Philadelphia Medicine Fall 2020 - 26

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feature

Innovative Management
within Reach for
Opioid Use Disorder
I
By Catherine Abrams

f someone told you that you had the power to decrease the number
of fatalities during an epidemic, prevent the transmission of
HIV and hepatitis C virus, reduce criminal activity and lighten
the strain on community resources, would you want to hear more?

Treatment of opioid use disorder (OUD) with evidence-based
medications can achieve these goals and impact the lives of the tens of
thousands of Philadelphians estimated to have OUD by preventing
overdoses, reducing drug-related comorbidities and supporting patients'
stability and recovery. The Health Federation of Philadelphia (HFP),
in partnership with the Philadelphia Department of Public Health
(PDPH), is offering free, high quality accredited continuing medical
education to help local providers be prepared to help these patients.
Unlike treatment with methadone, which can only be prescribed
for OUD within a strictly regulated Opioid Treatment Program
(OTP), buprenorphine is ideal for incorporation into primary care
practices. More than 50 community health centers in Philadelphia
have at least one provider who prescribes buprenorphine. This is
a great start, but more providers are needed to treat OUD using
the chronic disease management model and offer treatment with
buprenorphine in primary care settings.
Providers are required to obtain a waiver from the Substance
Abuse and Mental Health Services Administration (SAMHSA) before
they can prescribe buprenorphine as mandated by the DATA 2000
Treatment Act. This is obtained by taking an 8-hour waiver training
and completing the SAMHSA Waiver Notification of Intent form
(NOI). Nurse Practitioners and Physician Assistants must take an
additional 16 hours, totaling 24 hours of training, before they are
eligible to apply.

HFP engages local expert faculty who work in Philadelphia's
academic affiliated practices and community health centers to teach
the waiver and MOUD Preceptor training. As MOUD champions
who have pioneered their site's MOUD treatment models and
workflows, they intimately understand the challenges with launching
such a program and have practical guidance for overcoming them.
Content of this full day live program (offered online during the
COVID-19 pandemic) includes harm reduction, dosing to address
fentanyl dependence or high tolerance to opioid medications, working
with challenging behaviors, the use of motivational interviewing
techniques to facilitate conversations about substance use, treating
pain, and the use of urine drug screen results to enhance treatment
rather than alienate patients.

Additional local and national support is available to providers
prescribing buprenorphine. Locally, HFP hosts monthly online
MOUD Provider Collaborative meetings for graduates of the MOUD
Preceptor Program to discuss cases (de-identified), treatment issues,
local trends and successes. National resources include the Providers
Clinical Support System (www.pcssnow.org), which offers on-demand
training videos on a variety of topics, frequent live webinars and
mentorship opportunities. The UCSF Substance Use Warmline
(https://nccc.ucsf.edu/clinical-resources/substance-use-resources/)
is an on-demand call center staffed during business hours by
experienced pharmacists and physicians who can answer questions
related to MOUD.
In addition to obtaining a waiver and prescribing buprenorphine,
there are actions physicians can take right now to help address our
city's drug crisis. This includes screening and identifying patients
with substance use disorders and referring them to treatment. Naloxone can and should be prescribed to all patients who are at risk
for overdose, including those being prescribed prescription opioids.

Based on HPF's extensive experience with health professional
education in areas of trauma-informed care, integration of behavioral
health in community health center settings, as well as HIV and other
HFP invites all providers to take the buprenorphine waiver training
infectious diseases, PDPH enlisted HFP to offer live, interactive
and
encourages PCPs to attend the MOUD Preceptor Program to
web-based waiver trainings and a follow up preceptorship program
get
more
in-depth training. Training dates and more information
specifically designed to support integration of buprenorphine into
about
the
Primary Care Buprenorphine Waiver program is located
primary care settings. This Medication for Opioid Use Disorder
at
our
website:
(MOUD) Preceptorship program addresses the most common
concerns and barriers cited as reasons why some newly waivered https://healthfederation.org/training/opioid-epidemic-responseproviders feel hesitant to prescribe buprenorphine such as stigma, training. *
patient flow issues, time constraints, prior authorization challenges, Catherine Abrams is the Opioid Response Program Coordinator at the
worries about being inundated with patients with OUD and fears Health Federation of Philadelphia, www.healthfederation.org.
of patients misusing medication.
26 Philadelphia Medicine : Fall 2020


https://philamedsoc.org/ http://www.pcssnow.org http://www.healthfederation.org

Philadelphia Medicine Fall 2020

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