Addressing Maine’s Opioid Epidemic

 

 

Maine Quality Counts (QC) and Maine Medical Association (MMA) launched “Caring for ME,” a collaborative effort that aims to bring together a wide set of partners to promote shared messages, educational resources, and practical tools for health care providers at the QC Annual Conference in April 2016.

The Caring for ME collaborative goals are to:

  1. Support prevention efforts
  2. Maintain a compassionate and trauma-informed approach to chronic pain management
  3. Improve the safety of opioid prescribing
  4. Appropriately diagnose addiction when it exists
  5. Improve access to effective treatments for patients with substance use disorder

Caring for ME History and Upcoming Work

Caring for ME Leadership Group

The Caring for ME Leadership Group was formalized in the spring of 2016 when Caring for ME was announced as a joint initiative between Maine Quality Counts and the Maine Medical Association at QC 2016.  Many leaders in this group had been providing oversight to QC since 2013-14 as QC leading the work on cohorts of the Chronic Pain Collaborative and then the Improving Medication Assistance in Primary Care (IMAT Project.).  The group was formalized to align efforts across the state to address the opioid epidemic and support safe opioid prescribing.

The group supports the Caring for ME Mission Statement:  “Caring for ME supports Maine clinicians to improve their management of chronic pain and safety of opioid prescribing, and improve the identification of addiction and referral for substance abuse treatment services.  To do this, stakeholders are convened to create a shared vision, promote collective leadership, and provide a range of supports, educational tools, and quality improvement methods to Maine clinicians and practice teams.  These efforts align with the US Surgeon General’s Turn The Tide Rx Campaign.”

Building Stronger SUD System of Care_CCSME_Prjct Rpt & Plan_04-29-18

Clinician Leadership Program

Supporting Clinical Leaders to Address the Opioid Crisis in Maine

Maine Quality Counts (QC) is working with thirty Maine clinicians (Physicians, NPs, PAs, and Pharmacists) to improve their ability to respond to public health crises, with a focus on leading change to address the opioid epidemic.  With support from a grant from the Physicians Foundation, QC is working with the Maine Medical Association over the next two years to offer an opportunity for up to thirty medical providers across the state to develop leadership skills to impact a range of public health issues, and specifically to develop stronger skills to lead practice and policy change needed to address the opioid epidemic.   The program is also being coordinated with the leadership work happening in the state with the Daniel Hanley Center for Health Leadership.   This program offers an important opportunity for health systems, hospitals, health centers, medical practices and other organizations to identify clinical leaders interested in cultivating their leadership skills needed to bridge health care practices and systems, community partners, and public health, and advance practice and policy change to improve population health.

Program Goals

  1. Provide clinicians with an understanding of the public health system and key community partners involved in the complex issues of substance use disorder (SUD) and addiction treatment.
  2. Develop leadership skills needed to influence health policy and address public health crises, with a focus on the current opioid epidemic and the pressing need to address cultural bias and stigma related to SUD and addiction.
  3. Mentor clinicians who are rising into leadership roles, and offer networking opportunities across the continuum of care to align initiatives across the state and increase the impact on population health.
  4. Develop effective communication and marketing skills, including the use of social media, to more effectively influence public policy and opinion around critical health care issues.
  5. Help clinicians understand how social determinants of health and poverty impact clinical and public health systems, and develop leadership strategies that acknowledge their role.
  6. Develop resiliency and mindful leadership tactics to address clinician burnout and improve morale.

Program Expectations

  1. Introductory call: Overview of the Program, September 15. Recording of Introductory Call: Overview of Clinician Leadership Program (video)
  2. Participate in four Caring for ME Leadership Educational Meetings (CME credits available):
    • November 8, 2017, 9 am-4 pm:  Caring for ME Leadership Kick-off Meeting (MMA, Manchester): gain a better understanding of the role of clinicians to address the opioid crisis and influence the public discourse on substance use disorder.
    • April 4, 2018, 8:30 am-4 pm: QC 2018 Conference (Augusta Civic Center); Caring for ME Leaders Breakout Session.
    • November 14, 2018, 8:30 am-4 pm:  Leadership Meeting at MMA
    • April 3, 2019, 8:30 am-4 pm : QC 2019 Conference Breakout Session, Augusta Civic Center
  3. Participate in Clinician Leadership Circles:  Participating medical providers join “leadership circles” that offer an opportunity for peer mentoring, support, and problem-solving with experienced clinical leaders and peers; discussions will be held as one-hour conference calls three to four times a year, with the goal of helping participants develop effective skills and strategies at the practice, community, and/or state level. They meet on a monthly basis when in-person meetings are not held. Peer Leadership Circle Leaders include Drs. Noah Nesin, Dora Mills, Lisa Letourneau, Erik Steele, Elisabeth Fowlie Mock, and Amy Belisle
  4. Attend at least three Caring for ME educational webinars a year (to be held 12N -1 pm; dates TBD): webinars will address key policy, public health, and clinical issues related to the opioid epidemic; participants will be asked to contribute and apply learnings in Leadership Circles.

