Based on HealthTechS3’s webinar dated February 21 hosted by Faith Jones, MSN, RN, NEA-BC and featuring guest speaker, Rebecca Morgan, PHR, SHRM-CP on the topic of Opioid Use Disorder, we understand there are many life-threatening statistics around this disorder, including but not limited to:
- Every day >130 Americans die after overdosing on opioids
- >4M Americans report the use of pain medications for non-medical reasons
- 80% of the world’s opioids are prescribed in the US
To be highly simplistic, the way to end the opioid overdose epidemic is to:
- Stop making new users
- Expand access to treatment for existing users
- Keep existing users alive using harm reduction strategies
The epidemic is continuing to grow. In 2013, 22.7 million people needed substance abuse treatment but only 2.5 million received it (roughly 9%). Of those who needed it, 35% made an effort to find treatment but were unable to obtain it. There are certain providers who feel an answer is to stop prescribing opioids but analytics indicate patients will only supplant the opioids with other more easily available drugs, such as heroin. According to the National Institute on Drug Abuse, ~4-6% who misuse prescription opioids transition to heroin and ~80% who use heroin first misused prescription opioids.
Opioid Use Disorder (OUD), like every complex diagnosis, requires a multi-pronged approach to care. First, we must have greater access to diagnostic services. There is a misconception that if a patient relapses, they should not be allowed access to treatment. That is NOT the case. We would not tell a diabetes patient if they ate a piece of cake they are disqualified from receiving an insulin pump. In April/May 2017, the Department of Health and Human Services (HHS) sent letters to the governors of all 50 states announcing $485M in grants for their evidence-based prevention and treatment activities. These state-based grants are funded by the 21st Century Cures Act and distributed through the Substance Abuse and Mental Health Services Administration. This was an important step in providing access to care.
Next, as fellow Americans, we must change the way we think about addiction. Johann Hari has an excellent Ted Talk on what he learned in 30K miles of travels and visits with addiction “experts”, including a transgender crack dealer in Brooklyn to a scientist who feeds hallucinogens to mongooses to see how they respond. He did this with the intent to help him figure out how to cope with several of his family members who have addictions. What he believes is that the opposite of addiction is not sobriety, it is connection and bonds with people and life.
Lastly, we must be able to provide Medication Assisted Treatment (MAT). This is a safe alternative and helps a patient curb cravings and withdrawal symptoms. Ms. Jordan introduces us to a training program, IT MATTTRs. This multi-faceted training program is to build primary care and behavioral care practices’ capacity to treat OUD. The program initiated in Colorado supported by:
- High Plains Research Network
- State Network of Colorado Ambulatory Practices and Partners
- University of Colorado Department of Family Medicine
- Agency for Healthcare Research and Quality
Some of the training components include but are not limited to:
- Diagnosing OUD in primary care practices
- Referring OUD patients for behavioral health services
- Engaging appropriate patients in MAT
- Prescribing buprenorphine by primary care physicians
- Monitoring patients in a MAT program
Additional resources available to a care team through the IT MATTTRs program includes:
- Patient consent form and contract for buprenorphine treatment
- Payment schedule with diagnostic billing codes
- Diversion control plan templates
- Urine drug testing protocol and system templates
- MAT resource/drug protocol book
- EHR documentation templates
Other similar trainings may exist. As care providers, we must seek these out to cure this epidemic that is costing us billions of dollars each year. Opioids are ubiquitous drugs with important biologic impact but they, unfortunately, also cause physical dependence and addiction. Strong evidence supports that MAT – either with agonists (methadone, buprenorphine) or antagonists (naloxone) aid in addiction release. Primary care providers and behavioral health specialists will play a crucial role in bringing these scarce treatments to all who need them.
For more, information on this training or OUD, please contact Faith Jones at firstname.lastname@example.org.