Taking Healthcare by Storm: Industry Insights with Dr. Gary Stoner

In this captivating episode of Taking Healthcare by Storm, delve into the world of expert insights as Quality Insights Medical Director Dr. Jean Storm engages in a thought-provoking and informative discussion with Gary Stoner, MD, previous Director of the Women's Health Opioid Use Disorder (OUD) Program at Geisinger Medical Center.

If you have any topics or guests you'd like to see on future episodes, reach out to us on our website. 

This material was prepared by Quality Insights, a Quality Innovation Network-Quality Improvement Organization under contract with the Centers for Medicare & Medicaid Services (CMS), an agency of the U.S. Department of Health and Human Services (HHS). Views expressed in this material do not necessarily reflect the official views or policy of CMS or HHS, and any reference to a specific product or entity herein does not constitute endorsement of that product or entity by CMS or HHS. Publication number 12SOW-QI-GEN-062624-GK

Transcript

Welcome to Taking Healthcare by Storm, Industry Insights, the podcast that delves into the captivating intersection of innovation, science, compassion, and care.
 
 In each episode, Quality Insights Medical Director, Dr.
 
 Jean Storm, will have the privilege of engaging with leading experts across diverse fields, including dieticians, pharmacists, and brave patients navigating their own healthcare journeys.
 
 Our mission is to bring you the best healthcare insights, drawing from the expertise of professionals across West Virginia, Pennsylvania, and the nation.
 
 Subscribe now, and together, we can take healthcare by storm.
 
 Hello, everyone, and welcome to another episode of Taking Healthcare by Storm.
 
 I am Dr.
 
 Jean Storm, and I am the Medical Director at Quality Insights, and I am very excited today with the guest that I will be speaking to, and I think everyone is going to learn a lot and become inspired by his message.
 
 We are joined today by Dr.
 
 Gary Stoner, who is an obstetrician-gynecologist by training, but today we are going to be talking about opioid use disorder and his experience around treating opioid use disorder.
 
 And in our conversation, I learned that Dr.
 
 Stoner, though we will be calling each other by our first names today, we won't be addressing each other as Dr.
 
 Stoner and Dr.
 
 Storm.
 
 We are going to be calling each other Gary and Jean because we are a little more casual.
 
 I learned that Gary has a unique perspective in treatment of opioid use disorder and his relationship with his patients.
 
 And I really wanted to make sure that his message came across in the podcast.
 
 So Gary, Dr.
 
 Stoner, thank you for joining us today.
 
 Well, thank you for having me, Jean.
 
 I really appreciate the invite.
 
 So let's just jump in.
 
 Tell us how you came to do what you do.
 
 I am an OBGYN physician, and I went to medical school at Marshall University.
 
 Prior to going to medical school, I was a medical technologist.
 
 I ran a lab in Roan County, West Virginia.
 
 I lived in West Virginia for 10 years, but I always wanted to go to medical school.
 
 And when I was accepted at Marshall and went through the various rotations, at the time I trained, Marshall did not have an OBGYN program.
 
 So as a medical student, as you know, Jean, you're pretty much relegated to the back of the line.
 
 But during my rotation on OBGYN, I got to first assist on a lot of surgeries and felt needed as a medical student.
 
 And it really fostered my interest in OBGYN.
 
 And my wife was the year behind me in medical school.
 
 So I stayed on after I graduated back in the 80s and did a transitional year at Marshall.
 
 And then my wife and I went through the couples match and ended up at our first choice, which was Geisinger Medical Center in Central Pennsylvania, which is my home state where I was born and raised.
 
 So that's sort of where I started, where I've been.
 
 And I recently retired after 33 years at Geisinger.
 
 I retired last June.
 
 Very nice.
 
 Very nice.
 
 So we're going to be talking today about opioid use disorder.
 
 So tell us how you became interested in opioid use disorder.
 
 Roughly about nine years ago, I went part-time because my parents were ill, and I made several trips between Danville and Johnstown to keep tabs on my parents.
 
 So I really pared down to more of a part-time status, eased up on the surgery, eased up on being on call.
 
 And I filled part of that void with proctoring the resident clinics.
 
 And it was during that time that I realized there was a need for prescribers of buprenorphine to help pregnant women who were addicted to opioids.
 
 So I got my waiver to prescribe buprenorphine in 2014 and started back then to see patients who were pregnant and were addicted to opioids.
 
 That's my slice of the pie, so to speak, in who I take care of.
 
 And it sort of found me.
 
