to Dr. Gastala because of its diverse population.
When starting out, Dr. Gastala was eager to create weight-loss and diabetes prevention programs like she had done in the past, but quickly became struck by the number of opioid dependent patients she came in contact with. With Marshall County’s addiction treatment agency across the street from Dr. Gastala’s practice, she reached out about the problem she was seeing. The agency’s leaders asked her to consider prescribing buprenorphine, as the closest provider was an hour away from town. Buprenorphine is a medication that helps suppress cravings and withdrawal symptoms plaguing those addicted to opioids. While an opioid itself, it is strong enough to activate the brain’s opioid receptors easing cravings but not strong enough to provide a high. Dr. Gastala completed eight hour training to become one out of the small 5% of the nation’s doctors licensed to prescribe it.
Though uncomfortable at first, Dr. Gastala has continually worked to treat addicted patients, caring about them without judgement, encouraging them to continue visiting her, and working to understand the unaddressed mental health problems that often come along with the addiction. Dr. Gastala is joined by Andrea Storjohann, a nurse case manager who has become a vital partner to Dr. Gastala in treating such patients. Together they gauge patient progress, ask about the patient’s highs and lows since their last visit, drug test, in addition to monitoring their medication and making sure they continue to attend therapy.
While Dr. Gastala had no formal training on addiction and how to treat it, she taught herself from articles and books, by talking to another doctor who prescribes buprenorphine, and with monthly video conferences held with primary care doctors around the country taking on addiction treatment. Even though Dr. Gastala will be moving to Chicago, she will continue treating addiction at her new community health center. To learn more about her story, and her impact on treating the opioid addiction, visit here.