Chronic Pain Playbook and MAT Resources

For practices providing chronic pain management and/or for those interested in developing a policy and protocol for the prescribing of controlled medications, the Playbook below will provide you with a step-by-step guide, recommendations and templates for working with patients with chronic pain or those who are prescribed controlled medications.

  • Navigate to the Resources tab if you are looking for documents and materials in relation the project
  • Navigate to the Learning Opportunities tab if you are looking for upcoming learning opportunities including webinars and online modules
  • Navigate to the Learning Archives tab if you are looking for past webinars

Resources for Clinicians Responding to Maine’s Opioid and Heroin Crisis

Improving the Substance Use Conversation: A Guide for Health Care Teams

QC Substance Use Conversation Guide

Stigma is defined as “a mark of shame or discredit”, exposing people to distorted experiences within their communities and robbing them of opportunities for success. To bring awareness of stigma surrounding people seeking recovery, Maine Quality Counts developed a guide for conversations about substance use for health care teams who were leaning in to address the opioid epidemic.  The guide provides example scenarios and scripting to employ person-centered language and empathetic responses when discussing issues related to substance use.  

Public Law, Chapter 488

Joint Rule, Chapter 21

HHS Final Rule on Medication Assisted Treatment

  • The US Department of Health and Human Services (HHS) released a final rule on Medication Assisted Treatment (MAT) for Opioid Use Disorders has been released, expanding access to MAT in an office setting by allowing eligible practitioners to request approval to treat up to 275 patients. The rule also includes requirements designed to improve patient care and minimize the risk of diversion.

Compassionate Tapering- Understanding Opioid Dosing and Morphine Milligram Equivalents (MME) Conversions

Using a Team Based Approach to Treat Chronic Pain

Medication Assisted Therapy and Buprenorphine Prescribing

Supporting Prevention Efforts

Embracing Drug Affected Babies and Their Families in the First Year of Life

Caring for ME Monthly Leadership Meetings

July 11, 2018

October 12, 2017

July 12, 2017

Caring for ME Past Webinars

September 11, 2018: Caring for ME: Eat, Sleep, Console (ESC) Overview

Speakers: Bonny Whalen, MD, Kelley Bowden MS, RN and Alan Picarillo, MD

August 21, 2018: Caring for ME: Broadening Behavioral Health Integration around Substance Use Disorder

Speaker: Jesse Higgins, RN, MSN, PMHNP

July, 17, 2018: Caring for ME: A Look at Opioid Prescribing in Maine Following Two Years of Experience with Chapter 488

Speaker: Gordon Smith, Esq

Presentation Materials:

June 12, 2018: Integrated Care for Pregnant and Parenting Women with Opioid Use Disorders

Speaker: Daisy Goodman

Presentation Materials:

June 5, 2018: Opioid Use Disorder, Overdose, and Naloxone

May 15, 2018: Breaking Down Silos: Enhanced Referrals between the ED and ARC

Speaker: Ranjiv Advani, MD, FACEP

Presentation Materials

February 6, 2018: Alternative Treatments to Pain

Speakers: Elisabeth Fowlie Mock

Presentation Materials

January 23, 2018: Update on Chapter 488

Speaker:  Gordon Smith

Presentation Materials

December 13, 2017: MICIS Improving Opioid Prescribing and Patient Safety

Speaker: Elisabeth Fowlie Mock

Presentation Materials

December 5, 2017: MICIS Improving Opioid Prescribing and Patient Safety: Part 2

Speaker: Elisabeth Fowlie Mock

Presentation Materials

October 31, 2017: MICIS Improving Opioid Prescribing and Patient Safety- Part 1

Speaker: Elisabeth Fowlie Mock

Presentation Materials

September 26, 2017: Strengthening Connections: Knitting Together Substance use Prevention in Schools, Communities, and Healthcare