 It's something I didn't go looking for, but I knew there was a need.
 
 And when I started doing it, I really had an affection and an understanding and a sympathy for this disorder.
 
 Something that I didn't have previously because it lacked training.
 
 We lacked the training.
 
 When I was in residency, it just wasn't on our radar.
 
 But I've always had a compassion for the underdog and the person who has to struggle more than a person who has a lot of opportunity and privilege.
 
 And it has been the highlight of my last nine years of working at Geisinger that I actually cherish.
 
 And I miss these patients, although I do continue to keep in touch with several of them.
 
 Yeah, you know, you talked a little bit about West Virginia, and I know you practiced in Pennsylvania.
 
 So I just want to talk just briefly about West Virginia.
 
 We all know about the opioid epidemic.
 
 Why do you think, in your opinion, that opioids are such a big challenge in West Virginia?
 
 Well, one word, Jean, and that would be Kermit.
 
 Kermit, West Virginia.
 
 And I would direct any of the listeners to a 60-minute special that aired back in October of 2017 by the reporter then, Bill Whittaker, who interviewed Joe Rennessiti, who was an ex-DEA agent who was looking at the distribution companies who distributed opioids to various pharmacies around the nation.
 
 And it's really an excellent review of what happened in West Virginia, highlighting Kermit, in that 9 million hydrocodone pills were sent to one pharmacy in Kermit, West Virginia, over a two-year period.
 
 And Joe Rennessiti thought this was quite excessive, and he took the charge to try to get a handle on what these drug distribution companies were doing.
 
 If you do a little math on that, I asked myself, how long would it take to distribute 9 million hydrocodone pills from a pharmacy over a two-year period?
 
 Well, the answer is 12,000 pills a day, seven days a week for two years.
 
 The population of Kermit is 400, and Kermit is in Mingo County, population 25,000.
 
 9 million hydrocodone pills, you would be able to give every person in Mingo County a prescription for 30 hydrocodone pills every month for two years.
 
 I mean, this is way, way out of the box.
 
 And this happened across the nation with these distribution companies, McKesson, Amerisource, Bergen, Cardinal Health, just flooding these pharmacies with pills.
 
 So in my opinion, that's how it happened.
 
 Yeah, it's really, in West Virginia, I think continues to dig out from all of that.
 
 How do you, I know, I think you're fairly unique, and I'll tell you our background is maybe a little bit similar in that we've been both in, I did my training in Pennsylvania and practice in West Virginia, and you did kind of your education in West Virginia and then practice in Pennsylvania.
 
 How do you think the landscape with opioid use disorder is different in Pennsylvania compared to West Virginia?
 
 I would answer that, Jean, by looking at a couple statistics, which I talk about when I give presentations on stigma.
 
 In 1999, when you looked at all the states across the nation, back then in 1999, New Mexico ranked first in the nation for opioid use disorder death, with a death rate of 15 people per 100,000.
 
 West Virginia at that time in 1999 ranked 38th, with a death rate of 4 per 100,000, and Pennsylvania was 8th, ranked 8th, with a death rate of 8 per 100,000.
 
 Step forward about 17 years to 2016, West Virginia is now first in the nation with a death rate of 52 per 100,000.
 
 That's a 13-fold increase.
 
 Pennsylvania went from 8th to 4th, and their death rate increased from 8 per 100,000 to 37.
 
 That's about a 5-fold increase.
 
 New Mexico went from 1st to 12th, so you would think, well, they're doing better, but their death rate per 100,000 actually went up.
 
 So no one did better.
 
 No state did better.
 
 So the landscape, I think, between Pennsylvania and West Virginia is very similar, but just looking at those statistics, West Virginia outranked Pennsylvania 13-fold to 5-fold.
 
 Yeah.
 
 I think everybody is not going in the right direction.
 
 No, absolutely not.
 
 Yeah.
 
 So switching gears a little bit, you talked about your patients, and I was really inspired by listening to your story.
 
 So tell us how your patients are your mentors.
 
 Yeah.
 
 Well, to back up just a bit, what really drew me into this when I started, I got my waiver, I took the courses, I listened to all what you had to do to manage a patient, and I was scared.
 
 I was afraid.
 
 You can read about it, but until you start doing it and get that visceral feel for it, it takes time.
 
 I was really afraid of causing a precipitated withdrawal in a patient, something that patients know very much about.
 
 They're very attuned to this.
 
 Patients have told me about withdrawal.
 
 And I had no mentors in the clinic.
 
