(Founders, Dr. Brent and Sandra Boyett)
Many healthcare professionals discovered their calling at a very young age. If you ask a child or teenager what they would like “to be” when they grow up, “doctor” is a popular choice.
Some doctors, however, take a bit of a winding road to discover their passion.
That is the story of Dr. Brent Boyett and Pathway Healthcare.
After four years of dental school, four years of medical school and three years of residency training, Boyett was not prepared for what he found when he opened Boyett Health Services (BHS) and began practicing medicine and dentistry in rural Northwest Alabama in 2001.
Having ventured through medical school, he was exposed to a variety of different types of medicines and treatments for patients, but little was said about the threads of pain and addiction.
At the same time, the standards for quality medicine were changing. A system was being developed by the federal government and the insurance industry that would pay both hospitals and healthcare providers based on quality measures as opposed to the old “fee for service” model.
But in order to develop such a system, there had to be a way to measure success. What would the federal government and the insurance industry decide would be the barometer for the healthcare industry? Pain.
Pain became known as the “fifth vital sign” and the ability to eliminate it became the measure of a good doctor or hospital.
Doctors and hospitals who received federal funding were required to ask their patients to quantitate their pain on a scale from 1 to 10. If Doctor A was able to reduce your pain from a 10 to a 1 and Doctor B was only able to reduce your pain from a 10 to a 4, Doctor A was graded as being the higher quality doctor.
As a result of the new standards and financial incentives being directly tied to them, the usage of pain and anxiety medication began to skyrocket.
These statistics reveal the aftermath of the new system:
● In the first decade of the 21st Century, death due to prescription pain medication went up 400%.
● By 2011, the United States made up around 4.5% of the world’s population. That same year, Americans used 80% of the world’s opioid pain relievers.
● By 2013, drug overdoses killed more Americans than motor vehicle accidents, making it the number one cause of accidental death in our nation.
As the change in policy took place, Boyett and his staff at BHS couldn’t help but notice the problems arising in their own practice.
A 2013 study by the Center for Disease Control confirmed what was likely already known with regard to opioids and benzodiazepines (an anxiety medication that commonly creates dependence) in the state.
The study showed that:
● The Appalachian region of the U.S. used far more of these medications than the rest of the nation.
● Alabama ranked number one in the U.S. per capita for the use of opioid pain medication.
● In 2013, Alabama doctors prescribed almost one and a half prescriptions for opioid pain medication for every human living in the state.
With his practice firmly rooted in Northwest Alabama, this placed Boyett at what would be the epicenter of the worldwide opioid epidemic.
As the problem developed, it wasn’t uncommon for a doctor to be working in the emergency room and seeing patients coming in requesting refills of their pain medication. The complaints by patients of chronic, unverifiable pain syndromes—back pain, headaches and toothaches—became the norm.
The patients who had become dependent on opioids would list allergies to non-narcotic pain relievers and request specific medications that carried high abuse potential. These patients became known as “drug seekers” or “frequent flyers.”
In the midst of a growing problem, the patients who had developed these dependencies were judged, accused and sometimes appeased, but no one knew how to help them.
As a result, many in the medical community banished and tried to avoid them.
Predictably, the problem only intensified as the region’s dependency on opioids grew.
By 2005, just four years after Boyett had started his practice, drug overdoses in the ER were becoming more and more common. Nurses and paramedics would give Narcan, a medication that reverses the effect of opioids, and the patients would wake up, demand their pain medications back and leave against medical advice.
Boyett’s dental practice was not exempt from this epidemic.
Patients began coming into the dental office trying to have healthy teeth extracted in order to receive opioid pain medication. It was common for patients to call back into the dental office after routine dental procedures complaining of unexplained pain and requesting pain medication that Tylenol and Motrin would not satisfy.
Between 2001 and 2013, though conscious sedation was applied to many dental patients during that time, some patients became so tolerant to pain and anxiety medication that normal doses of these medications had no effect.
It became clear to Boyett that the approach he and his staff were using at his practice was ineffective. They watched as things in their practice and state went from bad to worse and they were forced to view drug use as a moral problem.
The solution, at least at first, was for Boyett and his medical staff to carry the burden for their patients.
The mindset of, “I say no, so why can’t they say no?” was adopted.
Ultimately, however, the problem was compounded by the fact that no one understood or even knew what to call the problem they were facing.