Speaker: Liz Blackwell-Moore

Presentation Materials

July 18, 2017: Opioid Prescribing Regulations – Updates on Chapter 488 and Related Rules

Speakers: Gordon Smith and Stephanie Nichols

Presentation Materials

Past Chronic Pain Collaborative Webinars

September 10, 2015: Utilizing Functional Assessment in Chronic Pain Management

Speakers: Bennet Davis and Donald Medd

Presentation Materials

December 10, 2015: Team Approaches to Chronic Pain including Social Work, Behavioral Health & Integrative Medicine

Speakers: Shelley Cohen Konrad, Brent Scobie and Megan Britton

Presentation Materials

January 14, 2016: Expanding the Team when Caring for Patients Living with Chronic Pain

Speakers: Edward Bilsky and Stephen Hull

Presentation Materials

March 10, 2016: Marijuana and Chronic Pain

Speakers: James Li and Christian Teter

Presentation Materials

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Upcoming and Currently Available Learning Opportunities

Upcoming Caring for ME Webinars

October 23, 2018 – Caring For ME Webinar: Delivering Compassionate & High Quality Care for Hospitalized Individuals with SUD/OUD – REGISTER

Presenters are all affiliated with Maine Medical Center and include Amy McAuliffe, PMH-NP, BC, Psychiatric Nurse Practitioner, IMAT Program; Frank Chessa, Ph.D, Director of Clinical Ethics; and Melia Knowles-Coursin, RN, Nurse Leader. Reactors will include Jayne Weisberg, LADC, LCPC, Inpatient Psych Consult Service and Kinna Thakarar, MD, Assistant Professor of Medicine

ACP launches new interactive module on opioid prescribing!

ACP has launched its first interactive multimedia module on “Prescribing Opioids for Chronic Pain.” This engaging CME-eligible module provides an overview of CDC guidelines on prescribing opioids for chronic pain and allows users to review common clinical questions and receive feedback while learning. The module also includes embedded resources from both the CDC and the ACP.

This module is FREE to ACP members and costs a nominal $10 for non-members. Upon completion, members can take a quiz to receive CME and Maintenace of Certification (MOC) points. The credit may apply to opioid education requirements set by their state or local institution.

To visit the module, click here. To see more of ACP’s opioid resources, visit https://www.acponline.org/online-learning-center/opioid-therapy.

AMA Opioid Education Microsite

The microsite, www.end-opioid-epidemic.org, includes nearly 300 education and training resources across three major categories:

Recommendations from the AMA Opioid Task Force

  1. State medical society resources
  2. Medical specialty society resources

Physicians can use the site’s “State Selector” and “Specialty Selector” to find tailored education and training resources. The AMA Opioid Task Force also has identified numerous national education and training resources. The site highlights the progress physicians have made in using prescription drug monitoring programs, reducing the nation’s opioid supply, increasing treatment capacity and increasing access to naloxone.

To further support physicians and patients locating physicians authorized to treat opioid dependency with buprenorphine by state, each state-specific page includes a link to the U.S. Substance Abuse and Mental Health Services Administration Buprenorphine Treatment Practitioner Locator.

Online Tools and Resources for Managing Patients with Chronic Pain

Weitzman Institute’s PainNET is a free, online learning community designed to deliver the tools and knowledge needed for safe, appropriate pain care.PainNET supports providers with new ways to manage complex pain patients and to find alternatives to opioidsQuestions or comments about PainNET? Please contact the Weitzman Institute.

Online Modules Offering Certified Medical Education (CME) and Maintenance of Certification (MOC) Credits

Providers’ Clinical Support System for Opioid Therapies (PCSS-O)

Cost:  FREE

Credits available:  CME credits available for various 1-hour webinars and through online clinical vignettes

  1. Webinar Series:The National Council for Behavioral Health, supported by PCSS-O is sponsoring a series of webinars. The series features national experts who will present and answer questions regarding strategies to safely and effectively prescribe medications for the treatment of chronic pain, the overlap between chronic pain and substance use disorders, and evidence-based adjunct approaches to treating or managing chronic pain.
  2. Online Clinical Vignettes:Vignettes are designed to increase understanding of the current state of opioid use disorder, understanding of treatment issues for special populations and ability to assess and treat patients.
  3. Online Learning Modules:A library of clinical online modules is also available and enhance prescribers’ and other health professionals’ knowledge, skills and attitudes regarding safe and effective use of medication assisted treatment (MAT) of opioid use disorder.

