Mass. Physician Assistants Help Address the Opioid Crisis | Connecting Point | Jan. 14, 2019


>>>THE CHAIR OF THE SPRINGFIELD
COLLEGE PHYSICIAN ASSISTANT PROGRAM HAS BEEN TAPPED FOR A
WORKING GROUP LOOKING AT ADDRESSING THE OPIOID CRISIS IN
MASSACHUSETTS. THE GROUP IS LED BY THE
MASSACHUSETTS DEPARTMENT OF PUBLIC HEALTH AND THE
MASSACHUSETTS ASSOCIATION OF PHYSICIAN ASSISTANTS. CHARLES MILCH HAS BEEN WORKING
WITH PEOPLE WITH SUBSTANCE USE DISORDER FOR MANY YEARS AND
SHARED HIS PERSPECTIVE ON HOW THIS GROUP WILL HELP TRAIN
FUTURE PHYSICIAN ASSISTANTS.>>I’M PART OF A WORKING GROUP
THAT’S PUT TOGETHER BY GOVERNOR CHARLIE BAKER AND THE HEAD OF
THE DEPARTMENT OF PUBLIC HEALTH. AND IT CONSISTS OF THE PROGRAM
DIRECTORS FOR THE NINE PA PROGRAMS THAT ARE IN
MASSACHUSETTS. THERE ARE NINE AT THIS TIME. AND WE WERE CALLED TOGETHER TO
PUT TOGETHER SOME COMPETENCIES FOR OPIATE USE DISORDER IN
PRESCRIBING SCHEDULE 2 SUBSTANCES WHICH INCLUDE
OXYCONTIN, OKAY SEE CODONE, FENTANYL AND METHADONE FEW
YEARS.>>THIS CRISIS HAS CHANGED
CURRICULUM AT THE COLLEGE LEVEL.>>ABSOLUTELY.>>YOU’VE BEEN IN THIS FOR A
LONG TIME. TEMP ME HOW IT HAS CHANGED IN
THE LAST 20 YEARS WOULD YOU SAY?>>20 YEARS AGO THERE WAS
ARTICLE IN THE JOURNAL, AMERICAN JOURNAL OF MEDICINE AND THE
ARTICLE WAS WRITTEN BY A PHYSICIAN AND IT TALKED HOW
PHYSICIANS WEREN’T TREATING PAIN. AND THEN FROM THAT POINT ON ALL
OF A SUDDEN PAIN BECAME ANOTHER VITAL SIGN. AND EVERYTHING — EVERYBODY WAS
EVALUATED BASED ON WHETHER OR NOT YOU TREATED PAIN OR NOT. TREATED PAIN APPROPRIATELY.>>RIGHT.>>WITH ENOUGH MEDICATION. AND THAT’S WHEN I NOTICED THAT
PAIN MEDICATIONS WERE BEING PRESCRIBED IN LARGER QUANTITIES,
MORE FREQUENTLY TO MORE PATIENTS. AND AS TIME WENT ON THERE WAS
THIS BUILD OR DEVELOPMENT OF MORE PEOPLE THAT WERE BECOMING
ADDICTED TO PAIN MEDICATIONS. IN 2010, I STARTED WORKING AT AN
URGENT CARE WE TREATED OPIOID TREATED PATIENTS, I WOULD GO
HOME SAY TO MY WIFE, I DON’T THINK ANYBODY KNOWS ABOUT THIS
PROBLEM. WE HAD OVER 500 PATIENTS THAT
WERE ADDICTED TO OPIATES, WE WERE TREATING THEM WITH A
COMBINATION MEDICATION. AND THE TREATMENT FOR OPIATE USE
DISORDER HAS TO BE INTERDISCIPLINARY, MORE THAN
JUST PRESCRIBING THINGS THERE HAS TO BE PSYCHOTHERAPY, THERE
HAS TO BE GROUP WORK AND SO WE PUT TOGETHER AN INTEGRATIVE
PATIENT FOCUSED PROGRAM AT ATKINSON FAMILY PRACTICE AND WE
CURRENTLY HAVE A SUPPORT GROUP THAT WE MEET ONCE A WEEK. I DO THAT WITH PETER WOOD, WHO
