SFR Talk: Doing Less Harm

Leslie Hayes always wanted to be a doctor—but she had no way of knowing she’d become one of the go-to physicians for heroin addicts in Rio Arriba County. Hayes’ clients at the Española clinic, El Centro Family Health, aren’t the only ones who have noticed her work. Earlier this month, The Atlantic Monthly and Liberty Mutual picked Hayes as one of three US winners in a contest to honor local leaders who display particular dedication to important, impactful causes.

LH: I’ve lived in northern New Mexico since I was 2—grew up in Los Alamos and was the only one to come back here. When I was 8, I read a book about how they’d eradicated smallpox. I decided I wanted to be a doctor, and I really never changed my mind.

You have to set intermediate goals. With many of my patients, it’s, ‘OK, they’re still using, but they’re not using as much as they used to.’ I always give the example that if you’ve got a guy who’s drinking 24 beers a day and driving and has liver disease, and you convince him to cut back to six beers a day and not drive—even though it’s still going to damage his liver, it’s so much better than it was. And I think we can do that for most of our patients. I think we can lessen the harm.

Often, in this country, we’ve really looked at addiction as being similar to pneumonia: You treat it, and it’s gone. I think we need to look at it as a chronic illness, like diabetes or hypertension. You’re not trying to cure it. What you’re trying to do is improve their quality of life, decrease the death rate, decrease the complications.

When I started prescribing buprenorphine [an opiate replacement drug], I started doing a lot of addiction work. One of my patients was a drug dealer, and he got on buprenorphine and was so excited about it. He knew everybody, and he kept saying, ‘You need to go in and get this treatment.’ I asked him once, ‘How did you get all these people to come in?’ And he looked at me and said, ‘There’s no such thing as a happy heroin addict. Anyone who is really in the throes of addiction is not happy and will do anything. If there’s treatment available, they will take it.’

I’d known there were addicts in Española in a theoretical sense. I started getting four to six people walking in a day, asking to be put on this medication; it was overwhelming. But it really made me realize there’s this huge population who never interact with physicians.

Caffeine does not affect the right neurotransmitters in the brain. You cannot get addicted to coffee.

My cousin was a heroin addict. He’d been clean for 15 years. He was working as a social worker, doing quite well, and he got colon cancer at age 43. Had surgery for it, got morphine post-op and, I think, between the stress of the cancer and the morphine post-op that precipitated relapse, he ended up going to jail and he died of an—well, we don’t know what he died of, but he died after getting out of jail.

Think of the worst you’ve ever felt in your whole life, and then think about feeling like that constantly for about six to 12 months in a row, and that’s what it’s like for somebody trying to give up one of these substances. They just feel terrible for a really long time. It’s not something that ever completely goes away.

Colleagues who I’ve talked to wean people off, and they’re fine. I can’t do that very easily in northern New Mexico because they’ve got their cousin living next door, the mother of their children—so many people in their lives are using that, if they don’t have something to block the cravings, it’s hard. I’ve had patients who have lived away for 20 years and were clean the entire time. They come back to northern New Mexico and, within three months, relapse.