In honor of National PA Week, Clinical Advisor is featuring PAs who are making a difference in the field. Today, we are highlighting Debra R. Newman, PA-C, MSPAS, MPH, who has practiced in the addiction medicine field for 14 years. She is a treatment provider at the Mental Health Treatment Court and Adult Drug Court, First Judicial District Court, Santa Fe County, New Mexico; a member of the American Society of Addiction Medicine (ASAM) Opioid Use Disorder Program Planning Committee; ASAM Weekly assistant editor; ASAM presenter, Moving Beyond the Barriers of Treating Opioid Use Disorder; and Providers Clinical Support System (PCSS) Exchange presenter.
Q: Can you describe your position at the First Judicial District Court in Santa Fe County?
PA Newman: I work in a unique system within the courts seeing adult drug and mental health treatment court patients as they are released from jail or prison. The clients are “paneled” by our team which consists of myself, the Chief Justice, court staff, a contracted therapy group, law enforcement, and public defenders.
For new clients, the court officer will review the client’s entire history and each of us will have the opportunity to ask questions related to the appropriateness of his/her inclusion in our program. We will then take a vote for their entry to either drug or mental health treatment court. For me, this process may include considering information on past treatment attempts with medication, history of overdose or suicide, whether they have access to naloxone, past psychiatric history or hospitalization, and motivation for inclusion in our program.
For current clients, this includes opportunities to broadcast treatment success because, for many clients, this is their first stint at extended recovery. This process is also a chance for me and other members of the team to offer treatment updates to the Chief Justice or further recommendations. For example, these clients often have a history of head injuries and present with poor memory and chronic headaches, among other symptoms. I may order a neuropsychological evaluation in such situations; the judge likes to know that we are addressing every need that might have been missed in the client’s past but may assist in their recovery. Additionally, we discuss client successes with the team: compliance with medication treatment, improvement in mood, further engagement with family, employment/education, housing, etc. These are outcomes that we all applaud when the clients are seen virtually after staffing.
Since October 2017, I have provided medications for opioid use disorder (MOUD) and naloxone prescriptions as part of ongoing harm reduction strategies in New Mexico. Having a PA in this position allows for broader, coordinated care for patients that includes ordering and review of laboratory tests, institution of buprenorphine/norbuprenorphine metabolite testing assuring consistency in buprenorphine treatment, establishment of a medical home, referral to specialty care, family planning, and coordination with local agencies to maintain patient safety.
Q: Who was your mentor?
PA Newman: My mentor was Gregory Baca, MD, an addiction medicine psychiatrist whom I worked with at a large Federally Qualified Health Center in Espanola, New Mexico, starting in 2008. Rio Arriba County where Espanola is located is known for decades as having the highest per capita overdose death rate from heroin in the United States. It is a highly disenfranchised community with high rates of hepatitis C virus (HCV) infection as well.
At this clinic, I worked with Project ECHO and treated addiction medicine, psychiatry, chronic pain, and HCV patients for over 4 years. Seeing the difference a provider could make not only in the life of a patient struggling with a substance use disorder but also the impact on the patient’s family and community was completely a game changer in terms of my direction in medicine. There was absolutely no way that I would want to work in any other field.
Plus, as Dr Baca and I would discuss many times, these patients were all too often the throw-away children whose families had abandoned, whose medical providers refused to treat or treated them abominably, or who received abhorrent treatment through the criminal justice system if they ever landed there.
Q: What unique programs or projects have you started or participated in to advance patients’ health?
PA Newman: Several years ago, I pitched an idea to the PA Foundation for a course for PA students that provided an introduction to addiction medicine, since so many PA programs and medical schools did not teach the subject. Fast forward to 2019 and the PA Foundation received support from the National Institute on Drug Abuse (NIDA) and the course was taught at the 2019 American Academy of PAs (AAPA) annual meeting. It was very successful and well received.
I also taught a course through the New Mexico Behavioral Health Providers Association to help providers throughout the state understand the role of medication in the management of opioid use disorder, their role in the treatment of OUD, and appropriate prescribing.
I am an active member of the American Society of Addiction Medicine (ASAM), serving on several of their committees. I pitched an idea to the ASAM several years back on a waiver course for providers who have obtained their x-waiver but are facing challenges understand how to move forward beyond those challenges. For the past several years ASAM has provided a well-received course that I helped develop called Moving Beyond the Barriers of Treating Opioid Use Disorder.
Q: How do you avoid burnout?
PA Newman: I wish I had the answer to that question! I think all PAs need to participate in daily self-care. For me, it is participating in a regular yoga practice, hiking daily with my dog Jake, and taking time to self-reflect on the blessings in my life. My patients are so very challenged by the struggles that they face not only related to their disease but also to the trauma that landed them there in the first place. Being patient, kind, gentle, and a good listener goes far not just in patient care but also with yourself. Then, self-select those people who feed your soul and give you sustenance.
Q: If you could go back in time to when you graduated from your PA program, what would you like to tell yourself?
PA Newman: I wish I had known more about the struggles that we face not being able to practice independently. Having been a PA now for 14 years, the inability to practice independently really is a barrier that experienced PAs should no longer have to face. I see new PAs at conferences who can’t get jobs. This has to stop.
Q: Is there anything else you would like to tell our readers?
PA Newman: Follow your heart. Do what you love. Work with a clinical team that has your core values. Understand that it is not just about the paycheck. What you will get back in spades in terms of changing a patient’s life for the better is priceless.