Physicians Fight Opioid Abuse Across the Commonwealth

By Robert Israel
Vital Signs Editor

For nearly two years, the MMS has been a leading force in the battle against opioid abuse. Prescribing guidelines, public awareness, and prescriber education have been hallmarks of the effort.

From Boston to Worcester to Greenfield and beyond, physician efforts continue the fight.

“We encourage physicians to use safer ways to prescribe opioids for patients suffering from chronic pain,” said Dennis M. Dimitri, M.D., chair of the MMS Task Force on Opioid Therapy and Physician Communication and immediate past president, “and to protect patients through the enforcement of safe prescribing. We educate physicians and medical students to understand opioid substance use disorder as a chronic brain disease to be treated through therapy and support systems.”

Current task force efforts follow a well-attended MMS leadership summit last fall, Medication Assisted Treatment: Improving Access to Evidence-Based Care, where strategies for increasing the availability and access to evidence-based treatments were explored as weapons against the influx of heroin, fentanyl, and illicit prescription drugs.

Another effective weapon is physician and patient education. Since May 2015, when the MMS began offering free pain management and safe opioid instruction, more than 8,000 individuals have completed over 23,000 course modules through the end of 2016. Physicians/prescribers enroll to learn best practices and then share their knowledge with patients. Their efforts, as seen in this report, can be felt in Massachusetts communities state-wide.

Activism in Franklin County

Ruth Potee, M.D., is a family physician in Western Massachusetts. She was honored in 2015 as Community Clinician of the Year by her MMS peers of the Franklin District Medical Society and has been a voice for change in erasing the stigma associated with substance use disorder, advocating for treating it as a disease.

To that end, Dr. Potee urges all physicians to join the fight against the opioid epidemic. “Physicians need to get the training they need and to dig deep and to talk to patients about opioid use, to ask the tough questions, to work in their communities, and to view this epidemic as a major public health crisis,” she said.

Franklin County’s opioid task force, which unites medical, law enforcement, civic and educational groups, and Baystate Franklin Medical Center, is doing just that.

“All our prescribers are in full compliance with the Massachusetts Prescription Awareness Tool (MassPAT),” said Thomas Higgins, M.D., chief medical officer at Baystate Franklin, referring to the state’s prescription monitoring program. “This has resulted in huge changes in prescribing behavior. Our nurses and emergency room personnel are trained in screening and intervention. Six newly-hired mental health counselors provide around-the-clock coverage to those patients presenting with opioid or other substance abuse. We monitor our efforts, and there has been a slight decrease to the substance abuse problem here.”

Educating Physicians/Prescribers in Worcester

At UMass Medical School in Worcester, Michele Pugnaire, M.D., senior associate dean, and Jennifer A. Reidy, M.D., co-chief of palliative care, train medical students who will take their place at the front lines in the opioid battle. This training program emphasizes a collaborative approach toward understanding, treating, and preventing addiction.

“At UMass, graduate-level nursing students study alongside pharmacy and general medicine students,” Dr. Pugnaire said. “This mixed-professional approach is a model for our communities: a united force of medical professionals battling the epidemic.”

UMass Medical’s “holistic teaching” model, Dr. Reidy noted, includes panels of patients who are invited to classrooms to share personal testimonies of their struggles with addiction and chronic pain.

“Patient panels are the heart and soul of medical training,” Dr. Reidy said. “Learning about health is knowing your community. Students learn how patients struggle with addiction and how these patients have become stigmatized. Unless we crack the stigma, we can’t advance against this epidemic.”

Treatment and Recovery in Boston

An example of how to “crack the stigma” of addiction, said Barbara Herbert, M.D., a task force member, can be found at Boston Medical Center. She cited the work of Alexander Y. Walley, M.D., who presented at the MMS leadership summit last fall, as indicative of helping patients who are “suffering from addiction to gain access to treatment that can lead to recovery,” she said.

“As this crisis we’re facing continues, there is a silver lining,” Dr. Walley said, “and that is that evidence-based treatments work. Fortunately, in Massachusetts, treatment is accessible. What is rewarding to me is that every day I see my patients get better. This is extremely hopeful.”

MMS President James Gessner, M.D., who was the first chair of the Opioid Task Force that developed MMS prescribing guidelines, sees the physician’s role as critical in the fight against addiction.

“Prescriber education is working, as opioid prescriptions are declining,” Dr. Gessner said. “We have advocated for partial-fill prescriptions and stressed proper storage and disposal to reduce the amount of drugs available for diversion. We are focusing on eliminating the stigma of addiction, recognizing it as a chronic medical disease, and are now moving to expand treatment options. State officials, legislators, policymakers and patients have now recognized that physicians are part of the solution to this epidemic.”

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