The problem was this: In 2013, while Alabama ranked number 1 in the world for the use of opioid pain medication, the state also ranked in the bottom 20th percentile for diagnosis and treatment of substance abuse disorders.
Words like addiction or abuse disorder were not used in reference to opioid abusers. Instead, it was called “chronic pain”.
If it became clear that a patient was struggling with “chronic pain,” they would be referred to “pain management.”
Over time, doses would progressively escalate and mood disorders such as depression, insomnia, and anxiety would often develop. Medication lists with multiple controlled substances would become longer and longer and eventually, medications were being prescribed to treat the side-effects of other medications.
These types of practices became the standard of care throughout the healthcare system.
It was clear something had to change. Unbeknownst to him at the time, Boyett would become a key figure in the process.
In 2008, a pharmaceutical sales representative called on Boyett in his office and suggested that he consider treating opioid dependence and provide a solution to the patients that he and his staff were seeing.
Having been required to do a one-month rotation with an addiction medicine specialist in medical school, Boyett remembered it being one of the biggest eye-opening experiences of his training.
Feeling burdened by what was facing his patients and staff, Boyett became certified to provide buprenorphine therapy in his practice and began to study the disease model of addiction. He would later go on to become board certified in addiction medicine in 2012.
What Boyett and his team would realize, however, was that discovering the problem was only the first step in a long process. The real challenge started when they began attempting to implement a solution.
He and his team began meeting on a weekly basis to write policy algorithms to treat opioid use disorders in a fair evidence-based way. Every week the nurses, the nurse practitioner, receptionists and managers would meet, identify problems and write down solutions. It was this team approach that, over time, developed into what is now Pathway Health’s addiction program.
The BHS team had to use a combination of medical knowledge and trial and error in order to solve a rampant problem. It was anything but easy.
Often time, however, facing a huge challenge forges a bond between team members. As BHS began to solve the riddle of opioid addiction with their patients, one of the byproducts was they grew closer as a family.
As the program improved, they also began to see the lives of their patients improve.
Mothers became mothers again. Their patients began getting jobs, better jobs, raises and promotions. They told them about debts being paid off and damaged relationships with friends and family being repaired.
As Boyett and his staff continued to meet for their policy development meetings, they could tell that the program was truly making a difference in the lives of the patients that they served.
When they tried to put a name on what they were seeing, at some point, they started calling it “life repair.”
They began to see depression be replaced by optimism, low self-esteem replaced by a healthy confidence and chaos replaced by control. The transformation in the lives of their patients as the result of the program ignited a passion in the entire team at BHS.
That transformation, and the subsequent passion it created in Boyett and his staff resulted in the evolution of Boyett Health Service becoming a primary care clinic with a niche in treating substance use disorders.
But Boyett and his staff did not stop there. They continued to see a need for other addictions that were not related to opioids.
As they learned more about the science of addiction, they began to turn their attention to other addictions such as smoking and alcohol. Their focus expanded beyond treating opioid dependence to treating a full range of substance use disorders.
They helped their patients stop smoking and get control over other unhealthy habits. While creating an environment of encouragement toward a healthy lifestyle, they also saw that effective methods could be used to treat substance abuse. Further passions were stirred inside Boyett and his staff as they developed a deep-seated need to perfect their ever-evolving program.
Their new program, combined with a sincere compassion and respect for their patients, began producing extraordinary results.
As a by-product, in 2014, Boyett Health Services closed its dental component and Boyett left the field of dentistry to focus on the treatment of substance use disorders.
Led by his wife of 18 years and registered anesthetist, Sandra, who also serves as the Executive Practice Manager at BHS, the dental staff was retrained to become researchers and BHS became involved with new treatments for addictive disorders. As a team, they became more passionate in the pursuit of helping people with addictive disorders who had seemingly been abandoned by the mainstream healthcare system.
After seeing continued success and growth of the program, Boyett decided to open the first Pathway Healthcare office in Madison, Alabama in October of 2016.
Now with multiple locations across multiple states and growing nationally, Pathway Healthcare has set out to broaden its reach and continue serving patients with substance use disorders.
While modern science cannot cure addiction, it can be managed like other chronic diseases such as diabetes and hypertension.
The staff at Pathway Healthcare is working with the goal of treating patients with substance use disorders so they can lead normal, healthy, and functional lives.