February 21, 2020
Ohio PAs Address Substance Use Disorder through Advocacy, Education and Research
This is the first of two articles from state chapters on how PAs are addressing the opioid crisis.
By Clayton M. Rotuno
Over the past two decades, Substance Abuse Disorder (SUD) – specifically involving opioid-based pain medications – has risen in the State of Ohio and across the nation. According to the CDC, the death rate from heroin overdose has nearly tripled since 1999: from six out of 100,000 to 16 out of 100,000. In response, Ohio PAs are addressing this epidemic through political advocacy, education, and innovative research.
In January, bueprenorphine became listed on the Ohio Physician Assistant Formulary as “may prescribe” for office-based treatment of opioid addiction. Since October 2000 when Congress enacted the Drug Addiction Treatment Act (DATA), this medication was restricted to the license of a Medical Doctor. In July 2016, Congress passed the Comprehensive Addiction and Recovery Act (CARA). This new law adds PAs to a federal waiver program which allows certain practitioners to prescribe buprenorphine as part of medication-assisted treatment (MAT) for opioid addiction.
Josanne Pagel, Executive Director of PA Services at the Cleveland Clinic and immediate past president of the American Academy of PAs, agrees buprenorphine’s status change is a breakthrough in battling SUD, “Allowing PAs to prescribe bueprenorphine in the out-patient setting increases access to patients needing this medically-assisted treatment. This is a great step forward in the battle against the opioid crisis.”
Tom Lumsden, a PA-C for the Lorain County Alcohol and Drug Abuse Services, Inc. (LCADA), went through a “24-hour waiver-training process” in order to prescribe buprenorphine under his own license. Now that he has obtained his waiver, the practice can see additional patients. Lumsden notes he still collaborates with his supervising physicians for more complex cases, such as those in which the patient is not willing to abstain from all types of substance uses during their rehab period.
In addition to increasing access to care, at least one PA is battling this disease by reducing stigma and improving education. Scott Petersen, MPAS, PA-C, and Pain Education Coordinator for Inpatient Pain Management at Cleveland Clinic Avon Hospital, in Avon, Ohio, believes that improving education on the disease process and reducing the stigma around receiving treatment could drastically reduce the number of Ohioans falling victim to overdose. Petersen cites the chemical changes that occur during the addictive disease process as reason to seek out the help of a medical practitioner. His effort to eliminate stigma and increase education are critical considering only 10 percent of patients who need treatment have received it in the past (Substance Abuse and Mental Health Services Administration, 2015). In theory, better informing patients and the general public about the disease process and the services available to treat it could allow prompt intervention before drug addiction becomes fatal.
And while increased access to pharmacologic therapies and education will help with the rising demand for services, the relapse rate of SUD patients is still around 60 percent (Witkiewitz et al., 2014). Kelsey Meyer, a PA-C in Ohio, researched alternative therapy for SUD patients and believes her findings provide additional hope for improved patient outcomes.
As part of her education at the University of Mount Union, Meyer spent a month at S’eclairer, a Psychiatric Medical Practice applying adjunctive therapies to SUD patients. Her area of practice was Mindfulness-Based Interventions (MBIs) which utilize ancient practices rooted in Buddhist tradition. These exercises have the ability to “alter learned reactivity” and “rehabilitate the addicted mind,” according to Meyer.
During her time at S’eclairer, Meyer led meditation-type interventions which included guided meditation and therapeutic walks. When asked whether she thought the meditation was beneficial to patients, she pointed to the medical literature and research that further supports it.
Meyer completed a systematic review of the medical literature on this topic as part of her Master’s Degree at the University of Mount Union. Her work revealed that MBIs have the ability to “create change in neurobiology and behavior,” equipping patients with the “tools to overcome this complex disorder and the overwhelming relapse probability.” This innovative approach to SUD patients offers additional hope in the on-going battle against substance abuse.
And while MBIs likely won’t entirely replace the use of opioid antagonists, these tools can empower patients to take control of their addiction and ultimately lead to lower relapse and fewer overdoses.
“If all of the bueprenorphine in the world ran out, those with an opioid addiction would still have the skills that mindfulness teaches,” says Meyer.
Clayton Rotuno, PA-C, is the Ohio Association of Physician Assistant’s Chair of the Diversity. This article was written for the Ohio Association of Physician Assistants highlighting the efforts of PAs in the State of Ohio to address the substance abuse crisis. Contact Clayton at OAPA@ohiopa.com.
AAPA is partnering with the American Society of Addiction Medicine (ASAM) and the American Association of Nurse Practitioners (AANP) to offer free online training courses that will allow PAs and NPs to prescribe bueprenorphine for the treatment of opioid addiction.