 I had a blank slate.
 
 So when I would talk to my patients, one thing that most providers really need to do in a lot of avenues in medicine, we need to shut our mouth and listen to the patients.
 
 The patients who have addiction are very savvy.
 
 They know their body.
 
 They know the drugs.
 
 They know how they feel.
 
 Buprenorphine is out on the street in the form of subutex and suboxone, and they use it.
 
 So when I would see patients, I would be asking them questions like, how much did you take?
 
 How did you feel when you took it?
 
 How long did it take till you felt better?
 
 When did you feel you needed to take more?
 
 And I was asking these questions because it was educating me on what sort of happens in vivo when patients are taking buprenorphine off the street.
 
 And I would incorporate their decision when I wanted to start them on buprenorphine in conjunction with what they told me about what they were already doing and how they felt.
 
 So it was sort of through that process that I got more and more comfortable by just listening to the patients.
 
 Yeah, it's such an important aspect, I think, of any medical practice, especially treating opioid use disorder.
 
 You know, you talk a little bit about getting your waiver and, you know, the process for prescribing medication for opioid use disorder has changed over the years.
 
 And I'll tell you, I was at a conference in March and in a forum, one of the physicians was talking about, you know, how not many physicians in his state had a waiver, and I was like thinking to myself, well, things have changed.
 
 So can you tell us a little bit about how the process has changed for prescribing medication for opioid use disorder over the years?
 
 Well, in conjunction with the 2016 CDC guidelines, you know, they are focusing on chronic pain, an exclusion of severe cancer, end of life, and palliative care.
 
 So my slice of the pie as a provider of care wasn't as much for chronic pain as it was for acute pain.
 
 But nonetheless, I think that the 2016 CDC guidelines really helped to get this on the radar of our thinking.
 
 When I reflect back to when I was a resident and was ready to discharge a patient after a C-section, she got a script from me for 30 Percocets with perhaps a refill.
 
 Why did I do that?
 
 That's what my chief resident told me to do.
 
 That's what his chief resident told him to do.
 
 I'm part of the problem in doling out opioids with not a really good appreciation for where this was all going to head, as we all now know some 30 years later after I trained, of all these pills that were doled out that ended up in people's medicine cabinets that were never used.
 
 We never talked to the patient.
 
 We never asked.
 
 I never did about, do you really think you need this?
 
 Or looking at how many opioids were they using during their convalescence while they were still in the hospital?
 
 So I think the biggest change that I see that I think is important for providers who do this is, number one, just listen to the patient and ask questions about pain, rather than that carte blanche just, you know, here's your script.
 
 And I know with Geisinger, you know, when I talk with a resident and I can see what's being prescribed, it's very minimal as it is in most places.
 
 Everyone has, it's on their radar and they're very cautious about how they prescribe.
 
 Yeah, it's certainly changed a lot.
 
 So you talked about, you got your waiver for prescribing buprenorphine, I think you said, in 2014?
 
 Correct.
 
 So that process has changed a little bit, right, for prescribing buprenorphine kind of over the years.
 
 You know, now physicians are just required to, you know, any physician is, when they get their DEA renewed or they apply for a new DEA, they just need to undergo just an eight-hour training and then any physician can then prescribe medication, you know, buprenorphine.
 
 So how do you feel about that kind of change over the years?
 
 Yeah, I have been asked this question a lot since the waiver was dropped.
 
 I'm not convinced personally how much of a dent this is going to make.
 
 The medication is just part of the equation, maybe half, maybe less than half.
 
 The other part of the equation is the person, the mental health, the adverse childhood event, the trauma, all of that that has to go in conjunction with treating a patient with opioid use disorder.
 
 This isn't a UTI where here's the macro bid and you're good.
 
 When you give buprenorphine, you just really have to know so much about the patient and where they live, who they're with, what their partner is doing, what background they come from, what environment are they going back into, what are the things that are going to stimulate them or trigger them.
 
 I would say to anyone listening who is doing this or interested in doing this, in my opinion, the medication is just part of it.
 
 You really have to incorporate that patient into your practice.
 
 In terms of OBGYN, once again, my slice of the pie, I have been asked questions about aren't we just trading one drug for the other, Dr.
 
 Stoner?
 
 Yes, we are.
 
 Buprenorphine is an opioid, but it has a ceiling effect and a longer half-life, and that makes all the difference in helping a patient through addiction when they're pregnant.
 
 You may know Jean of the Mother Study that was done back in 2010, 2012.
 
