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Focus on Rural Health

The Accidental Advocate

By Stacy Kusler on

In 1999, Dr. Melissa Henke was in her second year of medical school at the University of North Dakota (UND). That same year, 12 overdose deaths in North Dakota were reported.

Back then, training in addiction medicine and substance use disorder wasn't really a thing, according to the award-winning physician known for expanding access to addiction medicine in North Dakota.

"I don't actually remember having any training in medical school for it," Henke admitted.

Comparatively, in 2023, North Dakota lost 133 lives to overdose, and over 106,000 lives were lost nationally to the same cause.

Given that the opioid crisis has made addiction medicine and substance use disorder very much "a thing," Henke is making it her mission to change lives and minds about what addiction and recovery look like.

A Chance Meeting

Henke is a 2002 graduate of the UND School of Medicine & Health Sciences. After medical school, she entered a residency program that combined her two passions from medical school, neither of which included addiction medicine.

I truly love to hear people's stories, learn what makes them tick, and help people reclaim their lives.

"I always loved internal medicine," she said. "I loved how linear it was – if you had a patient with high blood pressure, give them a medication and see their blood pressure go down. I also loved psychiatry. I truly love to hear people's stories, learn what makes them tick, and help people reclaim their lives."

When she found Kansas University offered a combined residency for both specialties in a five-year program, Henke knew she found the right fit. But like her time in medical school, the residency didn't offer much in the way of experience working with or treating patients with addiction.

"We maybe had four hours a year of training in addiction medicine," she said. "I only saw the ugly side of addiction – those who were in active addiction. We just didn't have enough time to get to see people come out on the other side."

So how did Henke go from having an aversion to treating patients with addiction to now serving in multiple capacities, treating and advocating for patients with this exact diagnosis?

"Accidentally," she said.

Kurt Snyder and Melissa Henke, MD

Henke completed residency in 2007 and moved back to Bismarck, practicing at a local medical center. On an ordinary trip to Target one evening, Henke bumped into one of her former preceptors from medical school who was with her husband, Kurt Snyder, the executive director of the Heartview Foundation. Heartview Foundation is an organization offering residential, outpatient, and medication assisted treatment options for individuals with substance use disorders.

"The day I ran into them, their medical director had just handed in his retirement notice," Henke said. "Snyder asked me if I would take the job, and I said no on the spot."

Henke's experience, to that point, had only been the negative side of addiction treatment.

"It just wasn't my thing," she repeated.

Eventually, though, Snyder talked Henke into the medical director job by promising just one hour a week providing oversight of policies and procedures – and she didn't have to see patients. About a year later, the next thing Snyder talked Henke into was seeing patients and prescribing medication to help opioid users.

"Again, I said no way. But he had science to back up the medication that was really supportive. I read the literature and eventually agreed," she said.

That pivotal point in Henke's career set her on a pathway to impacting the lives of countless people struggling with a difficult disease that not many health professionals were equipped to handle.

I saw the hardworking, compassionate, forgiving, tenacious, really beautiful side of people. I was hooked.

"[After I started prescribing] I saw people's lives just completely transform in a way that I'd never experienced in medicine," Henke said. "I saw the other side of people abusing substances, and I saw the hardworking, compassionate, forgiving, tenacious, really beautiful side of people. I was hooked."

Addiction Epidemic

From there, she was all-in. Henke left her other job to spend more time seeing patients at Heartview. She was later appointed to the Governor's Council for Recovery Reinvented and began working as the director of the North Dakota Professional Health Program, an organization offering support and monitoring for physicians, physician assistants, medical students, and residents who are affected by mental illness or substance use disorder in a confidential and non-disciplinary capacity.

Her steadfast and persistent work to advocate for patients with addiction and substance use disorders, and her leadership in expanding access to addiction medicine in the state, earned Henke the 2021 Zezula award, a Governor's award for excellence in public service.

With two board certifications under her belt already, a third board certification in addiction medicine was pursued through the work she was already doing with her patients. Typically, adding another board-certification requires the physician to complete a fellowship, meaning several months away from work and family. Because of the growing need for addiction medicine physicians, the American Board of Preventive Medicine tried to make certification easier by offering a work pathway towards board certification, rather than a traditional on-site fellowship.

"I would not have gone back to do a full fellowship and leave my family, but the work pathway allowed me to achieve board certification status while continuing to see patients," Henke said.

For his part, Snyder is certainly glad for the Target run-in back in 2007.

"Heartview wouldn't be where it is today without Dr. Henke," he smiled. "Her willingness to be open-minded and work on the forefront of addiction research allows us to give patients a chance at a new life. She is much loved by staff and patients alike, and, in return, she is a fierce advocate for her patients."

With patient care being her first focus, Henke is equally passionate about educating future generations of healthcare professionals and offering experience with addiction medicine that she never received in medical school.

"It doesn't matter what field of medicine you go into, you will deal with people who use substances," Henke said.

Just Be Kind

When training a student, whether it's a medical student, physician assistant student, or licensed addiction counseling student, Henke goes beyond just having trainees observe her doing her job. She encourages full interaction with her patients and tells her patients to be open and honest with the students so they can learn how to treat patients with addiction better.

"I tell my patients all the time that if they are sitting in that chair, someone in the medical field has treated them poorly," she said. "We have to show [new providers] what recovery looks like. We are not in an opioid epidemic; we are in an addiction epidemic."

Stephanie Ziegler is a fourth year medical student who has her sights set on a future rural family medicine career. She spent a week at Heartview in her third year, and has now returned for a full month rotation. "I feel like my biases have definitely been broken down," Ziegler said of her time training with Dr. Henke.

For a lot of them, Dr. Henke is the first person to really understand them and set them on a path to success.

In other clinical rotations, Ziegler's interactions with patients who have addiction or substance use disorders left her feeling helpless. "I only saw withholding opioids as a response to their disease, not providing help." After training with Dr. Henke, though, Ziegler saw that there are ways to help. She is seeing patients alongside Dr. Henke who are in active addiction and fighting to make it through another day. Conversely, she also sees patients thriving in recovery. "For a lot of them, Dr. Henke is the first person to really understand them and set them on a path to success. I recently saw a patient who is 5-years sober. They have a job, a house, and their kids living with them. It's just amazing. I want to be like Dr. Henke, I really do," Ziegler said.

Educating the public is another mission for Henke, who believes that helping people understand the disease of addiction can help us all be better neighbors to our fellow North Dakotans. Her message is simple: "Just be kind."

To that end, Henke notes that because addiction is not something anyone would willingly choose for themselves, individuals and families suffering from a substance use disorder should not be "shunned" as if addiction is their chosen lifestyle.

Henke believes that kindness, not judgment, is something everyone can do.

"We are all human. We are all flawed. We all have crosses to bear, and judgment doesn't help," she concludes. "What people really need is a champion, so if I can be that voice of compassion and kindness, then then I'm happy to do it because what I see, over time, is that my patients are getting more job opportunities, more housing opportunities, and more educational opportunities, and that benefits everybody."

Stacy Kusler Stacy Kusler is the connection between rural healthcare facilities in North Dakota and qualified health professional job seekers. As the workforce specialist, she assists rural facilities to attract medical providers and other health professionals to their communities by sharing job opportunities. Through her position, Stacy is working to reduce the healthcare workforce shortages throughout the state.