Clinicians Trained in Medication Assisted Therapy for Opioid Use Disorder

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With South Florida facing a growing number of drug overdose deaths, the University of Miami Miller School of Medicine is training dozens of additional professionals to deliver medication assisted therapy (MAT) – an effective treatment for opioid use disorder.

“MAT is effective at improving retention in substance use disorder treatment and decreasing use of illicit opioids, and reducing overall mortality,” said Hansel Tookes, M.D., M.P.H., assistant professor of clinical medicine in the Division of Infectious Diseases. “With this program, we are beginning a major curricular change where every graduate of the Miller School will have the training required to prescribe these lifesaving medications.”

Dr. Hansel Tookes

On January 10 and 11, the Miller School offered training sessions to increase the number of health care providers who can prescribe buprenorphine and naltrexone, two of the medications used to treat opioid use disorder. About 115 physicians, nurses, physician assistants and medical students took part in the sessions, which were funded by a state opioid response grant, sponsored by Providers Clinical Support Systems and supported by the Miller School’s Addiction Training and Curricula Development: Integrated Opioid Education, and the State of Florida Department of Children and Families.

The training is part of a larger overall effort to integrate a longitudinal curriculum on substance use disorders into the NextGenMD curriculum, including case-based learning, interactive patient panels, overdose prevention training, and simulation sessions.

Under the Drug Addiction Treatment Act of 2000, providers can offer buprenorphine in an office-based opioid treatment (OBOT) setting provided they complete MAT Waiver Eligibility Training. UHealth’s Departments of Family Medicine and Internal Medicine recently implemented an office-based program allowing patients with opioid use disorder to be seen in a primary care setting rather than going to a specialized residential treatment facility.

“There are about 15,000 people in Miami-Dade who inject drugs,” said Dr. Tookes.  He noted there were 479 admissions to Jackson Memorial Hospital between 2016 and 2017 for injection drug-associated infections. In Florida, opioid overdose deaths increased from 2,175 in 2014 to 4,672 in 2016.

However, there are only six methadone programs in Miami-Dade and 148 waivered buprenorphine prescribers within 10 miles of the medical campus. “Our two days of training almost doubled the number of clinicians who are trained to prescribe these lifesaving medications,” said Dr. Tookes.

In the Friday session, Joshua Barocas, M.D., assistant professor of infectious diseases at Boston University School of Medicine/Boston Medical Center, told attendees, “The drug epidemic in Florida is not any different from Massachusetts or anywhere else in the country, and the incidence is much greater than in published national surveys.”

Dr. David Serota

David Serota, M.D., M.Sc., assistant professor of infectious diseases, led the Friday session, along with Dr. Tookes and Dr. Barocas, while Lindsay Cox, D.O., psychiatry resident at Jackson Memorial Hospital, and Tim Montrief, M.D., M.P.H., emergency medicine resident at Jackson, provided training on Saturday.

One of Dr. Tookes’ patients, Chetwyn “Arrow” Archer, also took part in the training, answering questions from attendees and giving his personal perspective. “I’ve been on buprenorphine for 15 months after 42 years of heroin use,” Archer said. “Now I have a job, and I volunteer at the Miller School’s IDEA Syringe Services Program.”

Dr. Tookes said patient-centered MAT can be highly effective in achieving recovery goals and leading to other positive outcomes, such as better relationships with family and friends, improved overall health, and the ability to hold a job.  “Listen carefully to your patients and help them make well-informed treatment decisions,” he said.

Reflecting on the importance of the sessions, Dr. Serota said, “We have a great need for expanding access to MAT in South Florida. We want our physicians and trainees to be able to deliver those services, understand the nuances of treating individual patients and spread that knowledge throughout our community.”