[ad_1]
Despite efforts to improve access to a decades-old drug that can reverse the course of the opioid epidemic, the biggest challenge remains that doctors do not want to prescribe it .
Authorized to be used in the 2002 Drug Administration, buprenorphine is an opioid that may respond to the urge of an addict but does not deliver euphoria. Associated with counseling, drug therapy is touted as one of the essential pillars of the fight against the opioid epidemic
. But it is unpopular among front-line professionals who fear that a base of stigmatized patients as criminals and drug addicts will quickly dominate their practices. "Many doctors would perceive that it is a population that they do not feel comfortable serving in large numbers," said Dr. Charles Winfrey, a psychiatrist working in Virginia and Virginia which prescribes Suboxone, the brand name for buprenorphine treatment.
"These are – many of them are street people with a criminal record, I treat a lot of criminals out there," he said.
Winfrey shares his work between his private practice in Virginia and the mental health department of the Martinsburg Veterans Affairs Medical Center in West Virginia.It is part of a push to the hospital to bring primary care physicians into the field of addiction treatment to increase the number of providers and expand access.
"What's interesting and wonderful, is to get them on Suboxone they stick to the program they are back to work, they are paying their rent and their bills, their wives and their kids are coming back home, everything is back to normal, and it is one of the most beautiful things that i have views, "He said.
About 2 million people in the United States have an opio addiction For a large part of this population, their addictions began with an overabundance of pain pills after surgery.
The powerful effects of drugs like OxyContin and Percocet have changed the receptors in their brains, prompting them to demand more drugs. When prescriptions ended and black market pills gained value, heroin consumption exploded.
Today, cheap synthetic fentanyl – 50 to 100 times more potent than morphine – kills almost all illicit drugs on the market
. The death rate from drug overdoses – nearly 64,000 people in 2016 – is expected to worsen before it improves.
In rural America, where the crisis strikes the most, family physicians and internal medicine specialists are often the only ones Tim Putnam, CEO of Margaret Mary Health Hospital in Batesville, Indiana, who provides services to 25,000 people.
"We have a habit of treating acute illnesses, and we have good programs in place for that," he says. "But this crisis that we are facing right now is causing us to create partnerships with organizations with which we have not worked closely in the past. So, it is complex and there are a lot of work items.
In a community-based assessment of health care needs, addiction problems rose to No. 1 in No. 7 in three years, he said. We are not a community that has a high rate of addiction, but we are a very close community, so everyone who becomes addicted, each overdose, every death is a pretty devastating event for us, "Putnam said.
Restructuring care includes matching Suboxone prescriptions with psychosocial treatment, such as peer support groups and safe housing. "Leading public health professionals and advocates of the disease". identify as the gold standard for the treatment of opioid dependence.
"Every physician should be able to prescribe buprenorphine (if it is the most appropriate treatment for the patient)." final report of the Presidential Commission on Drug Control and the Crisis of Opioids
"As president, you can get there right away. We invite you to do so.
"Payment Barriers"
A number of changes in recent years have removed significant bureaucratic hurdles, including easing restrictions on physicians to receive waivers from the Drug Act. Enforcement Administration. prescribe Suboxone. The drug is a controlled substance and has potential for abuse, but the risk is low.
Repayment was a problem. States that have opted for the expansion of Medicaid Obamacare have found open coverage for a large number of drug addicts who qualify under the new terms: those who are young and single and who have irregular employment.
Physicians who receive the DEA exemption can treat 30 patients in the first year and up to 275 patients in subsequent years. Nurse practitioners and paramedics may also receive waivers to prescribe Suboxone.
In total, there are 44,694 providers of opioid treatment services, according to the Administration of Addiction and Mental Health Services
. The American Society of Addiction Medicine, said that the actual number of specialists is about 3,000 in addictive medicine and 1,000 in psychiatry.
The Tens of Thousands of Health Care Providers Who May Prescribe Suboxone Probably Received About Eight Hours of Training on "
Although They May Be Allowed to Prescribe Agonist Drugs – Medicines That Block Desires opioids – and to provide follow-up care, doctors may feel concerned about opioid addiction. uncomfortable to go down this road after only a few hours of workout.
These feelings were confirmed in a survey conducted in 2016 by research. The Johns Hopkins University School of Medicine sought to understand why buprenorphine was rarely used in primary care and psychiatric settings, as well as in non-dispensed providers and patients benefiting from exemption.
"There are barriers to payment," said Dr. Clark, "and one of the things we do in the United States is to put things in silos.
The mental health or behavioral part of an insurance plan covers the medicine of addiction, so there is little problem of reimbursement for a psychiatrist who prescribes buprenorphine. Primary care physicians, however, may not receive the same payment because their specialty is not behavioral health.
Another major hurdle that researchers at Johns Hopkins University have observed is stigma – a lack of belief that agonist treatment works. When you have been diagnosed with a chronic illness, it's a good time to consider taking medication, "said Dr. Clark. "But the majority of treatment programs in the country do not use drugs for addiction.This is not true for psychiatry, this battle was fought and decided a long time ago." [19659002AtVAMCinMartinsburgtheMentalHealthDepartmentisworkingtoidentify"champions"inprimarycarewhowilltakepatientswithopioidusedisorderTheyhopetobegintraininginAugusttogivedoctorsthetoolstheyneedtofeelcomfortableprescribingSuboxoneanddetailingfollow-upcare
"We are really people, in primary care, who have emotional connection to patients," said Dr. Jonathan Fierer, chief of primary care at the hospital. He joins the training session and works to call on other doctors.
"We know their families and them, and we have seen them for years," he said. "We are probably more likely to develop the report that would allow us to introduce the whole subject of Suboxone use."
The AV in some ways is ideally located to build this type of program, with psychiatrists, social workers and primary care providers under the same roof.
Dr. Fierer initially hesitated to take part in the initiative, but became more confident after working with the Mental Health Services Department, the Rehabilitation Services Division and the Pain Management Program.
. with. But now, having looked a little more, I think it's a big step forward. "
Washington Times Commentary Policy
The Washington Times welcomes your comments on Spot.im, our third-party provider, please read our Comment Policy Before Submitting
[ad_2]
Source link
