Cut Opioid Relapse Rates with Evidence-Based Meds
Executive Brief
- The News: Opioid overdose deaths from fentanyl increased 100-fold since 1999
- Clinical Win: X-Waiver certified PCPs prescribed more OUD medications after training
- Target Specialty: Primary care providers treating patients with opioid use disorder
Key Data at a Glance
Condition: Opioid use disorder (OUD)
Treatment: Buprenorphine, methadone, naltrexone
Barriers to treatment: Lack of provider training, patient stigma
Provider certification: X-Waiver certified
Key recommendation: Embedding substance use disorders clinics within primary care
Result of clinic implementation: Largest increase in medication for OUD
Cut Opioid Relapse Rates with Evidence-Based Meds
The U.S. is in the midst of an opioid epidemic; overdose deaths from synthetic opioids such as fentanyl have increased more than 100-fold since 1999. Medications like buprenorphine, methadone and naltrexone can all help treat opioid use disorder (OUD), curbing relapse, overdoses and death. But many barriers exist to people with OUD getting these medications, from providers not receiving adequate training to people with OUD feeling too stigmatized to find a specialist.
"All these little things can be major barriers when you're in the throes of withdrawal or addiction," explains psychologist Erin Kelly, Ph.D..
Along with a team led by Dr. Kelly, Gregory Jaffe, MD, started a substance use disorders clinic embedded within the Jefferson family medicine clinic and residency program aiming to break some of those barriers and expand access to life-saving medication within primary care.
They published their findings in Substance Use & Misuse.
"The goal of this was to help create low-barrier access to these medications," Dr. Kelly says. Primary care providers (PCPs) are often the first point of contact for a patient in the medical system, making them a key route for prescribing OUD medications.
Initially, PCPs in the practice were trained to become X-Waiver certified—a certification that was required up until 2022 to prescribe certain OUD medications. The physicians also completed training on topics including harm reduction and trauma-informed care. The largest increase in medication for OUD within the practice came after the implementation of the substance use disorders clinic.
Patient feedback was overwhelmingly positive: They appreciated how effective and easy the treatments were to access, noting that they didn't feel stigmatized by their PCPs.
Dr. Jaffe says programs like these can expand and position PCPs at the front lines of combating the opioid epidemic. Sidney Kimmel Medical College students Sarah Lawson, Allie Hamilton, Jordan Lazarus and postdoctoral researcher Erica Li, Ph.D., helped conduct the study.
Clinical Perspective — Dr. Shruti Pandey, Hematology
Workflow: As a primary care physician, I've seen how embedding a substance use disorders clinic within our practice can streamline workflow, particularly with the implementation of X-Waiver certification for PCPs. This certification allows us to prescribe certain OUD medications, increasing access to treatment. With proper training, we can now provide more comprehensive care to patients with OUD.
Economics: The article doesn't address cost directly, but by expanding access to OUD medications within primary care, we can potentially reduce healthcare costs associated with overdose deaths and relapses. For example, medications like buprenorphine, methadone, and naltrexone can help curb relapse and overdoses, which can lead to significant cost savings.
Patient Outcomes: Patient feedback from the study was overwhelmingly positive, with patients appreciating the easy access to effective treatments and feeling less stigmatized by their PCPs. By providing low-barrier access to OUD medications, we can help reduce overdoses and deaths, and improve patient outcomes, as seen in the largest increase in medication for OUD within the practice after the implementation of the substance use disorders clinic.
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