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Changing Communities One Life at a Time
Hillary Tamar, MD, FASAM, was a family medicine resident in 2019 when she shared with a how an impactful experience in medical school showed her that addiction medicine can significantly change patients’ lives.At the time, she said, “[Patients] can go from spending all of their time pursuing the acquisition of a substance to being brothers, sisters, daughters [and] fathers making breakfast for their kids again. It’s really powerful.”
Dr. Tamar is now board certified in addiction medicine and still marvels at its transformative effect on the lives of her patients.
“You literally see people get better in front of you, which is incredible,” said Dr. Tamar, who joined ASAM more than five years ago. “It’s also gratifying to do the outreach work and see community members who don’t have a history of substance use disorder make an effort to understand and embrace greater access to medications for addiction – for example, medication for opioid use disorder (MOUD) – in their communities.”
Finding the Path
After completing her family medicine residency in 2020 in Arizona, Dr. Tamar moved to Seattle for an addiction medicine fellowship at Swedish Medical Center, which she completed in 2021.
“During my fellowship, it became clear to me that my very favorite thing was working at a methadone clinic,” Dr. Tamar recalled. “I knew that as an addiction medicine attending physician, this was what I really wanted to do.”
Dr. Tamar, who is also board certified in family medicine, then moved to Wisconsin and became a provider with Community Medical Services (CMS), which runs opioid treatment programs (OTPs) nationwide. She took on the role of medical director in 2022 and, in 2023, became the medical director of CMS’s eastern territory. Today, she oversees the delivery of care in Indiana, Michigan, Minnesota, Ohio, Texas, and Wisconsin. She also serves on CMS’s Medical Advisory Board.
In addition to these responsibilities, Dr. Tamar still enjoys caring for patients at multiple CMS clinics. The reason she pursued a career in addiction medicine holds true today: the medications used to treat addiction work well.
“In addiction medicine, especially with MOUD, if I can get you on the medication and you take it, it is going to work,” she said. “And if you take it, it’s going to decrease your risk of dying by a factor of about 50-70% over untreated opioid use disorder. So, to me, that’s the Holy Grail of medicine.”
After years of treating addiction, Dr. Tamar said her perspective on certain aspects of the field has changed. Community outreach is one example; Dr. Tamar did not realize its full value until she became aware of how stigmatized methadone is, despite it being the gold standard of care for opioid use disorder.
“If methadone is highly stigmatized and discriminated against in communities by people who are not taking it, then the people who need that care are going to be less likely to seek it out,” she said. “But if you can get into the community and attack those narratives before they reach the ears of people who are using substances, then it is much easier to get people into treatment, and it is much easier to expand evidence-based treatment within communities.”
Signs of New Life
Several years into her career, Dr. Tamar continues to hear moving stories from patients and community leaders about how addiction treatment has changed and even saved lives.
Just a few months ago, a patient told Dr. Tamar, “You know, this program feels like freedom.” Intrigued, Dr. Tamar asked her to share more.
“Before I started taking methadone every day, I would wake up and have to think, ‘What side quests will I go on today to be able to afford fentanyl?’” the patient disclosed. “Now that I am on the medication, I don’t have to think about that anymore. I get to wake up and do whatever I want.”
Another patient’s recent breakthrough also inspired Dr. Tamar. The woman shared how her taking medication had not only helped her but also motivated her friends to make changes.
“My friends look at my arms now and they can tell that I’m not using the needle,” the patient said. “They asked me, ‘How did you get off the needle? We want to stop using needles. We want to do whatever you’re doing.’ I told them, ‘You get on medication, and that is how you can stop using syringes.’”
The woman’s honesty about her small, influential victory moved Dr. Tamar.
“They were still actively using opioids, but they were using them in a way that was safer, and they were really happy with the strides they had made,” she said.
At the community level, Dr. Tamar has seen first responders validate an OTP in the local area. As Dr. Tamar and others sought approval for a new OTP from the county board of zoning appeals, they struggled to win over community members who feared the program would lead to more syringes on the ground and more people using substances.
Local first responders came to the rescue, sharing their experiences with a similar program.
“We had a member of the local police say that since CMS had become part of the community, they had seen the amount of overdose deaths and calls for overdoses for both police and fire decrease significantly,” Dr. Tamar said. “Hearing that from someone with a position like that within the community was powerful for me.”
The Value of ASAM
When Dr. Tamar reflects on her career, she sees ASAM’s influence throughout. One major way she has benefited from her ASAM membership is through educational programs the Society offers. From using ASAM’s resources to prepare for her board certification exams to ongoing lectures organized by ASAM and the Wisconsin Society of Addiction Medicine (WISAM), Dr. Tamar continues to grow as an addiction medicine specialist.
She also appreciates the networking opportunities ASAM and WISAM provide.
“I have the opportunity to meet other people who are like-minded and involved in other areas of addiction medicine within my state and other regions,” Dr. Tamar said. “It’s incredibly helpful for me, as someone in a leadership role. Since I oversee clinics in multiple areas of Wisconsin and the rest of the country, to be able to meet and collaborate with other addiction medicine providers who are working within those regions, hearing about the resources available there and how I can help my patients within those communities has been invaluable.”
Dr. Tamar said she encourages anyone who treats addiction to join ASAM and take advantage of all the organization has to offer.
“This is a relatively new sub-specialty,” she added. “It’s evolving constantly, and ASAM has excellent resources for staying up to date with those changes. And again, the networking is incredibly helpful, no matter where you are in your career.”
When asked what advice she would give those entering the field of addiction medicine today, Dr. Tamar explained that she often goes against advice she received in medical school. She was once told that if a patient says they are drinking a certain amount, she should assume they are drinking three times that. Dr. Tamar, instead, takes her patients at their word.
“I don’t see the value in wondering if people are being truthful with me. I try to create an environment where patients feel they can be honest with me – an environment that is not pain but harm reduction-focused. I think that when we look for the best in people, they give their best to us. That’s what I’ve noticed with my journey in addiction treatment.”
Looking Forward Again
Dr. Tamar said she’s excited about what’s on the horizon in the field of addiction medicine.
“One of the things I’m looking forward to in the next five years and that I’m passionate about is expanding primary care services as much as we can and as much as is feasible with our OTP,” she said.
As an example, Dr. Tamar added, CMS already treats hepatitis C at many of its clinics but is looking to expand that offering into more regions.
“We’re also hoping to expand access to care,” she said. “The more clinics that we can open, the more people will have access, because people are more likely to attend a clinic that’s close to them. Remember, this is methadone, so you’re going there all the time to dose.”
Dr. Tamar is also looking forward to working with more relaxed federal methadone regulations, which were eased in April 2024. She hopes these changes will lead to more stories of lives positively impacted by addiction medicine.
“I’m incredibly excited about aligning our policies with the new relaxed regulations,” she said. “We can use those broadened flexibilities to expand access to methadone.”