Interview with Tipu V. Khan, MD, FAAFP, FASAM; Addiction Medicine Fellowship Director, VCMC

Tell us about your background:  education, residencies, and career path.

I attended the University of Washington where I got a certificate in underserved pathways, caring for the underserved, on top of my MD degree. I came back to southern California and did a residence at Harbor UCLA and trained in the county hospital.  l then went to USC and did high- risk OB fellowship.  Then at a FQHC in full spectrum primary care, mix of all underserved.  In 2014, I joined VCMC.  

What is your current role and what was your initial role with the county, if different?

I always wanted to go back to academics, wanted a couple of years under my belt and I had real world experience after two years.  I realized I liked full-spectrum care, all of it, high-risk OB, and began looking for jobs for this and there wasn’t a lot.  There were two, one in Riverside county and one at VCMC.  VCMC had name recognition, and a stellar reputation.  I had three children who were 9, 6, and 3 years old at the time, and it felt like the right place for us to be.

What was it that interested you in this work?

For me, growing up I saw the lack of care for patients who had limited medical access.  Friends who wouldn’t get diabetes check-ups until they were in dire need of foot care.  One friend didn’t get proper care and that led to a bad outcome.  The underserved need more high-level care. That’s why I went down that pathway.  The ability to be an advocate for those who need a voice in the system was what interested me in this work.

Is there a ‘typical’ patient who comes to see you?

That’s what I love about my job, every week is different. One week I’m on the addiction consult service and it’s intense, high intensity. Then I’m in the ER, then a delivery, and the next week on primary care. The breadth and scope of practice is very different. Literally cradle to grave.

What do you see as the most urgent issue in the world of addiction at this time?

That’s a tough question:  Fentanyl, if I had to put it into one word.  That’s why the Prescriber’s Care Discussion Series for medical providers in Ventura County is a great approach.  It’s not going to happen with just law enforcement.  It will require a complete revision on how we approach the issue of addiction, with fentanyl overdoses. Every person or a family member knows at least two people who have overdosed or died. Not just one avenue to care will work here. We need to look at this in a different way.  We’ve tried increasing access to care; addiction is not something like small pox that comes and goes away.  We’ve struggled with this issue since the beginning of time.  It will never be entirely gone. We need to learn to live with it, with as little impact as possible.

What (if anything) do people most misunderstand about a person addicted to substances?

People who haven’t experienced an addiction, don’t understand it’s not under their control.  We want to say, ‘Just say no’, or ‘let god, let go.’  They have a disease; it’s disconnected from the pleasure pathway.  You’ve got an adolescent brain running your entire life.  That’s the neurobiology of the disease/brain. When I have that conversation with patients about the disconnect from the front of their brain, it clicks. A good amount of it is out of their control.  A lot of these people have a lot of underlying trauma from when they were much younger, and you’re not going to fix those pathways.  They don’t have that executive function.  They need education to help with skills to learn to cope without the use of substances.  Not a simple task.  In the world of addiction care there’s medication care and addiction medicine, which we approach from the medicine side; we use a lot of pharmacy care, medications Suboxone and Buprenorphine, along with all the behavioral part of it.  We have a good relationship with drug court and primary care, public health nurses, and for years we were the only addiction medicine group in the county; now we are the largest, though there are others in the county.  We take all insurance, self-referral from Gold Coast, word of mouth.

Tell us about the team you work with at VCMC?

We have five faculty and fellows, docs in trainings, and a strong behavioral health team in the clinic and great nurses.  Also, a good Substance use navigator at the hospital.  It’s the whole team and picture, great relationship with VCBH, we work with a woman and children residential treatment center, a house for women to detox and stay with their children.  This treatment center is the only such medical place in the county.

What do you feel is the most beneficial aspect of the Prescriber’s Care Discussion Series you recently facilitated?

What I really appreciated from the first one is that you’re not hearing one side of the story, it’s really encompassing all sides of the substance abuse scene. Law enforcement, coroner, we’re all trying to do the right thing but everyone approaches it from a different lens.  We don’t all see things the same way. Sgt. Hadjucko from VCSO might say, put more people in jail; that’s how they approach it from their lens.  The second series we talked about safely prescribing.

Anything else you’d like us to know about you and the work that you do?

We’ve built a community presence and even if someone hasn’t met with us they have heard about it.  Depends on where they are in their process.  Where they are in their change.  Some are not ready to have a discussion. But it is easier to have those conversations now than, say four years ago.  And that’s a win.