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I'm a ambulatory care pharmacist working in primary care in rural WI and see patients with our providers to manage (mainly) chronic disease. Initially I found myself being used as a resource for a lot of pain patients with polypharmacy and slid into a role helping with suboxone initiation and maintenance with our only suboxone provider in the clinic. I see a handful of patients on Suboxone who almost exclusively had been found to be misusing their prescription opioids. We recently established with a young patient with multiple substance abuse (including heroin [primary] and meth). Their needs are MUCH more acute than the other patient's I've worked with, I worry their going to harm themselves soon, and I struggle to know how to motivate them and what my role should be beyond providing MAT. One of my recent attempts at creating dissonance with their goals and behavior was met with anger on their part. 

They continue to come to visits once a week, seem to be taking buprenorphine off and on. They'll disappear for a week at a time and use heroin but come back the next when their "dope" runs out. Recently I thought they had found new motivation in getting clean to get subsidized housing, but now this week no longer one of their goals.

I'm very encouraged to find this resource and will probably scan this for the next several days looking for pearls on how to help my patient better.

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