5 minute read
Improving Services to Patients Experiencing Addiction Jerri Davis
By Jerri Davis CHCP Vice President of Education and Professional Development
We all know the pandemic has made the drug overdose epidemic even worse, especially in areas like San Francisco where by May 2020, three times as many people lost their lives due to drug overdose than from COVID-19. As California has seen rising rates of social inequities, homelessness, mental illness, and despair, the state also has seen an increase in opioid abuse, addiction, and overdose deaths, especially among those most marginalized in our society. This spring, powerful synthetic opioids such as fentanyl caused California’s 12-month all-drug overdose death rate to spike nearly 27%, significantly faster than the national average.
And it is not just opioids. An alarming increase in deaths involving the stimulant drugs methamphetamine and cocaine make it clear we face a complex and ever-evolving addiction and overdose crisis characterized by shifting use and availability of different substances and use of multiple drugs (and drug classes) together.
CAFP leads effort to improve services to patients experiencing Addiction in California
CAFP and CAFP Foundation received a grant from the CA Dept of Healthcare Services in October 2019 to convene our second California Residency Program Collaborative (CRPC) to improve education, outreach, and treatment for patients with substance use
California continues to lack the resources needed to treat the nearly 686,900 people suffering from opioid addiction.
disorder disease, including stimulant and opioid use disorder, with a focus on increasing capacity for effective Medication Assisted Treatment (MAT) implementation.
CRPC is designed using the Institute for Healthcare Improvement’s Breakthrough Series Collaborative model. This means the grantees will work individually on their own projects and collaboratively as a learning unit. The model encourages sharing of ideas, wins, barriers, strategies, tools, and resources. The project also supports extensive practice/program transformation support, including quality improvement (QI) education, coaching, resources, and tools to help implement change. The overall transformation process provides a structure for awardees as they work through implementation of their projects. The collaborative framework of the overall project promotes sharing among residencies even as specific implementation and challenges vary.
CAFP worked with other primary care specialty organizations to convene an Expert Advisory Panel that includes physicians specializing in Family Medicine, Emergency Medicine, Internal Medicine, and Pediatrics to help with the program. This panel had the difficult task of choosing the final 16 residency programs selected for awards. There were 34 applicants, and the final grantees include Family Medicine, Emergency Medicine, Pediatrics, Ob-Gyn, and Psychiatry Residencies. They were notified this spring and selected for their innovative local projects aimed at improving care for patients with opioid and substance use disorders, including stimulants.
In addition to their projects that range from adding or expanding street medicine outreach, increasing harm reduction efforts, and forging productive collaborations with community partners to developing inpatient MAT consult services, most of the grantees continue to encourage as many providers in their programs as possible to get training and education to begin offering MAT, especially
“While I was hesitant to start providing MAT, I realized my patients would be worse off had I done nothing. Once I started treating them, I quickly realized that my patients receiving MAT were the most grateful patients I ever had walk in my clinic. There are few experiences more rewarding than making a real difference in a patient's life.” – California MAT Provider
now that HHS has issued new practice guidelines removing the 8 hour X-waiver training requirement to treat patients with buprenorphine [https://bit.ly/xwaiverruling]. This guideline change was announced days after a report showing that fatal overdoses have skyrocketed to record highs during the COVID-19 pandemic.
CAFP has worked with expert faculty to offer a wide variety of education that is available to everyone through CAFP’s education portal Homeroom [education. familydocs.org] and we encourage you to take a look. Accredited CME sessions range from 20-minute activities on addiction as a brain disease and screening tips for SUD to longer activities on communication strategies around SUD, Pregnancy and SUD, Telehealth for SUD and Evidence for Treating Stimulant Use Disorder, to name a few.
In addition, we are fortunate in California to have access to so many terrific resources that support efforts to improve services to patients with SUD like the CA MAT Expansion Project [www.californiamat.org] consisting of a variety of programs – including the CA Substance Use Line (844-326-2626) offering free, expert, confidential 24/7 teleconsultation for substance use evaluation and management. Another terrific resource is CABridge.org providing a wide variety of practical tools, training, and support to increase the number of clinicians providing addiction treatment. Finally, links to the tools and resources being offered to the Collaborative are available on the CRPC website [ https://www.familydocs.org/crpc/ ] including AAFP’s EveryONE project and more.
We hope you are inspired by these residents and faculty that have taken on these projects to improve and expand the services they provide individuals suffering with substance use disorder.
In addition to a lack of providers offering addiction treatment, stigma has been identified as a barrier preventing broader access to life-saving medications for Substance Use Disorder (SUD). Because clinicians are typically the first points of contact for a person with an SUD, health professionals can reduce the potential for stigma and negative bias by learning the terms to avoid and use. The National Institute on Drug Abuse (NIDA) offers “Words Matter,” a handout with tips for providers to keep in mind while using person-first language, as well as terms to avoid to reduce stigma and negative bias when discussing addiction.
The medical evidence is clear: access to medication-assisted treatment (MAT), including buprenorphine that can be prescribed in office-based settings, is the gold standard for treating individuals suffering from opioid use disorder.
HOMEROOM ACTIVITIES:
• Screening and Identifying Opioid
Use and Substance Use Disorder • Medication Assisted Treatment (MAT) and its Utility to Treating OUD • Pregnancy and Women's SUD • Communication Matters:
Motivational Interviewing and
Substance Use Disorders • Medication Assisted Treatments (MAT) for Opiates, But What About
Stimulants? • Telehealth for Substance Use • Is Addiction a Brain Disease? • The Role of Abstinence in OUD
Treatment • Opioid and Substance Use Disorders in Special Populations: Youth and
Young Adult Athletes • Treating SUD - Linking with
Community Services • Incorporating MAT into Practice - A
Community Conversation
Visit Homeroom online at education.familydocs.org
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