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Fighting Disparity Through Addiction Medicine

While in his second year at Eastern Virginia Medical School, Daniel Ageze, MD, returned home to Addis Ababa, Ethiopia, which he had left as a teenager, to provide medical care for underprivileged Ethiopians who lived in the country’s rural areas.

In entering medicine, Dr. Ageze knew he wanted to specifically help the poor and marginalized. The disparities he witnessed among the poorer patients who traveled from far away to the nation’s capital, where he had grown up, disturbed him.

“I remember specifically one man who begged for more than two months just to get enough money to get the bus fare to come to the capital,” Dr. Ageze recalled.

At the time, the medical team Dr. Ageze served with wasn’t equipped to help the elderly man, whom Dr. Ageze believes had a brain tumor. When Dr. Ageze told the patient this, the man grew discouraged. He shared that he would have to beg for another two months just to get the bus fare “to go home and die” in his village.

“The amount of money that he needed, I would spend on dinner,” Dr. Ageze said, putting the man’s needs in perspective. “Then you come back to the States, and you see people complaining, even when they have an entire patient room to themselves with all the resources.”

Upon his return to the United States, Dr. Ageze grew uncomfortable with the fact that such a disparity could exist anywhere in the world, let alone his home country. What he witnessed forced him to question his purpose in life, his medical career, and even his cherished Christian faith.

Soon, however, as Dr. Ageze was on his spiritual quest to find the truth, he had an encounter that confirmed his understanding that the problem started with us. “We humans were addicted to the world, fame, power, and to ourselves. Even when the world had enough resources, we didn’t love one another enough to share,” he said. Dr. Ageze realized that, if the suffering in the world was to be lessened, he would have to be part of the solution. During his residency, he heard a lecture from an addiction medicine specialist. Dr. Ageze was moved so much that he asked if he could shadow the visiting physician at his clinic.

As the physician mentored him and he met patients with substance use disorders (SUDs) and learned about the field of addiction medicine, Dr. Ageze realized people battling addiction are struggling with their own disparities. His new purpose became clear – to care for those affected by such a debilitating chronic disease and are to some degree the “outcast” of the community.

“I wanted to be with patients who were facing such disparities,” Dr. Ageze said. “From that point, and through daily encounters with these patients, the concept of addiction recovery helped guide me back to Christianity.” It required humbling oneself, letting go of the self-centered approach to life even when it was not easy, embracing communities and more importantly our higher power, and lastly, “to be less of a talker and more a person of true action.”

From May 2020 to May 2021, Dr. Ageze worked as an addiction medicine specialist at Master Center for Addiction Medicine in Virginia. After working with patients with SUDs for a year, Dr. Ageze was surprised by how much the patients actually helped him.

“It literally expanded my knowledge of what it means to be a human,” he said. “It helped me grow in my faith and caring for these patients made me more connected in a way I could not have imagined. It helped me a lot.”

Dr. Ageze is now pursuing a master’s degree in Public Health, focusing on health promotion and behavioral science, at San Diego State University. He is also doing a preventative medicine residency at UC San Diego, with an addiction medicine track. “I want to address systemic problems that my patients face daily. My eventual goal is to open sober-living homes, God willing,” he said.

Dr. Ageze initially entered family medicine to work with patients of all ages. His goal was to build relationships with his patients and provide a continuity of care for them. During his residency, he learned that, on average, he would see most patients only one to two times a year, making it difficult to build those relationships.

For him, addiction medicine has proven to be life-altering.

“In addiction medicine, you’re seeing patients every week and there’s a lot more to each visit,” he said.

“You’re involved in their lives. You know their fears and the struggles they have. Because addiction is so stigmatized, a lot of patients don’t tell people about their true struggles, but when they find someone who understands addiction, they can open up and that’s big. You build these bonds and you’re really helping people regain and rebuild their lives, their marriage, etc.”

When patients relapse, Dr. Ageze said he’s grateful for the opportunity to provide them grace when they’re expecting a punitive or stigmatized response.

“I feel like I'm just passing out graces, you know,” he said.

“It’s saying, ‘OK, you can do it again,’ and getting people to not beat up themselves and actually lifting them up and helping them work through how they can do it differently next time. It’s an awesome feeling to be able to do that.”

Dr. Ageze said ASAM has helped him grow as an addiction medicine specialist. He learned about ASAM through his mentor, Dr. James Thompson, who told him about the Virginia ASAM chapter. Today, Dr. Ageze serves as chair of the local Virginia chapter’s Membership Committee. He also serves on ASAM’s Membership Council.

