BHW Behavioral Health Integration to Address the Opioid Crisis Peer Learning Team What Works? Evidence-Based Practices for Treating Opioid Use Disorder With the passage of time, health professionals are refining how they care for patients struggling with opioid use disorder (OUD) to achieve better clinical outcomes. Medication Assisted Treatment, for example, is shown to be more effective at treating OUD than medication or counseling alone. Dr. Daren Anderson, Director of the Weitzman Institute—a research and innovations center dedicated to transforming primary care for the underserved, especially connected to opioid use disorder—joined us to discuss the latest thinking on addressing OUD. Conversation highlights are below. How the Problem Started There are over 100 million people suffering from chronic pain and the majority of these seek treatment via their primary care provider instead of a specialty clinic, according to Dr. Anderson. While most providers would like to refer out these challenging patient cases to others, Dr. Anderson asserts Sources of Opioid Prescriptions* that patients with chronic pain must be managed in a primary care setting to effectively address the opioid epidemic. A number of factors contributed to dependence on opioids through prescriptions made by primary care providers (PCPs). These include: Most primary care providers lack training on how to support patients with chronic pain. “If you ask primary care providers, they often indicate a lack of confidence in how to treat chronic pain,” states Dr. Anderson. Many PCPs over-rely on prescribing opioids for chronic pain, which often goes beyond physical illness to include complex psychosocial and/or behavioral components. Opioids are often prescribed even when there isn’t a clear clinical indication they will be useful. Instead, a multidisciplinary team-based approach is needed when treating patients with chronic pain. Opioids are often prescribed to patients with untreated, unmanaged addiction illness. Prepared by Integrated Work June 2018

PCPs often treat pain but not addiction. Potential Solutions Opioids are also prescribed in increasingly higher doses for health challenges that are non-opioid responsive. Many patients continue rating their pain at a level 10 out of 10 even after receiving opioids. PCPs may ignore non-reassuring behaviors such as patients requesting additional medication. When medication is requested because a patient is “travelling” or “lost their prescription” among other reasons, this can indicate opioids aren’t being taken as prescribed. PCPs may devalue promising alternative treatments such as behavioral strategies, yoga, and chiropractic. PCPs often treat pain but not addiction. Potential Solutions Dr. Anderson asserts that with new technologies and approaches, positive movement can be made to educate PCPs, treat patients, and decrease the opioid epidemic. Webinars or one- off training sessions are insufficient in his opinion. The Weitzman Rural Pain and Opioid Practice Transformation Network, which Dr. Anderson directs, is focused on supporting PCPs and patients to decrease opioid use disorder through supportive tools and strategies. Participation in the Weitzman Rural Pain and Opioid Practice Transformation Network “the Network” helps increase PCPs’ skills and confidence to provide preventative care and utilize alternative pain management treatments with the ultimate goal of reducing opioid use disorder. The Network provides access to a number of tools to engage primary care medical and behavioral health providers caring for patient’s pain and/or opioid abuse in rural areas. Primary care practices joining the network gain access to the following resources: Weitzman ECHO® Pain and MAT is a web-based videoconference “virtual classroom” to support and educate primary care providers, enabling them to more effectively manage complex pain cases. Held twice-monthly, the live ECHO® sessions enable providers from across the country to present difficult patient cases and questions to a multidisciplinary team of pain specialists with expertise in anesthesiology, physical medicine and rehabilitation, behavioral health, pharmacy, acupuncture and traditional Chinese Medicine, among others. eConsults provides access to electronic consultations to pain and addiction specialists 24 hours a day, 7 days per week. 24/7 http://www.PainNET.net is an online Learning Community http://www.AddictionNET.net is an online Learning Community * Source: National Center for Health Statistics. Medication Therapy in Ambulatory Medical Care: United States, 2003-2004 Prepared by Integrated Work June 2018