Posts Tagged ‘substance abuse’

5 Practitioner Tactics for Tackling the Opioid Epidemic

August 15th, 2017 by Susan Butterworth, PhD, and Amanda Sharp, MPH, Q-Consult LLC
opioids

There is promising evidence that motivational interviewing can successfully reduce both the use of non-medical opioid use and overdose risk behaviors for prescription opioids.

Despite evidence and guidelines to the contrary, including significant risk of addiction, there remains a widespread belief among many clinicians and patients alike that opioid medication is a viable and effective first option for multiple chronic pain conditions. Practitioners feel pressure to provide opioids upon patient request, yet many have neither the resources nor the skill set to manage the physiological and psychological complications that can arise when treating a patient with opioids long-term.

As one qualitative study found, it can be awkward at best, and confrontational at worst, when refusing a patient’s request for opioids. Thus, clinicians are faced with the challenging balancing act of providing pain relief for their patients while simultaneously managing the potential for addiction and misuse – with most clinicians ill-equipped for the herculean task.

“Not providing the [opioid] prescription is very hard. It takes time to do the research on the patient. Confronting the patient with a problem is emotionally draining. Doing it 5-10 times in one shift is not only a reality, it is downright crippling. It sucks out [sic] last bit of energy out of your soul. Rather than confronting patients and arguing, it’s far easier to write a prescription for narcotics and move on to the next patient. This is the mindset of thousands of physicians.”
Anonymous Physician, April 25, 2013

Along with knowledge about alternative treatments, a valuable skill set for clinicians in this situation is an effective communication approach to address the possible scenarios that emerge:

  • Engaging patients in discussions about the risks of opioids;
  • Validating the frustration of chronic pain;
  • Evoking commitment to try alternative modalities;
  • Eliciting honesty about unhealthy/drug-seeking behaviors; and

Sharing concerns and resources for opioid addiction.

Motivational Interviewing (MI) is an evidence-based communication approach that has been adapted for the brief healthcare setting to address many lifestyle management issues, including chronic pain. There is one promising clinical trial that used a single MI session in an emergency department to successfully reduce both the use of non-medical opioid use and overdose risk behaviors for prescription opioids as compared to a control group. Even beginning proficiency in MI equips practitioners with the confidence and skills needed to engage patients in conversations that generally lead to outcomes of being able to maintain rapport and successfully incorporate best practice guidelines for chronic pain treatment.

Consider the following two scenarios:

Scenario 1: Your patient has recently hurt their back and has requested strong pain medication.

Scenario 2: You suspect your patient may have an addiction to opioids.

In both cases, a practitioner, competent in the MI approach, would be able to use the following strategies to successfully navigate these challenging waters. These principles and strategies are based on Miller and Rollnick’s description of MI practice.

Engage and Partner

Taking a minute or two to build rapport with the patient may be counter-intuitive to a busy clinician. However, consider the time that is spent in unproductive arguments and power struggles. Research has shown that taking a more patient-centered approach is more time-efficient in the long run. Although the clinician is an expert in clinical aspects, the patient is the expert of their life, and the only one with the ability to commit to the suggested treatment plan. By stepping out of the authoritarian role, ideally, the clinician can partner with the patient in a collaborative way to problem-solve together. When a person helps to identify the best treatment course for themselves, they feel more ownership and are more committed; thus, are more likely to follow through.

Express Empathy

A core component of engaging is being able to express empathy, or the ability to convey accurate understanding through the eyes of the patient. This takes compassion, effort, genuine interest, and reflective listening. The clinician does not need to become a counselor to provide a meaningful statement that lets the patient know that the practitioner “gets it”. When the patient feels understood and accepted, they are more receptive to the clinician’s advice and guidance.

Share Concerns while Supporting Autonomy

In MI, the clinician is not simply following the patient but is a full partner. After establishing rapport and trust, it is not amiss to share any concerns that the provider has, if patient autonomy is concretely verbalized. The patient can always go to another doctor to get what they want; by acknowledging that it is the patient’s choice to pursue what they feel is best for them, the patient relaxes. This allows the clinician to share their concern in a way that does not elicit defensiveness.

