By Alison Knopf
James Thomas Payte, MD, died January 22 at the age of 87. A pioneer in the treatment of opioid use disorder with methadone, Dr. Payte was one of the very few individuals who were never in medication-assisted recovery themselves, yet inducted as an “honorary patient” by NAMA Recovery, recalled Zachary Talbott, CADCII, CACII, MATS, ICADC, treatment center director with MedMark. Dr. Payte received this honor “because his commitment to patient issues rivaled advocates who were (or are) patients themselves,” Mr. Talbott told AT Forum.
“I vividly remember the last time I was with Dr. Payte in person; it was at the AATOD 2015 Conference in Atlanta, when we set together at the Policy Makers Luncheon,” said Mr. Talbott. He added that Dr. Payte, at one time the medical director of Colonial Management Group (CMG), was also at the hot topic roundtable at that same conference, along with Bettye Harrison (then account manager for the OTP accreditation program at CARF). The topic was the problem of ongoing “dose-capping” in opioid treatment programs (OTPs)—despite the fact that dose-capping was contrary to best practices, as well as a violation of federal accreditation guidelines (see https://atforum.com/2015/06/methadone-dose-capping-still-continues-in-practice-if-not-in-policy/).
“Tom Payte left a legacy of great patient care,” said Mark W. Parrino, MPA, president of the American Association for the Treatment of Opioid Dependence (AATOD). “He made tremendous contributions to our field, and devoted his professional career to improving the lives of patients.”
Mr. Parrino asked Dr. Payte to help organize the medical chapters for the first Treatment Improvement Protocol (TIP) from the Substance Abuse and Mental Health Services Administration, “State Methadone Treatment Guidelines,” published in 1993. Dr. Payte was chairman of the treatment committee of the American Society of Addiction Medicine at the time.
Dr. Payte also developed the curriculum for AATOD’s original training course for clinicians, in conjunction with Drs. Susan Neshin, Andrea Barthwell, and Peter DeMaria. “The course continues to this day as another example of Tom’s creativity,” said Mr. Parrino.
Dr. Payte wrote influential articles throughout his career; one of his seminal publications was coauthored by Dr. Joan Zweben—”Methadone Maintenance in the Treatment of Opioid Dependence. A Current Perspective.”
“What has always impressed me about Dr. Payte, and what will live on in my memories of him, was his undying devotion to patients, above all else,” said Mr. Talbott. “I continue to use his memo to all CMG staff from the early 2000’s titled, ‘Bad Patients? Or Bad Treatment?’ with all of my staff, especially new hires,” he said. “Dr. Payte reminds us that too often poor treatment outcomes are not the fault of the patient, but the fault of the provider—for not giving them all the tools they need to combat their illness.”
In terms of clinical advice, Dr. Payte’s teachings on peak-and-trough blood testing and on induction have been resources for many physicians, said Mr. Talbott. “Along with Dr. Bob Newman, the loss of Dr. Payte is one of the greatest losses to MAT patient advocacy since Dr. Dole’s passing in 1996.”
Remembering the “honorary patient” designation, Joycelyn Woods, director of NAMA Recovery, said Drs. Vincent Dole and Marie Nyswander coined the term when they were asked by news reporters how they could understand addiction and methadone. “Their response was that they were ‘honorary patients,’” Ms. Woods told AT Forum. Dr. Herman Joseph is also an honorary patient, she said.
“I also recall a story from the late John Finger [formerly the head of Texas NAMA] from his first few months in treatment,” said Ms. Woods. Mr. Finger thought Dr. Payte was a patient, because he was frequently sitting in the waiting room talking with patients, she said. “It reminds me of Dr. Dole, who did the same thing.”
MARS core training uses Dr. Payte’s Power Point slides, which are timeless, said Ms. Woods.
Mr. Parrino described Dr. Payte as “an extremely elegant gentleman, and a lovely human being”—and anyone who met him would attest to that. But, as Mr. Parrino said, he liked to describe himself as a “simple country doctor.”And here’s an anecdote that privacy devotees from today will cherish. When Dr. Payte began working for CMG, the company had purchased several programs, all of which Dr. Payte visited. “Some had cameras in the bathroom, and when he saw them, he asked for pliers to cut them out,” said Ms. Woods. “He told me that was one of the most satisfying things he had done in a while.”