There are tactical options that need to be employed to go a good way towards supporting the opioid crisis and getting through it. Ways to improve this dire situation were offered during the HealthStream webinar “The Evolution of the Opioid Crisis from Pain Management to Overdose.” Presenter Dr. Jill Warrington is the Chief Medical Officer at Aspenti Health and has been contributing to the field of laboratory research and medicine for 25 years. A graduate of Tufts Medical School of Medicine, Warrington obtained her Anatomic and Clinical Pathology Training at Duke University School of Medicine and joined the Larner School of Medicine at the University of Vermont in 2009, where she focused on substance use disorders. Warrington, who has served as a laboratory director at Burlington Labs Aspenti Health since 2011, offered these suggestions:
Must-Dos for Getting Through This Crisis
- Routinely screen all patients for substance use disorders. According to Warrington, “There’s a lot of screening tools there, and each has its advantage and disadvantage.” Some tools are intended to be self-administered by the patient, and others need support from a provider in terms of filling out the answers. In all cases, simply asking patients about substance use goes a long way towards early detection, prevention, and early diagnosis.
- Become waivered for buprenorphine. Warrington shares that “Medication-Assisted Treatment (MAT) is a cornerstone of opioid use disorder treatment, and an important step in helping patients towards recovery.” A wide range of individuals is eligible for becoming waivered, including physicians, nurse practitioners, physician assistants, clinical nurse specialists, and certified nurse midwives. Despite the broad eligibility, we know that very few people are in a state of capacity. Only 5% of eligible practitioners have actually obtained waivers, and of those waivered, only 13% are at capacity. Repeated studies demonstrate buprenorphine’s effectiveness in reducing the list of opioid use.
- Pursue harm reduction strategies. Many harm reduction strategies have been identified. Some of them are to prevent opioid related overdoses with naloxone, to promote access to sterile injection equipment, and to consider the value of sentinel testing strips to empower patients in testing their own drugs prior to use. These and many others have a common goal--to prevent the worst possible outcomes for people who are using.
- Get educated and empower others. Warrington recommends that healthcare professionals “empower your patients and your family with your knowledge.” This involves being as informed as possible about the crisis and sharing any relevant information with your organizations and teams. The early stages of the opioid crisis can be characterized as a failure of education. For example, as of 2012 only 0.1% of MDs were trained in addiction and less than 2% of board topics covered substance use disorders. According to Warrington, “The Association of American Medical Colleges recently acknowledged we still have a long way to go, but they’re optimistic about new and better solutions that they feel are starting to be employed in this national epidemic.”
- Adopt an organized nationwide approach to managing substance abuse to get through the crisis. New Joint Commission standards advocate for each organization to have leadership or governance over substance use management at the highest organizational level. Warrington reminded listeners that “Substance use, in particular opioid use disorder, can have a wide variety of touches within a healthcare system.” Because abuse can show up anywhere across a healthcare provider’s many departments and operations, an organization-wide, holistic approach is imperative.
- A population health approach is imperative. Warrington describes healthcare professionals as “immersed in the opioid crisis, and accustomed to think in terms of triage and being reactive.” She wants healthcare organizations to get above that crisis state and be proactive, thinking about risk stratification of our patients, establishing key performance indicators of what constitutes success, and reorienting to focus on outcomes. Countless studies have affirmed the value of moving care to cross-disciplinary coordination and a collaborative care model through integrated teams.
Access the full webinar: The Evolution of the Opioid Crisis from Pain Management to Overdose.