Manage Expectations

It is important to manage the expectations of the patient. By clearly and transparently stating up front what the clinician feels is best practice and ethically viable, the patient is not disappointed later. Openly share that alternative treatment options may not address the pain as completely as opioids might initially, or, in the case of addiction, that there may be withdrawal symptoms when discontinuing the medication. Honesty preserves trust and conveys the clinician’s desire to support the patient as fully as possible, while still maintaining his integrity of practice.

Provide Decision Support with Menu of Options

Now the patient is ready for a menu of options with the pros and cons succinctly laid out. These include therapies such as non-opioid meds, stretching, and alternative treatments. Some of these options may be those that the clinician is not prepared to provide; e.g., if the patient is still favoring the option of more opioids. The clinician has been transparent about which options he feels are best and is willing to provide; however, the patient is in the driver’s seat to choose the best treatment course for himself. In most cases, the clinician can positively influence the patient’s decision. If not, the discussion remains professional, rapport is not lost, and the patient will feel comfortable returning to this provider. This keeps the door open to further dialogue about the situation.

There are many resources available for those who are interested in getting trained in MI, and the approach can be used for any lifestyle management or treatment adherent situation. However, a fair warning that MI is a complex skill set and cannot be learned in a one-and-done workshop. Just like learning to speak a foreign language or play a musical instrument, it takes practice and feedback from an expert over time to develop a meaningful proficiency. As many clinicians can attest though, this is one hard-earned competency that is more than worth it — for the practitioner, the patient and society!

Susan Butterworth, PhD

Amanda Sharp, MPH

About the Authors: Susan Butterworth, PhD, is principal and Amanda Sharp, MPH is program manager for Q-Consult LLC. Both are both members of the Motivational Interviewing Network of Trainers. Please visit Q-Consult, LLC their blog and find out more about patient-centered initiatives that increase patient engagement and improve clinical outcomes.

HIN Disclaimer: The opinions, representations and statements made within this guest article are those of the author and not of the Healthcare Intelligence Network as a whole. Any copyright remains with the author and any liability with regard to infringement of intellectual property rights remain with them. The company accepts no liability for any errors, omissions or representations.

Infographic: The Opioid Burden on Hospitals

January 6th, 2017 by Melanie Matthews

The nation’s opioid epidemic resulted in a 64 percent increase in opioid-related hospital stays between 2005 and 2014. However, hospital rates varied widely by state, according to a new infographic by the Agency for Healthcare Research & Quality.

The infographic shows the states with the highest and lowest rates in 2014.

Infographic: The Opioid Burden on Hospitals

Behavioral Health Patient Engagement: Using Motivational Interviewing Techniques and Strategies To Improve OutcomesAs the critical role of an engaged, activated healthcare consumer becomes more apparent in a value-based healthcare system, healthcare organizations are focusing on patient engagement and activation programs.

In a recent industry survey on trends in patient engagement, healthcare organizations reported that behavioral health conditions presented a particular challenge to patient engagement initiatives. However, there is robust evidence that motivational interviewing is a powerful approach for treating substance abuse, anxiety and depression.

Behavioral Health Patient Engagement: Using Motivational Interviewing Techniques and Strategies To Improve Outcomes, a 45-minute webinar now available for replay, Mia Croyle with the University of Wisconsin School of Medicine and Public Health shares key learnings from patient engagement initiatives targeted at patients with behavioral health conditions.

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Infographic: Substance Abuse Trends

July 27th, 2016 by Melanie Matthews

Substance abuse—involving drugs, alcohol or both—adversely impacts individuals, families and communities. Stopping substance abuse before it begins can increase a person’s chance of living a longer, healthier and more productive life, according to a new infographic by Healthy People 2020.

The infographic examines adolescent alcohol or illicit drug use trends and Healthy People 2020 targets for adolescent substance use and binge drinking in adults.