He said ASAM’s conferences, review courses, and journals have helped him expand his knowledge. Above all, he enjoys meeting his colleagues in addiction medicine through ASAM.

“It’s great to see everyone’s passion for what they do,” he said.

When asked why he would encourage physicians outside of addiction medicine to consider entering the field, Dr. Ageze said physicians should first understand what addiction medicine actually is. There are numerous misconceptions about addiction medicine and chronic pain that are important to uncover.

He said he thinks many physicians would find the relatively new medical specialty to be the perfect fit for them.

“It’s a holistic type of care,” he said. “They will find joy in that. And those who love the continuity of care will definitely get it. It has a great mix of medical and non-medical interactions with patients as well. People who enjoy that would definitely love it. You’re really making a difference in people's lives. You are helping them find themselves, their true calling in life, while also saving their lives.”

Looking back, Dr. Ageze is grateful that he made the switch himself.

“I couldn't have planned it,” he said. “I feel like it's my true calling in life, God sent. It's not just my job. I wake up every day happy and really want to be there, helping my patients and seeing where it takes me.” He added, “There is more coming. Stay tuned!”

An Emergency Physician Finds New Life in Addiction Medicine

Early in her 19 years as a physician in the emergency department in Michigan, Tory Snyder, DO, realized many of the patients she had been seeing had something in common: substance use disorder (SUD).

The shared element of SUD, however, often presented itself differently. Smokers came in with issues tied to COPD. Other patients with SUDs came to the ER as a result of a car accident or having experienced domestic violence.

“People always think of addiction as the passed out, intoxicated person, but addiction really spans so much more than the typical stereotype,” Dr. Snyder said. “And it is something that in any busy emergency department, you see so much of it.”

After treating numerous patients with SUDs, Dr. Snyder started hearing positive feedback from them personally. One day, during a busier-than-normal shift in the ER, a woman pulled Dr. Snyder aside in the hallway.

“This is my husband,” the woman told her. “I just wanted to let you know you’re the doctor who took care of him and he just celebrated five years of recovery. I just wanted to thank you.”

Another day, as Dr. Snyder walked into a local store, a woman in the parking lot ran up to her with her arms open. The woman, who had previously overdosed on a lethal substance in an attempted suicide, gave Dr. Snyder a big hug.

“I’ve been waiting to see you,” she said. “I just want to thank you. I’m 14 months clean and sober.”

These stories and others like them are part of what influenced Dr. Snyder to move from the ER to residential addiction treatment. After two decades in the high-stress emergency room setting, she also sought a change of pace in her medical career. Dr. Snyder completed a year-long Addiction Medicine fellowship at Caron Treatment Centers, in 2021.

Dr. Snyder is now a staff physician at Caron, an internationally recognized nonprofit organization dedicated to addiction and behavioral healthcare treatment, research, prevention, and addiction medicine education. Dr. Snyder said her emergency medicine experience informs her role at Caron in many ways, including her background of providing care for people from all age groups and walks of life.

Of course, her past experience also provided her with variety of interactions with patients with SUDs in the emergency setting. Now, however, she gets to walk alongside these patients for longer than just one night in the ER.

“Here, you get to interact with people for a month or so, day in and day out,” she said. “You develop that doctor patient relationship. You get to know the person and the person gets to know you, and you can help walk them through the process of decision making as they begin their recovery.”

The best part about going on the journey with each patient, she said, is the positive personal transformation she sees each patient go through.

“Physically, they look healthier,” she said. “Many people put on weight because they are eating a good, solid diet. They are going to the gym and getting exercise. And the spiritual change, the emotional and mental health component to it, is huge.”

Dr. Snyder learned about ASAM as she researched Addiction Medicine fellowship programs and became a member while still working in emergency medicine. She said ASAM has helped her in her career transition and in her current role.

“ASAM has an incredible amount of CME offerings,” she said. “I did the review course with videos prior to starting my fellowship at Caron. It gave me a comprehensive overview of treatment and helped me understand that quality treatment goes well beyond detox and medication.”

She said physicians who work in intense settings, like an emergency department, could appreciate the change of pace that Addiction Medicine provides.

“Emergency medicine requires working at varying times of the day/night, a disrupted sleep schedule, and there is also just the stress of the job,” she said. “There are a lot of people in my age group who are looking for something else. They are not ready to leave medicine, but they are looking to transition to something that is different.”

Dr. Snyder said there are multiple reasons why she would encourage physicians to switch to the field of addiction medicine, but it all boils down to two reasons: purpose and need.

“You know, it is a place where we can make a difference,” she said. “And there is definitely a huge need for it. If you look at the number of certified Addiction Medicine doctors, it is pretty small.”