Author: LuAnn K. Kimker RN MSN, CPHIMSS, PCMH CCE, Director Clinical Innovation
Addiction, the opioid epidemic, overdose, are words seen and heard daily across various news venues and often in a negative context. It’s a complex problem – driven by the legal and illegal drug trade that gave rise to the current epidemic. If you haven’t already, I strongly recommend reading Dreamland, by Sam Quinones where he tells of the rise of the opioid crisis based on his investigative work as a reporter. One headline that recently caught my attention was the comparison of how we treat substance use disorders versus common chronic conditions such as diabetes, cancer or heart disease. We would never opt to NOT treat an individual presenting with cardiac symptoms or a heart attack, nor blame them for lifestyle choices or actions they may have taken or not taken that got them there. In fact, only 1 in 10 people who need treatment for a substance use disorder is receiving care — a ratio that would be unfathomable for conditions such as diabetes or kidney cancer.
Why is this? First, there is the stigma. Stigma is an issue fueling the substance use crisis in three ways: Stigma isolates people, discourages them from seeking treatment and impacts how health professionals treat patients. So first we need to think about changing the way we talk about people with a substance use disorder. (see Shatterproof’s, Stigma Reducing Language).
Second, we have not always looked upon substance use as a treatable chronic disease. Addiction negatively changes cells in the brain, just as diabetes changes cells in the kidney or lung cancer changes cells in the lung. We must use the latest scientific research and evidence-based medicine to make recommendations and treat the disease.
Next, we must accept that there is not one treatment that fits all. Persons with a substance use disorder will not be cured with a one-time treatment (e.g., one week or month of detox), but rather a process that provides acute detox (when needed), acute treatment, and long-term support and care, just like a chronic disease. Successful treatment includes on-going behavioral interventions and support as well as medical treatment. These services are often provided by Federally Qualified Health Centers, and positioning them to manage the issues surrounding substance use in the primary care setting is critical to our long-term success in battling this epidemic.
Primary care settings are well designed to manage chronic conditions and provide holistic care. That doesn’t mean it is easy, but just like treating HIV and diabetes, there is value in managing the patient in the primary care setting and either building in the specialty care in-house or referring out as necessary. Changes in treatment and legislation that allow providers to obtain the Drug Addiction Treatment Act of 2000 (DATA) waiver to treat opioid use disorder makes this easier, but there will still be challenges.
As with other approaches to managing a chronic condition you first must know what you’re dealing with. Azara DRVS now has a set of tools that can help you examine your patient population and provide early identification, prevention and monitoring of patients at risk for or those with known conditions. Here are some of the things you can do using DRVS measures, reports and registries:
- Understand which patients have an opioid on their medication list. [Opioid Potential Misuse Registry]
- Identify patients that have an alcohol or opioid use disorder but no diagnosis on their problem list through assessment results
- Identify opiates on a medication list of patients that are inactive and can be stopped
- Determine how many of your patients are on an opioid and benzodiazepine [Opioid and Benzo Measure]
- Understand how may of your patients with an alcohol or opioid use disorder are receiving treatment [AUD and OUD Treatment Measures]
- Manage your patients on buprenorphine [OBOT Registry]
- Evaluate how often controlled substance agreements are used with chronic pain patients [Controlled Substance Agreement Measure]
- Quantify how well you are screening for alcohol and or drug use in the general population to prevent use disorders [Unhealthy Alcohol Use: Screening and Intervention and Drug Use Screening (TBD)]
Get key data summarized in a dashboard to get a picture of the population.
Azara has been working closely with its clients and partners over the past six months to identify the reporting and analytics necessary to help them provide high-quality care and treatment for their patients with a substance use disorder. The first version of our Controlled Substance Module was released in November 2017, and we are currently working to map the necessary data for those clients who have purchased this module. While this is just step one on our journey to assist you, we already have plans for additional functionality, and we look forward to hearing your feedback and understanding your expanded reporting needs in this area.
If you are interested in learning more about the DRVS Controlled Substance Module, please contact your Primary Care Association, HCCN or Azara representative.