According to state-by-state cause-of-death data, more people are dying of drug overdoses than died of AIDS at the height of the AIDS epidemic.
Stigma and misperceptions can make it hard for patients to seek help from their doctors. While many people may think of heroin when they hear about opioids, 75% of heroin users actually start with prescription pain relievers.
Healthcare professionals can have an impact on the opioid crisis by identifying opioid use disorder (OUD), understanding pharmacotherapy treatment options, and discussing this issue with patients they are concerned about.
Where Medical Training Can Make a Difference
Anyone who uses opioids regularly, including people who use them as prescribed over longer periods of time, will develop tolerance. Any change in behavior due to opioid cravings is an important sign that a patient is developing opioid use disorder. The DSM-V defines opioid use disorder as “a problematic pattern of opioid use leading to clinically significant impairment or distress.”
With the fast rise in the urgency of addressing the opioid epidemic, there has been a lag in proper training of medical professionals to address opioid use disorder, treatment, and discussing these issues with patients. Healthcare organizations need effective opioid use disorder training so that more medical professionals are ready to meet the needs of their patients.
According to a 2013 piece published in the Journal of the American Medical Association:
A recent report highlighted that most individuals with addiction in the United States do not receive any treatment from a physician. Rather, much as in Canada, US addiction care is often provided by unskilled laypersons—that is, individuals without the mental health or medical training required to effectively deliver evidence-based interventions.
The report’s toughest criticism is saved for the medical community, stating that “most medical professionals who should be providing addiction treatment are not sufficiently trained to diagnose or treat it.” Research by this same group has also reported that 94% of US physicians “failed to include substance abuse among the five diagnoses they offered” when presented with symptoms of alcohol abuse.
Calling the lack of physician training a “monumental lost opportunity,” the report describes a “failure of the medical profession at every level—in medical school, residency training, continuing education and in practice—to confront the nation’s number one disease.”
Therefore, healthcare organizations have a public health obligation and opportunity to:
- Increase the number of prescribers who are comfortable talking to patients about opioid use disorder diagnosis and using shared decision-making to select an appropriate pharmacotherapy for opioid use disorder.
- Increase the number of clinicians (primary care physicians, nurse practitioners, physician assistants) who become DATA-2000 waivered prescribers, and
- Focus on pharmacotherapy
Pharmacotherapy for Opioid Use Disorder
When a person’s brain adjusts to expect an increased amount of opioids in their system, that can lead to withdrawal if they stop using. Opioid withdrawal symptoms can be managed medically — also called “detox” or “rehab.” However, just going through withdrawal doesn’t treat the underlying opioid use disorder. Fortunately, there are effective therapies that can reduce the risk of overdose and support recovery.
Along with behavioral counseling, the medical community can use medications specifically tailored to opioid receptors (methadone, buprenorphine, and naltrexone) to help patients manage opioid use disorder with far less danger of relapse and overdose. These types of combined therapies are known as pharmacotherapy for opioid use disorder.
The goal of pharmacotherapy is to use safe and effective medication along with counseling and behavioral supports to mitigate the symptoms of opioid use disorder and allow patients the best chance at recovery. According to AHRQ, the Agency for Healthcare Research and Quality, “practices should encourage and support physicians, physician’s assistants (PAs), and nurse practitioners (NPs) to take the required training and apply for waivers to prescribe buprenorphine.”
Talking with Patients About Opioid Use Disorder
With a recovery focus, managing opioid use disorder is similar to managing any other chronic condition. Every physician has practice motivating patients to take medications and change their behavior to support their health. Showing patients respect, eliciting their experiences, and approaching them with empathy can help increase motivation for change.
A common challenge for providers is covering information and next steps with patients in the short amount of time allotted for a visit or appointment. In most scenarios physicians will be evaluating a patient for opioid use disorder, building motivation to reduce opioid use, and collaborating with their patient to decide on a treatment plan and immediate next steps. With practice utilizing certain communication techniques, the process having a conversation on reducing opioid use, collaborating on a treatment plan, and discussing next steps can become more natural.
How can clinicians practice these skills and become versed with opioid use disorder training?
Opioid Use Disorder Training Through Medical Simulation
That’s where Kognito’s simulation technology comes in. Our new simulation Talk About Opioid Use Disorder targets primary care clinicians in a 30-minute interactive experience.
Talk about Opioid Use Disorder is a simulation to learn techniques for discussing substance use and practicing them with a virtual patient. In this conversation, the learner plays the role of a primary care provider and talks with Lori, a patient who has been on oxycodone for two years. The prescription drug monitoring program, PDMP, recently showed that Lori has received prescriptions from two other doctors. The learner’s goal is to discuss opioid use and pharmacotherapy with Lori and collaborate on a plan to address her use.
To navigate the conversation, learners practice communication techniques that motivate Lori by
- Showing her respect,
- Eliciting her experiences,
- and approaching her with empathy.
The simulation also contains information on opioid use disorder. Learners who complete the training should be more confident and better able to:
- Recognize people with opioid use disorder as patients in need of help.
- Reject outdated and moralistic beliefs about “addicts” and “addiction.”
- Understand the medications available to treat opioid use disorder and their effectiveness.
- Use shared decision making and motivational approaches to help people with opioid use disorder engage in healthier behavior and begin recovery through treatment.
- Seek a DATA-2000 waiver and/or use buprenorphine to treat patients in an office setting.
Upon completion of the simulation, learners can earn .75 CME and CNE credits.
More information on this simulation will soon be available on the Kognito website. In the meantime, contact us at firstname.lastname@example.org for demo access and pricing information.
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