Main description:

This book is an invaluable reference for medical practitioners seeking to integrate opioid use disorder (OUD) treatment into general medical settings, including primary care, the inpatient hospital, and the emergency department. It recognizes opioid-related deaths in the United States as a significant public health crisis and fills the gap in drug use and addiction treatment knowledge for care providers.

Timely and concise, opening chapters examine the history of OUD pharmacology and treatment, as well as the principles of care and treatment. Subsequent chapters analyze the shortcomings of current approaches to opioid addiction, including the high cost and low value of acute care delivered by minimally trained providers and the fixation on short-term detoxification and rehab. The book offers specific guidance for practical integration of effective opioid use disorder treatment into a range of healthcare settings. Chapters also discuss the unique complexities of caring for special populations with OUD, such as pregnant people and those involved in the criminal legal system. The book concludes with personal experience from individuals with a history of OUD.

Socially conscious and practical, Treating Opioid Use Disorder in General Medical Settings serves as a crucial evidence-based resource for physicians, nurse practitioners, physician assistants, nurses, and other healthcare professionals.

Contents:

1. Introduction: Opioid use disorder: the epidemic of our times (me)
2. Opioid use disorder pharmacotherapy; Understanding the history (potential Walter Ling, Mary Jeanne Kreek) -This chapter will review the history of OUD pharmacotherapy in the U.S., what we have learned from decades of scientific studies and clinical practice, and how to apply that knowledge to current patient care.
3. Reviewing the evidence: Integrated treatment models in primary care (Alex Walley, Chinazo Cunningham)-This chapter will review the evidence and best practices for integrating the full continuum of OUD treatment into primary care, focusing particularly on treatment with buprenorphine. This chapter will offer the reader a toolbox for providing this treatment, including guidelines around frequency of visits, toxicology testing, dose adjustments, and when more intensive treatment is indicated.
4. A reachable moment: Hospital based interventions (Zoe Weinstein, Anika Alvanzo)-This chapter will review the role of initiating addiction treatment in the genral hospital setting and linking patients back into community-based care, including primary care. This chapter will review the goals of inpatient addiction consultation, examples of team structures, and the importance of proactive pharmacotherapy initation.
5. Emergency department initiated care (Gail D'Onofrio)-This chapter will describe a model for ED-based intervention for patients with OUD, including a practical description of how to initiate buprenorphine in the ED and provide direct linkage into treatment.
6. Intertwined epidemics; incarceration and opioid addiction (Aaron Fox, Jody Rich, Bruce Trigg)-This chapter will describe unique issues and models for integrating addiction treatment into settings for people experiencing incarceration, including jails, prisons, and those under community supervision.
7. Novel models of care expansion; Project Echo (Miriam Komaramy, Colleen LaBelle)-Project ECHO is a telementoring model which has been used to effectively disseminate addiction treatment to rural healthcare settings that lack access to specialty support. This chapter will describe the ECHO model and the role of peer mentoring to increase provider comfort with SUD treatment.
8. The importance of interprofessional teams: defining roles (Chris Shaw, Laura Kehoe, Alyssa Peckham)-This chapter will review the important interprofessional roles in a team-based model of care. This will focus predominantly on the role of the clinical pharmacist and the nurse or nurse practitioner.
9. Integrating recovery coaches into medical teams (Chuck Weinstein, Marti Kane, Helen Jack, John Kelly)-Recovery coaches are increasingly being utilized in a variety of care settings. This chapter will discuss different ways in which recovery coaches are utilized and how other providers can best collaborate with recovery coaches when caring for individuals with OUD.
10. Supporting any positive change: harm reduction as an integral pillar of treatment (Jessie Gaeta, Kim Sue, Sharon Stancliff)-Integrating harm reduction into clinical practice is a crucial and often ignored component of addiction treatment, particularly in primary care. This chapter will review the philosophy and principles of harm reduction and provide practical examples of how to reduce the negative consequences of active opioid use. Examples include providing overdose education and naloxone distribution and safer injection education.
11. Training medical students, residents, and fellows in opioid use disorder management (Alex Walley, Michael Bierer, Tim Brennan, Jeanette Tetrault)-Educating medical students and residents in addiction medicine is necessary to develop a physician workforce which is capable of managing opioid use disorder. This chapter will provide examples for engaging and educating trainees in this field from clinician-educators.
12. Bringing primary care to opioid treatment programs (Christine Pace, Jonathan Giftos)-Another model for integration is bringing primary care to opioid treatment programs. This chapter will provide a practical overview of how to deliver primary care in an addiction treatment setting.
13. Patient-centered outcomes in opioid use disorder treatment (Yngvild Olsen, Robert Schwartz) -Historically addiction treatment has been centered on provider's requirements and goals rather than patients'. This chapter will provide a rationale for and examples of a patient-centered approach to treatment outcomes, including more flexible models
14. Incorporating a race equity framework into opioid use disorder treatment (Ayanna Jordan, Helena Hansen)The largest absolute increase in overdose deaths in 2017 occurred among black men in the U.S. and yet there has been a "whitewashing" of the current overdose epidemic that has centered largely on a narrative of the "innocent white victim." Racial disparities in access to and retention in opioid use disorder treatment persist and are notably evident in access to buprenorphine treatment. This chapter will critically examine racial disparities in our approach, policies and treatment models for opioid use disorder treatment and propose a race equity framework for care.
15. Treating opioid use disorder in general obstetric settings- including care for pregnant and postpartum women and the mother-infant dyad (Mishka Terplan, Adam Czynski, Davida Schiff, Jessica Gray)Pregnancy can be a time of incredible motivation for women and yet also of immense challenges. Harnessing that motivation and supporting women with opioid use disorder during pregnancy is crucial. However care during pregnancy is insufficient. Not enough attention is paid to the "fourth trimester" and the unique needs of women and the mother-infant dyad in the postpartum period. This chapter will examine the unique challenges of caring for individuals with opioid use disorder in the setting of pregnancy, from pre-conception to post-partum and beyond.