Medical Services and Patient Information
Dr. Chester is certified in Addiction Medicine by the American Board of Preventive Medicine, as well as by the American Board of Physical Medicine and Rehabilitation.
Celebrating over two decades as a full-time Maui doctor.
As an Addictionologist
In a private, one-on-one outpatient office setting, Dr. Chester uses scientifically proven medication and counseling techniques to help people gain control over withdrawals, cravings, overuse, high-risk use, and hazardous or harmful use of the following:
- Opioids
- Alcohol
- Benzodiazepines
- Nicotine/Tobacco
- Amphetamines/Methamphetamines
- Cocaine
- Cannabis
Withdrawal symptom management without being in a locked hospital or residential “detox” center can often be a more comfortable option. Our office is located in Wailuku, but most appointments are through telehealth using Zoom Healthcare. We can work around your schedule and lifestyle. Your safety, privacy and confidentiality are our top priorities.
By utilizing standard, time-tested medications, Dr. Chester can help you reduce the physical and emotional effects from coming down from alcohol, and any other drugs or medications. A gentle tapering versus an abrupt stop from any substance would be discussed during your initial meeting.
Phase two would include counseling, and depending on the goals you set together, strategies to keep your alcohol consumption to a minimum or completely off all alcohol use.
Dr. Chester teaches other healthcare professionals this approach, so you could discuss several strategies to help you safely and comfortably achieve your goals. Dr. Chester is a firm believer in reducing stigma associated with alcohol use disorder, hazardous drinking, and harmful drinking. If you currently have legal issues resulting from your alcohol and/or drug use, he is familiar with the court system.
As an Osteopathic Physician or D.O.
Dr. Chester was medically trained and licensed like an M.D., but received an additional three years of hands-on training in the musculoskeletal system. The musculoskeletal system is your body’s nerves, muscles, and bones. He treats people with pain and performs osteopathic manipulations, and trigger point injections.
Addiction Medicine and Treatment: What is Addiction Medicine?
Office-Based, Outpatient Therapy for Patients with Addiction: Buprenorphine Treatment & Maintenance
Pain Management: What is Pain Management?
Physiatry and Physical Medicine: Why Choose a Physical Medicine and Rehabilitation Doctor?
Osteopathic Manual Medicine and Manipulations (OMM): What is It?
FDA Consumer Update - What to Ask Your Physician Before Taking Opioids
Alcohol Use and Your Health From the Centers for Disease Control and Prevention (CDC)
What is Addiction Medicine?
American Board of Preventive Medicine - Significance of Certification
What does it mean to be Board Certified in Addiction Medicine?
Certified physicians have the knowledge and skills to provide prevention, screening, intervention and treatment related to drug use disorders and addictions. These addictions can be to alcohol, tobacco, or other drugs, including illicit drugs and prescription medications. In addition, these physicians can recognize and treat the psychological and physical complications of addiction. Certified physicians have taken a rigorous exam to verify they are competent to be Addiction Medicine physicians.
What type of treatments do certified physicians provide?
Certified physicians use the full range of evidence-based treatments available to treat addictions and drug use disorders. These can include behavioral therapy (such as individual or group counseling, cognitive therapy, or contingency management), medications, or their combination. The specific type of treatment or combination of treatments will vary depending on the patient’s individual needs and, often, on the types of drugs they use. The severity of addiction and previous efforts to stop using drugs can also influence a treatment approach. Finally, people who are addicted to drugs often suffer from other health (including other mental health), occupational, legal, familial, and social problems that should be addressed concurrently. Certified Addiction Medicine physicians also work with other members of the health care team to ensure that patients’ needs, and those of their families, are adequately met.
Reasons to become Board Certified in Addiction Medicine
The certificate is recognized throughout the world as signifying excellence in the practice of Addiction Medicine. It demonstrates that a doctor has met vigorous standards through intensive study, assessment, and evaluation. Certification is designed to assure the public that a medical specialist has successfully completed an approved educational program and an evaluation, including a secure examination designed to assess the knowledge, experience, and skills requisite to the provision of high quality patient care.