IS A PSYCHOTHERAPIST AND BEEN WORKING IN THE ADDICTION
MEDICINE FOR PROBABLY 30 YEARS.>>BUT IN 2010 NOW THAT IS A
DECADE AGO.>>A DECADE AGO.>>YOU SAW THIS COMING.>>YES.>>IT WAS REALLY NOT UNTIL 2016
MAYBE WHERE IT REALLY STARTED TO RAISE SOME EYEBROWS?>>IT RAISED EYEBROWS FIRST IN
VERMONT THEY DECLARED THAT THEY HAD A CRISIS. THEN I THINK ALL THE STATES
LOOKED AT THEMSELVES SAID, WE ALL HAVE THIS AND IT WAS
NATIONAL CRISIS. IN 2017, 70,000 PATIENTS DIED
OVERDOSE IN THE UNITED STATES THAT’S 130 DAY THAT’S A LOT. IT BECAME A CRISIS. CHARLIE BAKER IN 2016 PUT
TOGETHER A WORKING GROUP FOR MED SCHOOLS AND THEN THEY REALIZE
IT’S NOT JUST DOCTORS THAT ARE PRESCRIBING IT’S ALSO PHYSICIAN
ASSISTANTS, DENTISTS AND NURSE PRACTITIONERS THEN THEY
DEVELOPED THESE OTHER WORKING GROUPS TO REVIEW AND PROMULGATE
THE COMPETENCIES AND AGREE TO INCLUDE THESE COMPETENCIES IN
OUR CURRICULUM.>>BECAUSE A LOT OF PEOPLE HAVE
SAID, HEY, LIS THEN IS ALL BECAUSE THERE ARE OVER
PRESCRIBING THESE MEDICATIONS AND REALLY HAVE POINTED THE
FINGERS AT THE MEDICAL FIELD, MEDICAL PROFESSIONALS. HOW DO YOU KNOW HOW MUCH TO
PRESCRIBE? THERE MUST BE SO MUCH LIABILITY
INVOLVED. HOW DO YOU KNOW THAT YOU’RE
APPROPRIATELY TREATING SOMEBODY’S PAIN?>>THAT’S A REALLY GOOD
QUESTION. IT’S PATIENT SPECIFIC. AND SO PART OF WHAT WE END UP
DOING PART OF WHAT THE COMPETENCIES ARE GUIDING THE
STUDENTS ON ARE ASSESSMENT OF THE PATIENT. AND ACTUALLY UNDERSTANDING THAT
THERE ARE MORE OPTIONS FOR PAIN TREATMENT OTHER THAN OPIATES. AND THERE ARE A LOT OF OTHER
OPTIONS. ONE OF THE CHALLENGE IS GETTING
INSURANCE COMPANIES TO PAY FOR THOSE OPTIONS. AND SO —
>>WHAT ARE SOME OF THE OPTIONS?>>FOR EXAMPLE, I HAVE PATIENTS
THAT HAVE BACK PAIN AND SO MASSAGE THERAPY IS IMPORTANT,
PHYSICAL THERAPY IS IMPORTANT. PATIENTS HAVE BEEN SUCCESSFUL
USING ACUPRESSURE AND ACUPUNCTURE. THERE ARE OTHER OPTIONS OUT
THERE THAT YOU MIGHT NEED TO TREAT SOMEBODY FOR A SHORTER
PERIOD OF TIME USING OPIATES THEN MOVE THEM INTO SOME SUPPORT
OF REHABILITATION PROGRAM THAT YOU CAN PUT TOGETHER. THE PRACTICE THAT I WORK WITH
HAS ALL OF THOSE PIECES TOGETHER WHICH I REALLY LIKE. IT WAS PART OF WHY I LIKED TO
WORK THERE, I WORK WITH MASSAGE THERAPISTS AND NUTRITIONISTS,
PT, OT, PSYCHIATRY. WE ALL WORK TOGETHER. WE MEET ONCE — ACTUALLY TWICE A
MONTH WE MEET AND TALK ABOUT PATIENTS, PROBLEM PATIENTS THAT
WE NEED MORE CONSISTENT INTERPROFESSIONAL WORK WITH. WE DO THAT — I FIND THAT THAT
