By CHRISTOPHER SHANAHAN, MD, MPH, FACP, MCSTAP MEDICAL DIRECTOR
The Massachusetts Consultation Program for the Treatment of Addiction and Pain (MCSTAP) Clinician Mentoring Program connects Massachusetts clinicians with expert physician mentors for confidential, case-based guidance on managing chronic pain and substance
use. Through flexible, ongoing mentorship, clinicians build confidence and practical skills to deliver safer, more effective, patient-centered care for complex cases such as high-dose opioid prescribing, buprenorphine management, and co-occurring
pain and substance use disorders.
One Clinician’s Learning Journey: Managing Complex Opioid Therapy Over Time
Recently, a Massachusetts primary care clinician engaged with the MCSTAP mentoring program to address several complex cases on their panel. A particularly challenging patient was a middle-aged man with ankylosing spondylitis, managed long-term with opioids,
including oxycodone and methadone. He was self-medicating with methadone to avoid withdrawal symptoms, a practice that posed significant safety risks without improving his pain control.
The initial mentoring sessions with an expert MCSTAP physician and the MCSTAP mentee focused on revising the treatment plan. The mentor guided the clinician to discontinue methadone, optimize oxycodone dosing at an effective level, and emphasize patient
education alongside close clinical monitoring. Over the following weeks, as these recommendations were gradually implemented, the mentor provided ongoing support covering withdrawal management, pain control, and safe prescribing practices. As the
patient's status evolved, discussions shifted toward multimodal pain strategies and carefully planned opioid tapering.
Besides this patient, the mentor and clinician reviewed other complex cases within the clinician’s practice, focusing on risk mitigation and optimizing pain management for patients with chronic pain. One such case was that of an older woman with complex
pain and severe alcohol use disorder who was bed-bound from chronic abdominal muscle spasms. She was also suffering from severe depression. Discussing this case with his mentor, the PCC was able to develop a plan to balance her pain and addiction
treatments, focusing on minimizing sedative risks and exploring buprenorphine’s potential dual benefit.
Throughout the mentoring relationship, the clinician also sought advice on prescribing buprenorphine for opioid use disorder. These conversations enhanced the clinician’s confidence and preparedness to diagnose and treat opioid use disorder effectively.
The MCSTAP mentoring program provides sustained, case-specific guidance that adapts to changing patient needs, enabling clinicians to deliver safe, individualized, and patient-centered care for pain and addiction. Participation is free, voluntary,
and confidential. By centering discussions on the clinician’s questions about their panel of cases, mentoring fosters collaborative problem-solving informed by evidence-based best practices and principles of patient-centered care. Clinicians participating
in MCSTAP’s Clinical Mentoring Program are eligible for CME. (Click for more details).
To sign up to participate in MCSTAP’s Clinician Mentoring Program, call 1-833-PAIN-SUD (1-833-724-6783) or email MCSTAP@carelon.com. Based on your mentoring needs and schedule, MCSTAP will connect
you with a mentor who can meet with you at a time that suits your schedule.
Click here to learn more about MCSTAP’s Clinical Mentoring Program.
The Executive Office of Health and Human Services funds MCSTAP. To contact MCSTAP for a consultation, call 1-833-PAIN-SUD (1-833-724-6783), Monday through Friday, 9 a.m. to 5 p.m.
Click here to learn more about the MCSTAP program and other services it offers.
