Substance Use Disorder,
Medication Assisted Treatment,
Opioid Use Disorder
Kyle Kampan, MD, Professor of Psychiatry at the University of Pennsylvania Perelman School of Medicine describes his role with Centers of Excellence in advancing our training of primary care providers in Medication Assisted Treatment (MAT) and improving access to care for patients struggling with opioid use disorders (OUD). His work includes a focus on training primary care residents and helping providers overcome the stigma associated with OUD treatment. His bottom line: we have effective treatments, training is available, and the work is rewarding.
Q:What are the emerging educational issues for training primary care providers in IBH?
KYLE: One of the things that is important for providers to really understand is how to provide Medication Assisted Treatment (MAT) for patients with opioid use disorder (OUD) and that’s part of what I do here at the Penn Center for Excellence. I try to provide this training, primarily right now with the use of buprenorphine for the treatment of OUD. I hope someday to expand that so that we can start using extended release injectable naltrexone which is another very effective medication used for MAT.
Q: What are some of the most prominent issues around trainees?
KYLE: One of the things that we try to do with trainees is make sure they understand how buprenorphine works. I try to train them up on how it’s different as a medication and so we talk a lot about the pharmacology. We teach trainees on how to provide MAT; how to do it safely, how to do it effectively, how to take care of the patient and make sure they are well monitored and that they have adequate psycho-social treatment, all of the components to ensuring that MAT will be effective.
Q: What is the most promising innovation in IBH training that has caught your attention?
KYLE: At Penn, the Center of Excellence for the treatment of opioid use disorder has been very promising. We have successfully integrated the treatment of OUD into primary care and OB/GYN. The Center has treated several hundred patients with OUD in just its first year and the program continues to grow. One of the nice things about the Center for Excellence is they provide a lot of support services. There is a treatment screening center where patients with OUD can get interviewed and get set up for MAT. There is assistance in obtaining the laboratories that are necessary. There is assistance in getting the pharmacy and the prescriptions all set. Overall, it’s a very well-supported program.
Q: What are some of the most pressing challenges for educational programs?
KYLE: We have to continue to expand our treatment of OUD. We also need to improve our ability to treat comorbid psychiatric illnesses in our patients. One of the most important things to understand is that the patients with opioid use disorder not only have opioid use disorder, but also can have co-morbid psychiatric illnesses. They don’t always, but often, have a co-morbid psychiatric illness that needs to be addressed. Some of this is easy for the providers to do, others are a little bit more complicated and may need psychiatric support. So how to coordinate the psychiatric support for the physicians who are prescribing MAT to these opioid dependent patients with co-morbid psychiatric illnesses is a challenge that will need to be addressed.
One of the nice things about buprenorphine is that we can eliminate stigma because it is a medication that can be provided right out of a doctor’s office during a regular medical visit with primary medical providers who have that extra training. It significantly reduces stigma in that patients do not need to go to a methadone clinic, for example. It is a wonderful way to fight the stigma.
Q: What are insights you would like to share for providers new to the field?
KYLE: I think that many in the IBH workforce may feel intimidated by the challenge of treating OUD patients. My message is that we have the tools to treat these patients effectively. One of the things that I like to stress for new providers is that they don’t need to be nervous about doing this. Treating patients with opioid use disorder is rewarding, they are among my favorite patients that I treat. It is a very bad disease for sure, but buprenorphine is a very effective medication. The vast majority of patients are going to respond to it very well and treating these patients is extremely gratifying. The training is available and the work is rewarding, and there are guidelines, such as Substance Abuse and Mental Health Services Administration (SAMHSA), that are constantly releasing new resources. SAMHSA actually just came out with a new tip, Tip 63, which talks about the use of medications for the treatment of opioid use disorder -- that’s an outstanding reference. Another great resource is the American Society for Addiction Medicine (ASAM) guidelines for the use of medications for the treatment of patients with opioid addiction.
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