Fighting Disparity through Addiction Medicine

While in his second year at Eastern Virginia Medical School, Daniel Ageze, MD, returned home to Addis Ababa, Ethiopia, which he had left as a teenager, to provide medical care for underprivileged Ethiopians who lived in the country’s rural areas.

I specifically remember one man who begged for more than two months just to get enough money to pay the bus fare to come to the capital,” Dr. Ageze recalled.

At the time, the medical team Dr. Ageze served with wasn’t equipped to help the elderly man, whom Dr. Ageze believes had a brain tumor. When Dr. Ageze told the patient this, the man grew discouraged. The man shared that he would have to beg for another two months just to get the bus fare “to go home and die” in his village.

“The amount of money that he needed, I would spend on dinner,” Dr. Ageze said, putting the man’s needs in perspective. “Then you come back to the States, and you see people complaining, even when they have an entire patient room to themselves with all the resources.”

Upon his return to the United States, Dr. Ageze grew uncomfortable with the fact that such a disparity could exist anywhere in the world, let alone in his home country. What he witnessed forced him to question his purpose in life, his medical career, and even his cherished Christian faith.

Dr. Ageze realized that, if the suffering in the world was to be lessened, he would have to be part of the solution. During his residency, he heard a lecture from an addiction medicine specialist. Dr. Ageze was so moved that he asked if he could shadow the visiting physician at his clinic.

As the physician mentored him and he met patients with substance use disorders (SUDs) and learned about the field of addiction medicine, Dr. Ageze realized people battling addiction are struggling with their own disparities. His new purpose became clear – to care for those affected by such a debilitating chronic disease and who are to some degree the “outcasts” of the community.

“I wanted to be with patients who were facing such disparities,” Dr. Ageze said.

Dr. Ageze initially entered family medicine to work with patients of all ages. His goal was to build relationships with his patients and provide continuity of care for them. During his residency, he learned that, on average, he would see most patients only one to two times a year, making it difficult to build those relationships.

For him, addiction medicine has proven to be life-altering.

“In addiction medicine, you’re seeing patients every week and there’s a lot more to each visit,” he said. “You’re involved in their lives. You know their fears and the struggles they face. Because addiction is so stigmatized, a lot of patients do not share their true struggles, but when they find someone who understands addiction, they can open up and that’s big. You build these bonds and you’re really helping people regain and rebuild their lives, their marriage, etc.”

With a recent move to California, Dr. Ageze is active in the addiction medicine world. He is pursuing a master’s degree in Public Health, focusing on health promotion and behavioral science, at San Diego State University. He is also doing a preventative medicine residency at UC San Diego, with an addiction medicine track. “I want to address systemic problems that my patients face daily. My eventual goal is to open sober-living homes, God willing,” he said.

Besides seeing patients, he is actively engaging with key stakeholders in the region to further advance the mission of ASAM and addiction medicine. From a research point of view, he is working to understand the public health effects of the passage of Proposition 64, the law that legalized recreational cannabis in California. He is also conducting research that will allow an implementation of low-threshold substance use treatment access for those seen at the emergency department as follow-up care. This program will serve diverse patients who are at high risk for low follow-up rates and risk for overdose deaths. Dr. Ageze is also collaborating on a project with a local NGO to reduce rates of houselessness and devise plans to provide assistance and access to care. Lastly, he is working with San Diego County to help guide substance use treatment and mental health integration into mainstream primary care. Through these activities, he strives to actualize his belief that “there is hope, and we will become the change we would like to see.” 

“I treat addiction because it is such a preventable chronic disease. It is a sign/symptom of something deep-rooted. One mentor once said to me, ‘Overdoses and rise in substance use, whether opioids or another synthetic substance, are just a cry for help, a symptom that reflects on the health of our health care system.’ I agree. It speaks to the infrastructure of our health system, including the social and governmental support we have at each socioecological level. The numbers are evident -- more minorities are dying and facing disproportionate levels of disparities. We need to rebuild our system the way it should be – diverse and free from systemic racism. We need to create an environment that allows for social and health equity. That starts with the workforce, and it is encouraging to see ASAM being proactive about addressing these issues and promoting DEI.”

Dr. Ageze said ASAM has helped him grow as an addiction medicine specialist. He learned about ASAM through his mentor, Dr. James Thompson, who told him about the Virginia ASAM chapter. Today, Dr. Ageze serves as chair of the local Virginia chapter’s Membership Committee. He also serves on ASAM’s Membership Council and enjoys the diversity of its members, who are of various practice backgrounds, ages, races, ethnicities, and genders, including ASAM staff who give their perspectives and support. Topics that focus on diversifying the ASAM membership and those sitting at the main tables have been refreshing and encouraging for Dr. Ageze. “We must build and diversify the addiction medicine workforce and break away from the older ways of thinking including turf wars. Too many people are dying such preventable deaths for us not to change. We need every hand, every perspective, and those that are right for every person and background at the table.”

He said ASAM’s conferences, review courses, and journals have helped him expand his knowledge. Above all, Dr. Ageze enjoys meeting his colleagues in addiction medicine through ASAM.

“It’s great to see everyone’s passion for what they do,” he said.

When asked why he would encourage physicians outside of addiction medicine to consider entering the field, Dr. Ageze said physicians should first understand what addiction medicine actually is. There are numerous misconceptions about addiction medicine and chronic pain that are important to uncover.

He said he thinks many physicians would find the relatively new medical sub-specialty to be the perfect fit for them.

“It’s a holistic type of care,” he said. “They will find joy in that. And those who love the continuity of care will definitely get it. It involves a great mix of medical and non-medical interactions with patients as well. People who enjoy that would love addiction medicine. You’re really making a difference in people's lives. You are helping them find themselves, their true calling in life, while also saving their lives.”

Looking back, Dr. Ageze is grateful that he made the switch himself.

“I couldn't have planned it,” he said. “I feel like it's my true calling in life -- God sent. It's not just my job. I wake up every day happy and really want to be there, helping my patients and seeing where it takes me.” He added, “There is more coming. Stay tuned!”