NYC Health + Hospitals is integrating opioid use disorder treatment into its primary care model with expanded access to buprenorphine, a prescription drug to manage opioid addiction, through adult medicine clinics in 18 community and hospital-based ambulatory care centers. The clinics are located in all boroughs of New York City and will integrate the clinical management of buprenorphine into primary care, "making availability easier and treatment more holistic," the system said.
Buprenorphine is already available through the system facilities' emergency departments, inpatient care, and specialty outpatient clinics.
Each clinic has a clinician who leads opioid treatment there and has undergone special training and licensing to authorize the prescription of buprenorphine. Right now there are 40 clinicians at the clinics who can prescribe buprenorphine. System-wide there are 169 authorized prescribers, and the system said it expects the number to grow.
Doctors who want to be able to prescribe buprenorphine must undergo four hours of online work and four hours of in-person training, followed by a four to six-week licensing process. Nurse practitioners and physician assistants can also go through the training and be licensed. The training is often called "x-waiver training" clinicians will have an "x" added to their unique Drug Enforcement Agency identification number that indicates they are qualified to prescribe buprenorphine.
WHY IT MATTERS
Buprenorphine is an important treatment option because it does not require a daily clinic visit, unlike methadone. It also carries a low potential for abuse and "negligible" risk for overdose, NYC H+H said.
The opioid epidemic has been raging for several years now, with tens of thousands dying annually from overdoses. The Affordable Care Act broadened the availability of treatment for opioid addiction and some health systems are changing prescribing protocols and taking their own measures to combat the crisis. A major legislation package was also passed by Congress recently to address the crisis and provide funding for treatment and other solutions.
WHAT ELSE YOU NEED TO KNOW
Patients at H+H primary care clinics can ask their provider, a nurse, or a social worker about treatment options for opioid use.
The clinics are also beginning to screen for opioid use such that providers may also start the discussion. The provider takes a patient history and performs a physical exam. If a patient is diagnosed with opioid use disorder, an appropriate treatment plan for that patient is devised and those needing a higher level of care like methadone may be referred to a specialty clinic.
For those for whom buprenorphine is an option, the patient will receive one to three doses and instructions on how to proceed, then a follow-up appointment is scheduled. At first, weekly visits may be required but over time, depending on how treatment progresses, those visits can become monthly or every few months.
"The initial goal is to increase the number of patients system-wide every year by 125," the system said.
NYC H+H emergency departments are also implementing new procedures for treating opioid abuse patients who present for care. Patients will be screened for "risky substance use" in triage or the nursing assessment, which will help identify patients in need of intervention by one of the new Emergency Department Addiction Teams. Peer advocates and licensed social workers or counselors will connect with the patient identified and help them get ongoing treatment in place.
Notably, peer advocates with their own real-life experience with substance use disorder treatment also connect with vulnerable patients with the goal of getting patients to care and resources. Currently being piloted in five of the system's EDs, the program will eventually be rolled out to all Health + Hospitals emergency departments.
ON THE RECORD
"A key component in the success of treatment for opioid use disorder is the patient's willingness and commitment to treatment, which can be triggered by a range of different factors, and it is critical for us in the healthcare field to engage, connect, and treat patients wherever they are on their road to recovery," said Dr. Daniel Schatz, director of program and policy in the Office of Behavioral Health at NYC Health + Hospitals. "Increased access to buprenorphine--including now through primary care--is yet another tool that will help save more lives."
"NYC Health + Hospitals sees approximately 20,000 unique patients with opioid use disorder every year, many of whom aren't ready to enter into a substance treatment program," said Dr. Mitchell Katz, president and chief executive officer of NYC Health + Hospitals. "Empowering primary care providers to play a greater role in connecting patients to care for opioid addiction is a useful strategy since these are the clinicians most likely to have ongoing relationships with these patients. Personally, I completed the x-waiver training so I can best help my patients."
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