"When you write about heroin you are writing about America.”
It’s a startling message, and one that the acclaimed author Sam Quinones drove home from Massachusetts via Skype to a group of 50 Greater Cincinnati health care professionals who gathered at a venue in Springdale on Nov. 28. The attendees were there to hear Quinones describe how he came to write the best-selling book Dreamland: The True Tale of America's Opiate Epidemic.
But this wasn’t like book club.
After the presentation, the attendees—family physicians, physician assistants, nurses and social workers from different health systems—broke off into small groups to discuss their firsthand experiences with patient addiction and queried each other for input on veiled patient scenarios and inquires as to how else they might help fight a monster that has come out of the shadows: opioid addiction.
"Community providers are near the epicenter of the epidemic and this grant gives us the means to train faculty and physicians in the diagnosis and prevention of opioid use and abuses,” says Jeffrey Schlaudecker, MD, MEd principal investigator and associate professor in the Department of Family and Community Medicine at the University of Cincinnati College of Medicine.
The department recently received a $79,605 grant from Health Resources and Services Administration (HRSA), an agency of the U.S. Department of Health and Human Services, for a one year educational program on medication assisted treatment. This grant is part of a larger, five-year $1.75 million grant from HRSA.
The opioid-prescribing pendulum, Schlaudecker says, has swung to the other side; whereas once opioids were frequently prescribed they are now seen as the cause of great medical, financial and emotional strife to the patients and providers.
The epidemic, Quinones says, extends far beyond the clinician/patient relationship and affects jails, public health, police, "and the list goes on and on…but it’s really at the county level where we are suffering the most.”
This includes Hamilton County, Ohio, where, according to the grant, there are an average of 9.5 overdose victims per day presenting to emergency departments.
"It is more important than ever for our primary care providers to have the knowledge, skill and comfort to assist in treatment and help move the larger culture of health care toward a solution,” says Daniel Hargraves, a family medicine researcher who organized the event on behalf of the department.
The event, Hargraves says, is just one of many activities intended to engage clinicians in the overall effort to battle the epidemic. Earlier in October, for example, first-year residents at the College of Medicine attended a naloxone administration didactic and skills session, co-led by Patricia Wigle, PharmD, from the James L. Winkle College of Pharmacy. Naloxone is a medication used to protect an individual experiencing an opioid-related drug overdose. An overdose of opioids may cause a person’s respiratory system to shut down, and naloxone can work quickly to reverse the effects. Here, residents were able to practice assembly and demonstrate use of three different modes of naloxone administration.
Additionally, UC faculty members Chris White MD, JD, MHA and Reid Hartmann, MD have developed another program within this grant that assist residents in the areas of screening tools, interventions, initiating narcotics medication contracts and how to have conversations with family and patients about narcotics dependence. Residents in the department also have access to a two-week rotation in addiction medicine with the Brightview Treatment Center, where residents shadow a facility physician, look at lab work, follow a social worker and participate in one-on-one counseling sessions for persons living with substance abuse disorders.
This multi-layered approach—to include physicians in training/faculty/ and physicians in practice—is essential, says Schlaudecker, as "the opioid epidemic cuts across every fabric of social identifier, challenging the capacity of community resources.”