APPROACH IS MUCH MORE SUCCESSFUL. THE PROBLEM WITH THE OPIATE USE
DISORDER POPULATION, THEIR PROBLEM IS THAT THIS IS A LIFE
LONG ISSUE. IT’S SIMILAR TO HAVING OTHER
DISEASES LIKE DIABETES.>>ONCE YOU’RE HOOKED IT’S THE
REST OF YOUR LIFE?>>ONCE YOU’RE HOOKED, YOU NEED
TO BE VIGILANT. AND IT’S DIFFICULT, IT’S A
PROCESS. IF PEOPLE SLIP, A SLIP IS THEY
GO BACK AND USE THEN THEY CAN COME BACK AND THE CHALLENGE IS
TO TRY TO USE THOSE SLIPS AS AN EDUCATIONAL OPPORTUNITY FOR THEM
SO THAT THEY CAN — WE CAN WORK ON — HOW DO WE NOT DO THAT
AGAIN. HOW DOES THAT — HOW CAN YOU
AVOID THAT SITUATION WHERE YOU END UP HAVING THAT SLIP. WORKING WITH PETER AND WORKING
WITH THE SUPPORT GROUP, WE HAVE THESE CONVERSATIONS ON A WEEKLY
BASIS, PEOPLE COME IN THEY SAY THEY HAD THIS ISSUE OR THAT
ISSUE. OR THEY ARE GOING TO APPROACH A
SITUATION THAT IN THE PAST HAS DRIVEN THEM TOWARDS USING
OPIATES AND SO HOW DO THEY MANAGE THAT. SO WE WORK ON ALL OF THOSE
THINGS. BUT IT’S AN ONGOING PROCESS.>>THIS AFFECTS EVERYBODY.>>IT AFFECTS EVERYBODY. IT’S IN FAMILIES, AFFECTS PART
OF WHAT WE TRY TO DO IS TO TRY TO HELP OUR OPIATE USE DISORDER
PATIENTS THAT HAVE CHILDREN NOT PASS THAT ON TO BREAK THE CYCLE. NINE TIMES OUT OF TEN, THEY CAME
FROM A BACKGROUND WHERE SOMEBODY IN THEIR LIFE HAD AN ADDICTION
ISSUE. SO WE WORK WITH THEM TO TRY TO
HELP THEM BREAK THAT CYCLE SO THAT THEY DON’T PASS THAT ON TO
THEIR CHILDREN. SO WE HAVE TO — THERE’S A WHOLE
CADRE OF PATIENTS THAT WE’RE GOING TO HAVE TO MOVE THROUGH
THEIR LIFE, HELP THEM THROUGH THEIR LIFE AND IT’S AN ONGOING
PROCESS. IT’S NOT — NOT LIKE, OH, YOU’VE
STOPPED USING HEROIN AND WE CAN PULL — YOU DON’T NEED TO USE
THIS ANY MORE HAVE A GOOD LIFE. IT’S THERE ALL THE TIME. IT’S INSIDIOUS. IT’S VERY — IT’S DANGEROUS,
ESPECIALLY NOW WHEN THEY HAVE — IF YOU BUY HEROIN ON THE STREET
YOU DON’T KNOW WHAT IT’S LACED WITH. THEY LACE WITNESS FENTANYL OR
CARAFENTANYL AND PEOPLE DIE FROM IT IT’S A DIFFICULT PROBLEM.>>ARE YOU ENCOURAGED BY THE
FACT THAT THE OVERDOSE STATS ARE DOWN SOMEWHAT IN MASSACHUSETTS
SINCE THE ATTENTION HAS BEEN BROUGHT TO THIS ISSUE?>>ABSOLUTELY. I THINK THAT THAT — I APPLAUD
GOVERNOR BAKER FOR THIS WHOLE EFFORT AND I SUPPORT HIM
COMPLETELY. I THINK THAT’S A MAJOR STEP IN
MINIMIZING THE DAMAGE THAT HAPPENS FROM THIS CRISIS. SO I THINK HE DID A GREAT JOB. IT’S AN ONGOING TASK WE HAVE TO
KEEP UP.

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