Highland Physicians Lead Initiatives in Opioid Use Disorder
Highland Family Medicine (HFM) physicians Elizabeth Loomis, M.D., and Holly Russell, M.D., have committed themselves to efforts to help those addicted to opioids since their first experiences with patients during residency. Dr. Russell serves on the Monroe County Opioid Task Force and co-directs the HFM buprenorphine program with Dr. Loomis. Working collaboratively with physicians and other health care providers, community leaders, community organizations, and funders, they have spearheaded several initiatives including:
- Bridge Program with Highland Emergency Department: Patients who present at the Highland ED with opioid use disorder can begin buprenorphine on the spot. (Buprenorphine is main ingredient in suboxone. It helps with treatment because receptors block the effect of pills and decrease cravings.) The ED’s program includes an on-call system with HFM clinicians, who are able to order a three-to-five day prescription for patients and arrange appointments for them with a HFM clinician within that window. Appropriate patients are started on buprenorphine in the ED and then HFM providers can continue treatment until patients who need extensive treatment can access a chemical dependency program. This helps keep patients safe during the initial phases of recovery, as it usually takes one-to-four weeks before they can be enrolled in a formal program.
- Suboxone Clinics at Highland Family Medicine: There are three dedicated suboxone clinics at HFM with six clinicians who run the sessions and an additional eight clinicians who see primary care patients for suboxone in their practices. Currently, 130 patients participate in the clinic, with sessions added based on need. “When we started these sessions we were one of the only primary care practices to do this,” said Dr. Loomis, who is Board Certified in Addiction Medicine. “Many of our patients do not need an intensive chemical dependency program, but they do need a provider to help them in the long term with suboxone. Many of these patients are also dealing with depression, anxiety, and other chronic illnesses and Highland Family Medicine can care for them.”
- Provider Office Training: Dr. Russell, Dr. Loomis, and Kristin Smith, D.N.P., conduct buprenorphine trainings in the community and have trained more than 100 people in physician offices last year. Eight hours of training are required in order to be licensed to prescribe. Grant funding is used for trainings and to provide ongoing technical assistance. Dr. Loomis, Dr. Russell, and a Credentialed Alcoholism and Substance Abuse Counselor go to the office, talk to the provider, answer questions, and help set up office flow. “We provide this training free of charge to any clinician who wants to be able to prescribe,” said Dr. Russell. “This will give greater access to buprenorphine for those in need in our community because opioid use disorder is one of the many chronic diseases that primary care doctors can treat long term.”
- Education: All HFM residents get buprenorphine (suboxone) waiver training and rotate in the suboxone clinic. There is also an elective for extra experience offered. Dr. Russell is in the process of redesigning the curriculum for the second year medical students around safe opioid prescribing and treating opioid use disorder.
- Research: Dr. Russell and Dr. Loomis are conducting research about the ED bridge program and studying providers’ knowledge and attitudes before and after the trainings.
- Program Expansion: Specialty based trainings in opioid use disorder and burprenorphine (suboxone) prescribing are underway to focus on issues important to physicians and their patients. OB/GYN staff and residents were offered training in February. Training will also be offered to Geriatric providers and expanded to other specialties and other counties in the UR Medicine health care system.
“In the future we hope to make these trainings sustainable outside of grant funding,” said Dr. Russell. “We need to keep training physicians and residents so they feel comfortable with the process and can hold trainings of their own. We need to stay vigilant on this issue.”