How can PCPs properly manage patients with opioid use disorder?

January 26, 2022

5 minute read


Source: Healio Interview

Disclosures: Lu does not report any relevant financial information.

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A new medical training program in an area hard hit by the opioid epidemic will help fill a gap in addiction management training, according to a news release.

The CDC estimates that there were more than 101,000 projected overdose deaths in the United States — many of them related to opioid use — in the 12 months ending June 2021.

“We need better training in addiction medicine at all levels,” Tiffany Lu, MD, MS, assistant professor of medicine in the division of general internal medicine at Montefiore Medical Center and the Albert Einstein College of Medicine in New York and director of the Montefiore Buprenorphine Treatment Network, said in the press release.

The medical education program is funded by a 3-year, $447,000 grant from the Substance Abuse and Mental Health Services Administration. It will expand addiction medicine education and training programs for Albert Einstein College of Medicine medical students and Montefiore Health System residents. Healio spoke with Lu to learn more about the program, what doctors can do to help curb the opioid epidemic and more.

Helio: What does the study programme train?

Read: This longitudinal addiction medicine program involves extending education to both the medical school at the Albert Einstein College of Medicine and the residency training programs at the Montefiore Health System.

For medical students, we will introduce preclinical and clinical training on addressing addiction stigma, providing drugs for addiction treatment, offering overdose prevention counseling and facilitating a safe management of opioids.

For internal medicine residents, a 2-week clinical rotation including inpatient and outpatient training in addiction medicine is now required. This clinical rotation is also available as an elective for family medicine and other medical residents.

For medical students and medical residents (internal medicine, family medicine, and psychiatry), an 8-hour buprenorphine training that incorporates clinical expertise from faculty on delivering patient care in our Bronx communities will be offered and required.

Helio: Most new doctors have never been formally trained in addiction management. How to properly manage dependency?

Read: First and foremost, physicians must approach addiction as a chronic disease that deserves care across the continuum of healthcare settings with a patient-centered, non-judgmental approach, just as they would approach other illnesses. chronic conditions such as diabetes and hypertension.

Second, physicians must also become familiar with clinical tools to properly assess and diagnose substance use disorders and help patients navigate community resources for the treatment of substance use disorders. Physicians should also be aware of effective medications and psychosocial treatment options for substance use disorders, including methadone, buprenorphine, and naltrexone.

Third, drug use is part of our society, so it is important for doctors to understand that people who use drugs have different goals and are ready to stop using drugs. Being able to discuss with our patients practical strategies to reduce the harms associated with drug use, including naloxone for overdose prevention, safer injection practices, and prevention of HIV and viral hepatitis, will help physicians meet patients where they are.

Helio: What should primary care physicians know about pharmacological treatments for opioid use disorders? When should they be prescribed?

Read: All PCPs should benefit from our ability to prescribe effective drug treatment for opioid use disorder, or OUD, especially buprenorphine. Buprenorphine is a well-studied partial opioid agonist drug that can be prescribed in a variety of medical settings, including primary care, and may help people with TOU reduce their risk of death from overdose, improve their engagement in the treatment of TOU, reduce or discontinue opioid use and improve psychosocial functioning. It can be prescribed by any PCP who requests a [Drug Enforcement Agency] waiver — the 8-hour training is no longer required to obtain a basic prescription waiver. Patients can successfully initiate and continue buprenorphine treatment through their team of primary care providers, with life-changing results.

Helio: How can doctors reduce the stigma associated with treating opioid use disorder?

Read: We can start by proposing it. For too long, physicians have had a habit of avoiding talking to patients about substance use and simply referring patients to specialized programs. However, these programs may not be accessible, affordable, feasible or desirable. When we have physicians who confine addiction care to specialized settings, we send a message to patients that their addiction needs are not part of their medical and psychosocial care needs. Learning to integrate drug treatment assessments and counseling into our practices is an important way to reduce stigma.

In learning to assess and counsel patients on addiction treatment options, physicians must also practice person-centered language and lessen the stigma that has long been associated with the use of outdated terms such as “abuse.” , “abuser” and “drug addict”.

Helio: What harm reduction and overdose prevention strategies do you recommend for use in a primary care setting?

Read: First and foremost, primary care teams need to be aware that we are in the midst of an overdose crisis that is largely caused by the widespread contamination of the street drug supply with synthetic opioids like fentanyl. Effective overdose prevention strategies include prescribing naloxone to any patient (or family member or friend of someone who uses drugs), particularly if they use heroin or drugs. other opioids. Additionally, discussing ways to reduce the risk of overdose — such as going slowly and testing doses before use, not using alone, and not mixing with alcohol or other substances that can cause excessive sedation — can and should be done in primary care settings.

In addition, PCPs can help injecting drug users access evidence-based harm reduction services by referring patients to community-based needle service programs and facilitating hepatitis testing and treatment. viral, HIV and sexually transmitted infections. At this point, people who use drugs can be successfully treated for their viral hepatitis and HIV, reducing harm both at the individual level and at the public health level. General practitioners are prepared to treat hepatitis C and HIV through a chronic care approach.

Helio: When a PCP refer patients with opioid use disorders to an addiction specialist?

Read: Referral to an addiction specialist depends on the complexity of the patient and the comfort of the PCP. When patients are not meeting treatment goals in primary care, which may be due to co-occurring substance use disorders or psychiatric diagnoses, then they may benefit from assessment by local specialists substance abuse or specialized addiction programs.

PCPs can also benefit from joining mentoring networks with addiction specialists, which can be done through local provider support systems or national platforms such as [Providers Clinical Support System] or Project ECHO.

Helio: How do you plan to share your program with other health systems?

Read: We will compile educational tools, resources and assessment results throughout the implementation of our project. We will share this locally with medical schools and hospital systems in the greater New York area, and we will use local, national, and regional conferences and peer-reviewed journals to share the program.

The references

Albert Einstein College of Medicine and Montefiore Health System receive federal grant to expand education and training in addiction medicine. Published December 16, 2021. Accessed January 5, 2022.

Jamison RN, et al. Opioid management. 2014 ; doi:10.5055/jom.2014.0234.

Jamison RN, et al. Medical Pain. 2016. doi: 10.1111/pme.12871.

Statement from Dr. Rahul Gupta on current CDC data on overdose deaths. Published January 12, 2022. Accessed January 19, 2022.

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