 It was a multi-center study with Henry Jones as one of the principal investigators where they looked at pregnant women who were taking buprenorphine and pregnant women who were taking methadone, the gold standard.
 
 When they looked at some of the outcomes of the babies who did develop NAS, the babies of mothers who were taking buprenorphine required less morphine for withdrawal, less duration of morphine for withdrawal symptoms, and they required less of a hospital stay.
 
 So buprenorphine, in a lot of people's opinion, has edged past methadone for use in pregnancy.
 
 Methadone is still great, it's still used, it's effective.
 
 I am not a methadone provider, but patients who have been on it, I pimp them with questions.
 
 How did you feel on it?
 
 How are you doing it?
 
 Because it's a full agonist, they're a little more woozy.
 
 So as far as what has changed in the world of OBGYN, I put my money on the buprenorphine.
 
 It's moms do great on it and it's better for the baby.
 
 Yeah, I think most people feel that kind of overall, I think, in the landscape.
 
 So you talked a little bit about how you started prescribing buprenorphine.
 
 Maybe you can give us an idea of how you started and maybe it'll help some individuals who are just starting their journey in prescribing, kind of to describe how you felt and what you did taking those first few steps.
 
 Yeah, well, I remember them very vividly.
 
 I guess in a word, how did I start prescribing carefully?
 
 Maybe in two words, extremely carefully.
 
 It was a medication I wasn't familiar with, only what I read about.
 
 And as I've already alluded to, I was very concerned about causing a precipitated withdrawal.
 
 Patients have told me, patients who have had precipitated withdraws say it is horrible.
 
 It's worse than just stopping an opioid because you just ripped those full agonists off the receptor and the body perceives that as a withdrawal.
 
 So I was very careful.
 
 I wanted the patient in front of me or I wanted the patient to stay.
 
 After I prescribed the medication, I wanted to dispense it right there in the clinic, have them go sit a while.
 
 Then I would have them come back in the office and, you know, how are you doing?
 
 How are you feeling?
 
 You know, you sort of titrate it out.
 
 It was really pee-pee steps the way I started.
 
 But when I got more and more and more comfortable with the medication, and I'm talking over a period of years, I would begin to prescribe buprenorphine over the phone to a patient I never saw.
 
 I'm big on staying in touch with patients.
 
 All my patients get my cell phone number.
 
 I thought I was crazy for doing that at first, but it really helped me practice appropriately and stay in touch with my patients.
 
 So I took the step to trust them, to trust what they were telling me.
 
 Because I always ask myself the question, what's the worst alternative in not trying to help a patient?
 
 The track that they are on is the worst alternative.
 
 So I would talk to them about precipitated withdrawal, even over the phone when they're not in my presence.
 
 And most of them knew about this.
 
 And let them know you have to be in a moderate degree of withdrawal.
 
 And they know the symptoms before you start taking buprenorphine.
 
 And I want to see you tomorrow morning, or you call me tonight and let me know how things are going.
 
 And I became very comfortable with that approach.
 
 Sometimes it didn't work, or the patient was just bilking me out of some buprenorphine because it can be diverted.
 
 But I will take the first step to trust my patients.
 
 But more than not, trusting the patients first paid big dividends in the way I work with my patients.
 
 I feel like that's such a big message, or maybe I want to repeat, like trusting the patient pays big dividends both ways, I think, in that provider, you know, physician-patient relationship.
 
 Yes.
 
 It's such an important message.
 
 So do you feel that access to buprenorphine and other medications for opioid use disorder is still a challenge for most individuals?
 
 I think so, but in my opinion, and there again, I'm talking from the culture and the geography where I trained, I think access was the problem, not because we didn't have the infrastructure to provide buprenorphine, but it was a transportation issue for the patients.
 
 Their cars were always broke.
 
 They had to bum somebody's car.
 
 They had to ask somebody for a ride, or they had to use the rabbit transit, which only ran certain hours.
 
 So access to me was a problem more so from a transportation standpoint from the patient.
 
 Geisinger, in our footprint of Central PA in the northeast of 45 counties, a lot of our OB-GYN providers had, we had sufficient providers to provide buprenorphine.
 
 We have four MAT clinics, free-standing units in Williamsport, Bloomsburg, Scranton and Wilkes-Barre.
 
 So the access and the ability for a patient to get the medication was there.
 
 Now, in West Virginia, being more rural, and I'm sure in other areas of the nation, access is a problem just because of geography, and I can only make presumptions about other places.
 