Safe & Competent Opioid Prescribing Education (SCOPE of Pain)

Offered by:  Boston University, offered in collaboration with the Council of Medical Specialty Societies (CMSS) and the Federation of State Medical Boards (FSMB)

Cost:  FREE

Credits available:

      • 2 MOC Part II credits
      • 2 AMA PRA Category 1 credits

SCOPE of Pain is an online educational program that will help you safely and competently use opioids, if appropriate, to manage your patients with chronic pain. Learn how to:

  1. Decide on appropriateness of opioid analgesics
  2. Assess for opioid misuse risk;
  3. Counsel patients about opioid safety, risks and benefits;
  4. Competently monitor patients prescribed opioids for benefit and harm;
  5. Make decisions on continuing or discontinuing opioid analgesics; and
  6. Safely discontinue opioids when there is too little benefit or too much risk and harm

Pain Management/Prescribing Opioids

Offered by:  Massachusetts Medical Society (MMS)

Cost:  FREE

Credits available:  up to 3 CME credits per video

MMS offers online courses via video on topics related to:

  • End-of-Life Care
  • Medical Marijuana
  • Pain Management
  • Patient Safety & Quality Improvement
  • Communication
  • Practice Management
  • Clinical Medicine
  • Public Health
  • Ethics
  • Risk Management
  • Electronic Health Records

Extended Release/Long Acting Opioids:  Achieving Safe Use While Improving Patient Care

Offered by:  Interstate Postgraduate Medical Association (IPMA)

Cost:  FREE

Credits available;  3 CME/CE credits

The iBook covers all six units of the FDA Blueprint and includes video clips, case studies, poll questions, specific drug information, tools and resources, plus links to valuable websites.  Three CME/CE credits are available upon completion of the evaluation and assessment.

SAFE (Strategies, Assessment, Fundamentals, Education) Opioid Prescribing REMS 2016

Offered by:  American College of Physicians

Cost:  FREE

Credits available:  up to 3.75 CME and 3.75 MOC credits

This FREE online course, recorded at Internal Medicine Meeting 2016, features 6 half-hour educational recordings that you can complete at your own pace.  The course will guide you in prescribing effective opioid pain management medication while ensuring that the risks are minimized.  It will help you adopt best practices for administering all phases of therapy, provides evidence-based tools to help you screen at-risk patients, and equips you with patient counseling guidelines to achieve best results.

Chronic Pain:  Safe & Effective Strategies for Prescribing Opioids

Offered by:  Interstate Postgraduate Medical Association (IPMA)

Cost:  $280/learner

Credits available:

30 credits from your physician’s board for meeting MOC Part IV requirements for Performance in Practice and AAPA Category 1 PI-CME credits.

Together with your practice team, this virtual quality improvement project provides an opportunity to improve safe and effective strategies for prescribing opioids in patients with chronic pain, improve teamwork and receive Maintenance of Certification Part IV credit for practice improvement.  Your project will take 4-6 months to complete and will include 3 phases:  assess, improve and reflect.

The microsite, www.end-opioid-epidemic.org, includes nearly 300 education and training resources across three major categories:

  1. Recommendations from the AMA Opioid Task Force
  2. State medical society resources
  3. Medical specialty society resources

Physicians can use the site’s “State Selector” and “Specialty Selector” to find tailored education and training resources. The AMA Opioid Task Force also has identified numerous national education and training resources. The site highlights the progress physicians have made in using prescription drug monitoring programs, reducing the nation’s opioid supply, increasing treatment capacity and increasing access to naloxone.

To further support physicians and patients locating physicians authorized to treat opioid dependency with buprenorphine by state, each state-specific page includes a link to the U.S. Substance Abuse and Mental Health Services Administration Buprenorphine Treatment Practitioner Locator.

We would like to thank our CARING FOR ME funders which include: The Maine Attorney General’s Office, The Physicians Foundation, Maine Independent Clinical Information Service, and the Board of Licensure in Medicine