By Dr. Ed Cladera, M.D. and Medical Director of AristaMD
Featured in Becker’s Hospital Review, published March 14, 2019
Through telehealth solutions like virtual doctor consultations, PCPs now have timely access to addiction medicine specialists who can help reduce the risk of addiction, identify an addiction, and effectively manage patients with addiction, overall reducing the potential for opioid abuse and reducing morbidity and mortality.
The United States is amidst a crisis in population health related to opioid dependence and abuse. The Centers for Disease Control and Prevention (CDC) estimates the total “economic burden” of prescription opioid misuse alone in the US to be $78.5 billion a year. This includes multiple factors such as healthcare costs, lost productivity, addiction treatment, and criminal justice system involvement.
According to the CDC:
- As many as 1 in 5 people receive prescription opioids long-term for non-cancer pain in primary care settings.
- Opioid prescribing in the US has tripled since 1999.
- Every day, more than 1,000 people are treated in emergency departments for misuse of prescription opioids.
- More than 40% of all US opioid overdose deaths in 2016 involved a prescription opioid.
- The US makes up 5% of the global population and consumes approximately 80% of global prescription opioid drugs.
Primary Care Providers (PCPs) play a significant role in the identification of opioid abuse, management of opioid dependence, and proper opioid prescribing. A New England Journal of Medicine article suggests that longer duration and better coordination of treatment can be achieved by supporting clinicians’ training and the use of various treatment philosophies.
Prescribers need advanced certification and training to prescribe methadone and buprenorphine for addiction treatment. However, PCPs often do not receive support or resources to build confidence in managing the psychosocial complexities of patients with opioid use disorder. The American Medical Association (AMA), the largest physician association, agrees with increased training for medication-assisted treatment of opioid use disorder but disagrees with mandatory training—stating that such training may not be relevant for all primary care physicians.
“Primary care providers are the most likely to have contact with patients who are struggling with substances, yet we have traditionally avoided that responsibility,” says Miriam Komaromy, MD, board-certified in both addiction and internal medicine and serving as associate director of the University of New Mexico’s Project ECHO, a learning approach for training primary care providers on how to offer addiction treatment.
PCPs face many barriers to accessing the guidance they need for their patients. Virtual doctor consultations, or eConsults, can help provide that guidance. According to Beth Tanzman, executive director of Vermont’s Blueprint for Health, which leads a hub-and-spoke framework to expand access to opioid expertise, “Doctors said we don’t have access to higher levels of care when we need to refer patients. We don’t have anyone we can call to consult as we would for treating other chronic conditions, and we don’t have the staff to provide team-based care.”
However, through AristaMD’s eConsult platform, PCPs now have timely access to addiction medicine specialists who can help reduce the risk of addiction, identify addiction and effectively manage patients with addiction, overall reducing the potential for opioid abuse and reducing morbidity and mortality. This is of particular significance given that the government’s annual mortality report found life expectancy in the US, for the first time in decades, has declined due to early deaths caused by prescription opioid overdose.
PCPs also receive guidance from AristaMD’s pain medicine specialists to help select non-opioid alternatives, learn about more effective opioid pain regimens, and develop strategies to taper/wean patients off opioids while avoiding severe withdrawal symptoms. With support, PCPs can better reduce the risk of opioid dependence and improve patients’ quality of life—this is especially important for patients with chronic pain. Patients with chronic pain who are prescribed opioids misuse the medication approximately 21-29% of the time, while another 8-9% develop an opioid use disorder and an estimated 4-6% transition to heroin.
PCPs have a professional responsibility and a significant impact in tackling the prescription opioid epidemic and can play an essential role in the solution. To do so, they must be supported with tools and resources to manage patients consistently—AristaMD can help! In addition to providing physicians rapid access to pain and addiction medicine specialists, AristaMD raises awareness in the identification, treatment, and management of opioid use disorder through educational webinars, evidence-based content newsletters, and high-yielding blog posts readily accessible to busy clinicians.