- A certified physician is one who has shown mastery of the knowledge expected of a physician practicing in the field of alcoholism and other drug dependencies. Certification is an evolutionary process, and periodic demonstration of the mastery of current knowledge is a critical element.
- State Hospitals and Medical Facilities call on Certified Physicians for testimony and identifying legislation that affects substance abuse issues and treatment.
- Credibility with third party payers when advocating for patient treatment/length of stay.
What is Suboxone and Buprenorphine?
Buprenorphine Treatment & Maintenance
Office Based Therapy for Patients with Opioid Dependence
About Buprenorphine:
Buprenorphine (byoo-pruh-nor-feen) is the first medication for opioid maintenance and detoxification that private practice physicians can dispense in their office. Buprenorphine is a partial agonist that blocks the effects of other opioids. Buprenorphine interacts in similar, but significantly different ways, at the same mu receptors in the brain where heroin, methadone, and prescription pain relievers such as Oxycontin initiate their effects. This distinctive pharmacology gives buprenorphine its safety margin and low potential for diversion. It eliminates the major motivation for opioid abuse by preventing withdrawal symptoms and it produces less stimulation and physical dependence than full agonists. It is available in two forms, alone (Subutex®) or with naloxone (Suboxone®) and it is administered sublingually (under the tongue).
Benefits of Buprenorphine:
- Patients do not need to go to a methadone clinic to receive Buprenorphine. Buprenorphine is prescribed in a doctor’s office, is dispensed in local pharmacies, and can be taken at home as a sublingual pill.
- Milder withdrawal and detoxification process.
- Eliminates cravings and prevents withdrawal symptoms such as pain and nausea by blocking the effects of other opiates.
- Long lasting. Once maintained, the frequency of prescription is determined by the physician and can vary from weekly to monthly, depending on the patient’s needs.
- Safer than heroin or traditional prescription opiates; buprenorphine alone is unlikely to result in an overdose. Like methadone, buprenorphine reduces the craving for opiates and permits productive living. But buprenorphine has a ceiling effect, which means there is less likelihood of abuse or of an overdose.
- Reduced health risks, especially those related to IV drug use, such as HIV and hepatitis B and hepatitis C viruses, skin infections and vein problems.
- Lower risk profile than methadone.
- Maintenance treatment provides emotional stability, providing an opportunity to address psychosocial problems.
Contact Information:
To make a referral or for more information about the program, please call us at (808) 249-8887.
Links:
- Buprenorphine Treatment Information from The National Institute on Drug Abuse (NIDA) https://nida.nih.gov/videos/facts-medication-treatment-opioid-use-disorder-oud
- MedlinePlus – A Service of the US National Library of Medicine http://www.nlm.nih.gov/medlineplus/druginfo/medmaster/a605002.html
- The National Alliance of Advocates for Buprenorphine Treatment www.naabt.org/links.cfm
- Suboxone Website www.suboxone.com
- Board Certification in Addiction Medicine www.abam.net
Pain Management…
I take a non-surgical approach, and my diverse training allows me to look at pain from many different angles. Physical Medicine and Rehabilitation training has taught me how to check the nerves, joints and muscles of the body. And in conjunction with my Osteopathic Medicine background, I employ a holistic approach to the body. In other words, by using a “hands on” approach, I can feel where muscle “tightness” or “spasm” may be the source of the problem. For example, knee pain can originate from an ankle, foot or low back problem; shoulder, elbow or hand pain can originate from a problem in the neck.
My very first step is to make certain that the problem is not stemming from a larger medical problem, such as cancer, brain or spinal cord injury, infection, immunity or hormonal imbalance.
Then with the “current standard of care,” I make a diagnosis and begin treatments which carry the smallest risks. These treatments may include a prescription or over-the-counter medicine, and almost always, a personally tailored home exercise program. I believe in manual therapy, such as Osteopathic Manual Therapy, but may send patients to Chiropractors for adjustments, Massage Therapists, Acupuncturists, and Physical and Occupational Therapists. Sometimes, a small brace or therapeutic pillow may provide additional relief.
