A quick search for “opioid-use disorder” (OUD) brings up thousands of news articles from all over the country. It’s a high-profile problem—one that almost everyone is aware of, from senior public health officials in the federal government to the layperson in small town America.
But despite the prominence and urgency of this issue, OUD is not going away. If anything, the problem may be increasing: between 2010 and 2016, there was a nearly 500 percent increase in diagnoses of OUD. And every day, more than 115 people in the United States die after overdosing on opioids, according to the National Institute on Drug Abuse. The economic impact is also staggering. The Council of Economic Advisers has estimated that in 2015 alone the costs of the opioid crisis were more than $500 billion.
This national crisis requires an all-hands-on-deck approach. We need to forge partnerships that enable organizations to work together, focus on what they do best, and address the issue from every possible angle. There’s a role for everyone when it comes to curbing the crisis, including healthcare providers, public health professionals, law enforcement and the general public.
PAs, or physician assistants, are also well positioned to make a difference.
PAs are medical professionals who diagnose illness, develop and manage treatment plans, prescribe medications, and often serve as a patient’s principal healthcare provider. PAs work in all medical settings and specialties, and with more than 400 million patient interactions per year and 30,000 PAs practicing in primary care, they can have a significant role in supporting and treating patients affected by addiction. So, it is important to provide PAs and PA students with resources and tools to help them become part of the solution and reach members of their communities who need help. And there are multiple organizations and programs that aim to do just that. Here are some of the things our three organizations are doing to help increase PAs’ role in addressing the opioid crisis.
The PA Foundation, the philanthropic arm of the American Academy of PAs, has partnered with Allied Against Opioid Abuse (AAOA), a national education and awareness initiative to help prevent abuse and misuse of prescription opioids. As a member of the AAOA coalition, the PA Foundation is connecting healthcare providers, patients, and their families with resources to help prevent old or unused prescriptions from ending up in the wrong hands. In addition, the PA Foundation provides PAs and PA students with educational resources they can provide to patients and caregivers to educate them about OUD.
To bring this effort to life in a new way, the PA Foundation recently engaged with PA students at AAPA Conference 2018, recognizing the critical impact these future prescribers will have on their patients. This engagement resulted in more than 400 students signing a “Pledge to Pause Before You Prescribe.” The pledge is a symbol of their commitment to fully understand the patient’s family and medical history with addiction, discuss safe storage of opioids, and confirm the patient knows how to safely dispose of any leftover medication before prescribing an opioid.
The Physician Assistant Education Association (PAEA), the national organization representing the 235 accredited PA programs in the country, is also working on a number of initiatives related to the opioid crisis. In January, PAEA became a partner in a $12 million Substance Abuse and Mental Health Services Administration (SAMHSA) grant, which will support an initiative to encourage PA educators and students to treat OUD. This will include encouraging them to become eligible to participate in a five-year temporary DEA waiver program created by Congress in 2016 that authorizes PAs to prescribe buprenorphine as medication-assisted treatment (MAT) for OUD. MAT has great potential as an effective treatment, but it is not available everywhere it is needed. During the same 2010-2016 period in which the number of OUD diagnoses increased nearly 500 percent, the use of MAT increased only 65 percent. PAEA aims to have 30 percent of PA faculty and 30 percent of PA students waiver-eligible by 2020.
Equally important to improving education about OUD is expanding PAs’ ability to treat patients suffering from it. In 2016, AAPA advocated for Congress to create the five-year waiver program for PAs to be able to prescribe buprenorphine to treat OUD. AAPA is asking federal policymakers to make the waiver program permanent and to equalize training requirements for eligible healthcare providers to obtain a waiver. Last year, AAPA joined with the American Society of Addiction Medicine and the American Association of Nurse Practitioners to provide free 24-hour education to earn the MAT waiver. Completing this training helps PAs do their part to help patients break the addiction cycle by qualifying for a waiver to prescribe buprenorphine in office-based treatment settings. PAs may also be able to admit patients and write orders in opioid treatment programs; however, their ability to do so varies and is governed by state and federal laws and policies.
Also critical to improving OUD is integrated team approaches to treatment—something that comes naturally to PAs. One notable example is a rural health clinic and an associated federally qualified health center in Oregon that are using an interdisciplinary model to treat patients with OUD and have already seen positive results. Included in their treatment model are comprehensive behavioral health strategies, a combination that increases the likelihood for recovery. Both also take the concept of team approach to another level by utilizing behavioral healthcare providers, physicians, PAs, nurse practitioners, registered nurses, residents and medical students.
As all healthcare professionals understand, this is not a problem that will be solved overnight. It will take time and dedication from everyone involved in patients’ healthcare teams. It has to be a multi-pronged effort—one that involves enhanced access to education, prevention and treatment.
L. Gail Curtis, MPAS, PA-C, DFAAPA, is immediate past-president and chair of AAPA’s Board of Directors; Stephanie McGilvray, MMSc, PA-C is the president of the PA Foundation; and Lisa Mustone Alexander, EdD, MPH,PA-C is the president of PAEA.