Pic 0: A title card appears before transitioning to a close-up of Dr. Owens. After a moment, text appears next to her which reads “Continue seeing them” and “Focus on well-being and safety.”
Dr. Owens: Thanks for accompanying Dr. Pasko in working with Lori to address her opioid use! In real life, some patients might not be as ready to change. Don't get frustrated if it takes several visits before a patient is ready to discuss treatment, or even believe that you want to help them. The most important thing is to continue seeing them and focus on their well-being and safety.
Even with the aid of pharmacology, many people recovering from opioid use disorder experience relapses. It's a difficult but common part of the recovery process.
Pic 1: The text is replaced by new text which reads “Harm Reduction Steps” with an icon of a red heart with a white cross within it next to the text.
Taking certain harm reduction steps can greatly increase your patients' chances of survival during a relapse or before beginning treatment.
Pic 2: New text appears underneath with a bullet point which reads “Prescribe naloxone.”
Most importantly, always prescribe naloxone to patients with OUD. Naloxone can be administered by a patient's family and friends, or first responders, to rapidly reverse the effects of opioids. This prevents respiratory distress in case of accidental overdose.
Pic 3: A new bullet point appears above the previous which reads “Warn patients about mixing drugs.”
Warn patients about mixing drugs. 65% of deaths from heroin overdose and 77% of deaths from pain reliever overdose also involve alcohol or another medication, often benzodiazapines. Let your patients know these risks, and that, while you don't recommend it, if they do mix drugs, they should use a smaller amount of each one.
Pic 4: Another bullet point appears above the previous which reads “Discuss how they administer opioids.”
Discuss with your patients how they administer opioids. Patients who inject opioids may be at risk for vein damage, bacterial infections, or viruses like HIV and hepatitis C. Encourage patients who inject drugs to use resources for new syringes and equipment.
Pic 5: Another bullet point appears which reads “Encourage patients not to use alone.”
Encourage patients not to use opioids alone. To reduce the risk of death during an overdose, patients should make sure that a friend or family member is nearby who can administer naloxone.
Pic 6: This bullet point reads “Stay involved.”
And lastly, stay involved. Patients may feel ashamed to tell you if they start using again. Help them see they can trust you even during setbacks.
Remember that continued opioid use can be a sign that their treatment dose is too low, or that they need more counseling, behavioral health, or case management support. Some patients may benefit from the additional structure and daily monitoring in an Opioid Treatment Program, but a return to opioid use does not in itself indicate this need.
Pic 7: The previous text fades and new text appears in blue which reads “Community Support,” accompanied by a small blue circle with three white figures inside.
Many patients with OUD experience better recovery outcomes when they receive community and psychosocial support. Yet, there are often far fewer counselors and support services than patients, especially in rural areas. And it can be difficult to cover the costs of these services.
Pic 8: The screen transitions to a map of America with text which reads “Over 23 million Americans needed treatment for drugs or alcohol in 2012, but only 2.5 million people received aid at a specialty facility. (NSDUH 2009, TEDS 1998 to 2008).”
Pic 9: The screen returns to Dr. Owens.
This is why it's so important to be able to offer patients pharmacology for OUD. Medications keep patients stable while they do the hard work of changing their behavior and rebuilding their lives. And the support they get from you can make a difference! Research found that patients who received standard medical management during medication monitoring visits had similar outcomes to patients who also saw a substance abuse or mental health counselor.
So, as a primary care provider, the best thing you can do is to have multiple options available to treat patients with OUD. One of the most important is buprenorphine.
Pic 10: Text appears next to Dr. Owens that reads “Getting Waivered.” After a second, the following bullet points appear: “8 hours for physicians,” “24 hours for NPs and Pas.”
To get a DATA-2000 waiver to prescribe buprenorphine, you must complete training: 8 hours for physicians, 24 hours for Nurse Practitioners and PAs, and then apply online.
Pic 11: The text disappears and is replaced by new text which reads “Resources.”
Waiver applications are reviewed by the DEA and SAMHSA within 45 days of receipt. For more information or the links to the application and training sites, please check your Resources section.
Pic 12: The screen transitions to one with the following text:
For more information contact the SAMHSA Center for Substance Abuse Treatment’s Buprenorphine Information Center.
(next to an image of a phone) 866-BUP-CSAT (866-287-2728)
(next to an image of a piece of mail) [email protected]
Pic 13: The screen returns to Dr. Owens.
Getting a waiver gives you a powerful tool to offer patients, a treatment far more effective than we had in the past. By offering pharmacology to patients who are struggling with opioid use, you can halve their chances of dying of an overdose. This epidemic is killing tens of thousands of Americans every year. Let's all do our part to stop it.