If these initial steps do not begin to resolve the problem, additional tests and treatments may be considered. Some procedures I perform regularly are trigger point injections and simple joint injections. I leave the procedures that carry more risk, including surgery, to other physicians, but keep up-to-date on these procedures, so I’ll know when to refer patients to others for evaluation.
Chronic pain may not be curable, but may be tightly controlled. Like most diabetes and high blood pressure, chronic pain may not always be fully curable, but may be controlled or “tamed,” with only mild flare ups on rare occasions. This may become a realistic goal.
-Jeffrey H. Chester, DO
Why Choose a Physical Medicine and Rehabilitation physician?
Physical medicine and rehabilitation (PM&R) physicians or physiatrists (fizz ee at’trists) are specialists in diagnosing and treating problems of the musculoskeletal system. They take thorough histories and perform physical examinations to find the source of your pain, injury, or disability, even when standard diagnostic tests don’t reveal specific problems. If any other services are needed, such as those of a physical therapist or athletic trainer, the PM&R physician supervises, collaborates with, and coordinates them. The result is a specially designed treatment program for you.
Many PM&R physicians also study pain management, musculoskeletal rehabilitation, pediatrics rehabilitation, traumatic brain injury, spinal cord injury and sports medicine.
Diagnosis and Treatment Expertise
Because PM&R physicians offer an aggressive, non-surgical approach to pain and injury, these physicians are the ideal choice to a variety of diseases and conditions. Here’s a listing of just some of the areas that PM&R physicians have extensive training in diagnosing and treating:
- Low Back Pain
- Neck Pain
- Fibromyalgia/Myofascial Pain
- Spinal Cord Injury
- Electrodiagnostic Medicine/EMG
- Acute and Chronic Pain
- Musculoskeletal Disorders
- Stroke and Neurological Disorders
- Carpal Tunnel Syndrome
- Arthritis
- Pinched Nerves and Herniated Discs
- Osteoporosis
- Cardiac Disorders
- Brain Injury
- Sciatica
- Arthritis
- Carpal Tunnel Syndrome
- Edema /Swelling control
- Trigger Point Injections
- Hands-on manual therapy
Treatment Philosophy
PM&R physicians believe in treating the whole patient, not just the patient’s symptoms. They share their medical knowledge to help patients understand their condition and provide the tools and resources to manage it. They use a variety of treatment methods to reduce or eliminate problems and to decrease the possibility of recurrence. This comprehensive approach produces not only cost-effective results, but also a high degree of patient satisfaction.
♦ PM&R physicians add quality to the lives of millions of patients each year ♦
Electrodiagnostic Medicine/EMG information for patients
How do I prepare for the test?
- Continue all of your usual medicines. Bring your medicine list or bottles with you.
- Eat and drink normally. If you are diabetic or have “low blood sugar,” bring a snack.
- Wash with soap and water.
- Wear shorts, short sleeves and/or any clothing that will allow for easy access to most body areas, including your arms, legs, back and neck.
- DO NOT use skin lotions, skin creams, moisturizers, or sun block. It will interfere with the test.
- Feel free to bring a relative or friend with you.
Who performs the test?
Dr. Chester personally performs all of the testing, and interprets the results. He does not use a technician.
What is the test like and how long does it take?
- All testing is done in a private room while you are sitting or lying down.
- Most testing can be completed within one hour.
- Small breaks of 4 to 5 minutes are not usually required, but are possible during the test.
- There are usually two parts to the test:
- Nerve flow testing – a small amount of electrical current to “stimulate” the nerves.
- Muscle testing – a very thin needle into certain muscles to record nerve and muscle interaction.
What are the risks?
PROBLEMS ARE VERY RARE AND THE RISKS ARE VERY SMALL. A thin needle for the muscle testing is usually needed, so the risk of bleeding and infection is possible. If there are any other risks, Dr. Chester will tell you before he begins.