 Yeah, transport, I think, remains an issue in many areas in medicine.
 
 So do you feel it's challenging for individuals to remain on buprenorphine and MOUD, other modalities, indefinitely?
 
 Boy, that's another question I get quite honestly.
 
 How long does the patient have to be on this?
 
 And it's up to the patient, in my opinion.
 
 How long do you have to be on an antidepressant?
 
 You got to talk to the patient, and I have patients who want to get off of it, and they strive to get off of it, and we make inroads to do that.
 
 Other people are afraid to come off of it.
 
 You know, I think of the definition of recovery.
 
 When you look at SAMHSA's definition of recovery, it's a process of change through which individuals improve their health and wellness, live a self-directed life, and strive to reach their potential.
 
 I agree with this.
 
 This is the SAMHSA definition.
 
 It's neat, it's clean, but it's a bit sanitized.
 
 I worked with a peer recovery specialist who said that her definition was, the goal isn't just to be sober, it's to build a life which you don't feel the need to escape.
 
 And boy, that punches me in the gut, particularly when I can almost see the faces of some of my patients when I say those words to myself, that so many of these patients have just lived pretty horrible lives in terms of trauma and adverse events, particularly when they're children, hence their proclivity to go to opioids.
 
 Not that it's right, not that it's justified, but it explains it.
 
 And that's where the compassion comes in, at least my compassion when you understand that, that why you can't judge these folks.
 
 So I have patients who I still stay connected with.
 
 They come with me when I give presentations.
 
 One woman in particular, she's totally off everything.
 
 One of my other patients, she's still on the injectable form, but they're living lives.
 
 The ideal would certainly be total abstinence.
 
 I think it's good to be off any and as many drugs as you possibly can be.
 
 But if it's allowing you to build a life which you don't feel the need to escape, what harm is there in staying on it?
 
 Yeah, and I think this is the perfect segue to talk about stigma because you were talking about compassion.
 
 So what are your thoughts on the impact of stigma for individuals seeking treatment?
 
 In my opinion, Jean, it derails everything.
 
 When these people are judged, first of all, they are leery of the medical profession.
 
 They are leery of the judicial system.
 
 They've had bad experiences.
 
 I'm thinking of a situation where when I first started, I was working with one of my colleagues and the nurse roomed the patient for my colleague.
 
 The patient admitted to the nurse that she had used since her prior visit.
 
 She had a relapse.
 
 She mentioned this to the physician who was about to go in and see her.
 
 So number one, it's a brave thing to admit that and a scary thing to admit that.
 
 And this particular provider said, I'm not seeing her.
 
 She broke the contract.
 
 That was an extremely pivotal moment for me, you know, to heck with the contract.
 
 What does that have to do with anything?
 
 You know, I found myself just very pulled even more into it when, you know, the patient was being judged and that patient is going to feel stigmatized.
 
 We just lost a patient.
 
 The rules, the regulations, the protocols, all of that is extremely important.
 
 The reimbursement, how do you get paid to do this?
 
 All of those variables are necessary in the treatment of opioid use disorder.
 
 But if you start judging patients and they feel stigmatized by you, by the way you stand next to them, by the way you look at them, by the way you hold your arms, they know they're being judged.
 
 And then you have lost the biggest component of treatment, and that's the patient.
 
 So to me, judgment and stigma that causes fear in patients to want to come in is absolutely the rate-limiting step in successful recovery, in my opinion.
 
 Now talking about a topic that everyone kind of knows about, the COVID pandemic, and I just thought it was interesting in our initial conversation, when I said pandemic, you said, are we talking about COVID or opioid?
 
 Which is so interesting.
 
 But do you feel that the COVID pandemic affected access and individuals' ability to be maintained on treatment?
 
 Yes, I do.
 
 I certainly felt that when the pandemic hit, we could tell that things were slowing up.
 
 I talked to other people within our system.
 
 I was having been the director of the Women's Health Opioid Use Disorder Program.
 
 I was connected with several other hospitals and knew all the providers, and everyone was pretty much telling me the same thing.
 
 And even outside of Geisinger, people were saying that things seemingly had slowed up, hence the teleconference thing, which became more important.
 
 But I kept in touch a lot with my patients by phone call and tried to help them maintain that access.
 
 But yes, I do think COVID drove people back into the wood.
 
 And bouncing off of that, I want to talk a little bit just briefly about one of the big buzzwords in medicine now, which is person-centered care.
 