Behavioral health conditions affect nearly one of five Americans, leading to healthcare costs of $57 billion a year, on par with cancer, according to a 2009 AHRQ brief. Despite this impact, and the ACA’s provision for behavioral healthcare as an essential health benefit, progress toward total integration of behavioral healthcare into the primary care system has been slow.

2015 Healthcare Benchmarks: Integrating Behavioral Health and Primary Care captures healthcare’s efforts to achieve healthcare parity and honor the joint principles of the patient-centered medical home, including a whole person orientation and provision of coordinated and/or integrated care.

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Infographic: Daily Drug Use in the United States

July 23rd, 2014 by Melanie Matthews

Every day in America millions of young adults use illicit substances, ranging from marijuana, heroin, and cocaine, to hallucinogens and inhalants. Out of the 35.6 million young adult population (from 2012) in the United States, one fifth used an illicit drug in the past month, and the percentage of those users has increased from 2008.

The infographic below shows how often drugs are used daily in the United States and the number of first-time illicit drug users on an average day.

Daily Drug Use in the United States

Bringing the most comprehensive research and information available today to the mental health field, the Dartmouth Psychiatric Research Center and Hazelden have redesigned the innovative Integrated Dual Disorders Treatment: Best Practices, Skills, and Resources for Successful Client Care curriculum.

Far surpassing its predecessor in ease of implementation and ongoing usability in clinical settings, this updated and expanded curriculum is redesigned not only to more effectively teach clinical skills and provide practitioners with resources and tools for their practice, but to offer the guidance necessary to align the work of departments and transform agencies into integrated treatment providers.

Get the latest healthcare infographics delivered to your e-inbox with Eye on Infographics, a bi-weekly, e-newsletter digest of visual healthcare data. Click here to sign up today.

Have an infographic you’d like featured on our site? Click here for submission guidelines.

Guest Post: 3 Ways to Reduce Prescription Drug Abuse

April 17th, 2013 by Joe Baxter

prescription drug abuse

Drug manufacturers should educate providers on proper use of pain relievers.

Prescription drug abuse is the nation’s fastest-growing drug problem, according to the Office of National Drug Control Policy (ONDCP). There are many explanations, but most noticeably is the problem of overprescribing by physicians. The ONDCP has established a prescription drug abuse prevention plan that includes stopping ‘pill mills’ and taking action against physicians who over-prescribe.

The problem is not always neglectful physicians, but rather, uninformed ones. According to the ONDCP’s strategic plan to reduce abuse, most physicians receive little training on proper prescribing methods and recognizing substance abuse in their patients. A survey in 2000 found that only 56 percent of national medical residency programs required between 3-12 hours of substance use disorder training. A study done in 2008 showed improvement nationally but the efforts were not applied equally across the board.

There is indeed a discrepancy among practitioners and proper prescribing practices. To fix this issue, the ONDCP plans to work alongside Congress to implement the following:

  • Require authorized prescribers requesting DEA registration to have training on responsible prescribing practices and abuse/dependence recognition prior to registration.
  • Require drug manufacturers to create educational material to train providers on proper use of pain relievers.
  • Encourage medical and healthcare boards to require education on proper prescription practices in medical, nursing, pharmacy and dental programs. They also want to outreach to student groups to distribute educational materials.

Unfortunately, there are those practitioners who abuse their power and prescribe opioids for non-medical purposes. Because these physicians, who are illegitimately prescribing, are functioning under a medical umbrella, they rarely get caught.

The proliferation of over-prescribing has also led to illegal pill mills. These are doctors, clinics and/or pharmacies that are prescribing powerful prescription drugs for non-medical purposes. The ONDCP will try to eliminate these pill mills in hopes that prescription drug abuse will decrease.

Retired from the field of medical research, Joe Baxter is now a freelance writer specializing in medical journals. Apart from writing, he spends the rest of his free time traveling abroad and working in his wood shop.

HIN Disclaimer: The opinions, representations and statements made within this guest article are those of the author and not of the Healthcare Intelligence Network as a whole. Any copyright remains with the author and any liability with regard to infringement of intellectual property rights remain with them. The company accepts no liability for any errors, omissions or representations.