What do I do after the test?
You may go about your normal life after your appointment. Take all your medicines as prescribed. A detailed note regarding the test will be sent to your doctor. If you feel any discomfort, have any questions or concerns during normal business hours, please call our office at (808) 249-8887. If you are unable to reach us, and it is a medical emergency, dial 911.
What is Osteopathic Manual Medicine (OMM)?
Osteopathic Manual Medicine (OMM) is incorporated in the training and practice of osteopathic physicians. With OMM, osteopathic physicians use their hands to diagnose injury and illness, and to encourage your body’s natural tendency toward good health. By combining all other medical procedures with OMM, D.O.s offer their patients the most comprehensive care available in medicine today. OMM helps align the spine and relieve muscle spasms, resulting in more flexibility and less pain.
What to Ask Your Doctor Before Taking Opioids
Every patient should ask questions when getting a new prescription. This is especially important when your doctor, dentist or other health care professional prescribes you an opioid, such as hydrocodone, oxycodone, codeine and morphine.
What should you ask?
- Why do I need this medication — is it right for me? This conversation could begin like this: “My condition is causing pain. How long do you expect it to last? What medication are you giving me? If it’s an opioid, are there non-opioid options that could help with pain relief while I recover?”Opioids approved by the U.S. Food and Drug Administration (FDA) can be used to treat certain kinds of acute and chronic pain. They also can have some very serious side effects.
If your doctor thinks your pain is best managed with a prescription opioid, then ask:
- How long should I take this medication? Find out when and how to stop using, or taper off, opioids. Ask that your doctor prescribe the lowest dose and the smallest quantity you may need and find out when to call to follow up on how well it is working. Other questions to consider:How can I reduce the risk of potential side effects from this medication? Take your medicine exactly as prescribed by your health care provider. If you are still feeling pain, call your health care provider; do not take an extra dose. Learn to identify serious side effects (such as excessive sleepiness or a feeling of craving more of the medication) so you and your family will know when to call a doctor or go to the hospital. Ask your pharmacist if your prescription comes with a Medication Guide (paper handouts that come with many prescription medicines) for more information.
What if I have a history of addiction? Tell your health care provider about any history you have had with substance misuse or addiction to drugs or alcohol and if you have a history of smoking cigarettes. You should also tell your health care provider if anyone in your family has had a problem with substance misuse, alcoholism or drug addiction.
What about the other medications I’m taking? It is also very important that you tell your health care provider about all of the medicines you are taking, especially those prescribed to treat anxiety, sleeping problems, or seizure. Even medicines you take only occasionally could interact with the opioid pain medicine. Ask your health care provider about possible interactions.
How should I store my opioid medicine? If you have children at home — from a toddler to a teenager — consider a lockbox for your medications. Even one accidental dose of an opioid pain medicine meant for an adult can cause a fatal overdose in a child. Also, teenagers and others in the home or who are visiting may seek out opioid pain medicines for nonmedical use. They may look in bathroom medicine cabinets for a chance to steal these medicines.
What should I do with unused opioid medicine? Don’t store it in case you have more pain later. Your leftover opioids can be targeted by people who you’d never expect to take it: friends, relatives, and even your kids and their friends. If there is no drug take-back program near you, FDA has created a list of opioid pain medicines we recommend you flush down the toilet when they’re no longer needed. This way there can be no accidental exposures or mistakes in the home.
Can I share this medication with someone else? No. Your prescription is for you. Your doctor considers many factors when prescribing opioids. What’s safe for you might lead to an overdose for someone else.
- Can I have an Rx for naloxone? You should discuss with your doctor whether you should also receive a prescription for naloxone, a drug that can reverse the effects of an opioid overdose and could save lives. In many cases it makes sense to be prepared for potential problems by keeping naloxone in your home.Play it safe. It doesn’t matter who is writing the prescription, ask these questions before taking opioids.
This article appears on the FDA Consumer Updates website which features the latest on all FDA-regulated products. [updated: December 21, 2016 / Published: November 21, 2016]