 So what do you feel about the application of person-centered care on treatment of opioid use disorder?
 
 Yeah, well, in medicine in general, who are we supposed to focus on?
 
 This little verbiage that has been in our vernacular for some time has always sort of made me giggle a little bit.
 
 I think, though, for opioid use disorder, it is a fair amount to be person-centered.
 
 I look at opioid use disorder, the management of opioid use disorder, as its own specialty.
 
 In OB-GYN, depending on the volume of patients you have, you need to be ready when that patient is ready.
 
 It's just the mindset of the patient.
 
 And I know this causes some consternation in the mind of people, like, well, why should we kowtow to these drug addicts?
 
 You know, you can't...
 
 And I'm talking from my own personal...
 
 The way I practice, I had a lot of bandwidth.
 
 I had a lot of ability to see someone that morning or to see them that afternoon or to see them the very next morning.
 
 You need that person-centered care for this disorder, because when the patient is calling for help, it can't be, oh, well, we'll see in two weeks on Tuesday morning.
 
 You really have to help accommodate that patient, or at least that's what I tried to do.
 
 And listen, and just listen to the patient.
 
 I know there were studies done of how long does the doctor, does the provider, listen to a patient before they start interrupting them and injecting about 11 seconds.
 
 And you can't do that with opioid use disorder.
 
 Yes, I agree.
 
 Meeting the patient where they are is crucial.
 
 So last question, Gary, and I ask many of my guests this question because it is one of my curiosities.
 
 If you are in charge of healthcare in the United States, what is the first thing you would do?
 
 Yeah, I know we've talked about this before, Jean, and I've given it a lot more thought.
 
 And the number one thing that would make my head spin 360 degrees is the issue of preauthorization of buprenorphine.
 
 And this is a big reason why I gave all my patients my cell phone number.
 
 And I can't tell you the number of times the patient literally called me from the pharmacy.
 
 Dr.
 
 Stoner, I'm here at the pharmacy, and they tell me it's not approved or this needs to be done or that needs to be done and they're only going to give me five tablets and I have to come back for the rest.
 
 You know, it just drove me crazy.
 
 If there was one thing I would focus on probably initially, it would be getting rid of the preauthorization of buprenorphine, especially in pregnancy.
 
 Ironically, this is supposed to have already been taken care of.
 
 And I talked to some of our officials in Harrisburg at some state meetings about this.
 
 But it hasn't filtered down to the trenches.
 
 It hasn't filtered into the pharmacy.
 
 It is still a huge bugaboo and an impediment and a barrier to adequate care.
 
 And I know you have to sort of regulate that stuff.
 
 But, you know, come after me.
 
 If anybody thinks that I'm prescribing wrong or there's something that doesn't add up in the way I'm doing things, like Joe Rennessy thought of these drug distribution companies, then come after me and let me explain myself.
 
 But don't penalize the patient for a system that's broken.
 
 In addition to pre-authorization, the opioid settlement money, boy, that's going to need some oversight, billions of dollars coming in and where's that going to go?
 
 And then finally, the third thing that I thought about was education, particularly to medical students, sensitivity training about opioid use disorder.
 
 And I recently last fall, a patient and I went to our medical school at Geisinger, spoke to the students there.
 
 I was subsequently told by the instructor who asked me to come up that the students thought it was one of the best presentations they ever had, particularly listening to a patient.
 
 So sensitivity training early on, something I didn't have in my training.
 
 I don't know how it went with you, Jean, but this just wasn't on our radar back then.
 
 And to get patients out in the front of young providers, who I do think are more liberal and compassionate in their understanding, you know, sort of already get it, but it doesn't help to sort of punctuate that by the presence of the patient.
 
 Some great things to put on my wish list about healthcare.
 
 Gary, Dr.
 
 Gary Stoner, thank you so much for joining us today.
 
 And I will say, spoiler, I really hope to have you on again, perhaps, and we can kind of explore opioid use disorder in other areas.
 
 Sure, that would be great.
 
 Perhaps invite a patient to come along.
 
 And I'm game for, you know, however we need to spread the word about this vitally important topic.
 
 Wonderful.
 
 Thank you so very much.
 
 I look forward to talking again.
 
 Bye-bye.
 
 Same here, Jean.
 
 Thank you so much.
 
 Thank you for tuning in to Taking Healthcare by Storm, Industry Insights, with Quality Insights Medical Director, Dr.
 
 Jean Storm.
 
 We hope that you enjoyed this episode.
 
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