Rural opioid users tend to be younger, unmarried, have lower incomes, and are more likely to lack health insurance which may negatively impact the rural population’s ability to seek treatment and recover from illnesses presenting chronic pain.
In addition, the rural healthcare system is characterized by numerous resource, workforce, access, and geographic challenges that can complicate the delivery of care for Opioid Use Disorders (OUD).
An initiative called “Rural Opiate Addiction Management (ROAM), a telehealth-based model to help manage the widespread opiate addiction in rural communities, is a collaborative effort between Washington State University https://wsu.edu and the University of Washington, School of Medicine (UW-SOM) www.uwmedicine.org. The initiative is funded by the state’s Life Sciences Discovery Fund www.lsdfa.org.
The project offers a “virtual” clinical grand rounds on buprenorphine and addiction issues. The program also offers a training curriculum to meet the requirements for the Substance Abuse and Mental Health Services Administration (SAMHSA) www.samhsa.gov buprenorphine waiver. This waiver is needed from Drug Enforcement Administration https://www.dea.gov to allow the prescription of buprenorphine to treat addiction.
Despite the potential advantages of buprenorphine as opioid replacement therapy for addicted patients, few physicians have taken the course that allows them to legally prescribe this medication.
Project ROAM enables course participants and instructors to develop a mentoring relationship, plus provides practice management consultations on billing issues, the use of clinical protocols, and how to manage reporting forms.
Since many rural providers lack specialty pain management training, many rural providers are not aware of or do not adhere to the latest evidence-based opioid prescribing guidelines. To address this problem, the UW-SOM initiated a TelePain program to help primary care providers provide pain management and opioid prescribing skills.
This program includes weekly video conferences conducted with pain management specialists. The specialists present case studies from community clinicians, provide for interactive consultations with pain specialists, and how to use measurement-based clinical instruments to assess if treatments are effective and the outcome.
UW-SOM has also launched an online medical training tool referred to as “Collaborative Opioid Prescribing Education” (COPE) which is designed to improve interactions between prescribers and patients as they make decisions on their chronic opioid therapy. COPE uses videos to train providers on communications skills in order to help them make decisions as to how to present pain control solutions.
The State of Washington has adopted a bill that requires mandatory education on the use of prescription monitoring programs and clinical tracking tools. Also FDA intends to issue a risk Evaluation and Mitigation Strategy which may call for a coordinated risk management plan for patients taking long-acting opioids.