Since early 2019, I've had the pleasure to serve as clinical instructional designer, content manager, and grants program manager at a unique integrated pain and addiction medicine institute, part of the osteopathic medical school at my alma mater, designated as a State of New Jersey Medication for Addiction Treatment Center of Excellence (MATCOE). In these roles, I've primarily focused on continuing medical education (CME) funding/programming. Having the opportunity to transition from my grounding is an incredible honor.
I'm ever-grateful to have learned so much and still. Through this work, I've cultivated deeper empathy for all patients living in chronic pain and/or with substance use disorder (SUD)/addictions, and have zeroed in on the urgent need to eliminate disparities in social determinants of health (SDoH) and advance health equity for and with historically excluded populations and medically complex patients across the United States.
All excerpts from courses/content approved by our stakeholders.
The American Society of Addiction Medicine (ASAM) Placement Criteria outlines the treatment continuum as four broad levels of service, within five broad levels of care: early intervention, 0.5; outpatient services, 1; intensive outpatient/partial hospitalization services, 2; residential/inpatient services, 3; and medically managed intensive inpatient services, 4.
Within the five levels of care, there are decimals, 2.1, 3.1, 3.3, 3.5, and 3.7, to represent benchmarks along the continuum, meaning patients can move up and down in terms of intensity of their treatment, without necessarily being placed on a different level of care.
From our Comprehensive Overview of MAT CME course for licensees, part of the Opioid Medical Education Program.
Also through this work, my abilities are respected and stretched further by my physician leadership, and I'm proud to share that I've led a full portfolio of innovative, incredibly successful programming, primarily focused on the confluence of acute or chronic pain and preventing, treating, and/or reducing harm in substance dependence or SUD among special populations.
It cannot be understated how these multitude of distinctive and humanistic experiences have helped shape who I am today. I came into this work driven by healing and I continue with a clear understanding of my why—and for that, I'm forever grateful. Most importantly, I'm a kinder and more patient person, and I attribute that to all that I've learned in the field.
Across late 2020, as part of my existing role, I had the opportunity to collaborate with partnering physicians, part of my alma mater's allopathic medical school, to lead oversight of the MATCOE Training and Education Program. This experience resulted in a milestone outcome of medical licensees who completed our CME didactics, and the opportunity to become skilled in facilitating large-scale educational sessions with physicians and all prescribers.
With the confluence of the overdose crisis and pandemic increasingly impacting the state and on a global scale, I recognized that continuing on my path was where I could be helpful.
Left to right, clockwise: Medical students engaged in community outreach to increase access to and uptake of vaccinations (photos featured in our MATCOE reports); a licensee who participated in our MAT CME course in September 2020 and who began providing buprenorphine for OUD eight months later; and our COVID–19 Response Guide for New Jersey Licensees and Naloxone Distribution and Training Programs Guide, both part of OMEP.
This collaboration led to connecting on shared values and new colleagues creating and proposing a uniquely-designed role for me. I'm very happy to share that I've since continued in my initial position, albeit in a less consuming capacity, and have joined my new colleagues as content manager as of early 2021. In this role, I'm working closely with physician leadership and defining direction, establishing tone, and stewarding content strategy across departmental and institutional addiction medicine efforts. It's been a rush of new work and similarly, having the opportunity to continually collaborate and innovate.
Photo of MATCOE Emergency Department Addiction Pathways (EDAP) prototype.
My new work supports a full portfolio of pre-award to post-award clinical innovations, with initial focus on clinical design programming. Most recently, I had the opportunity to work with the addiction medicine medical director on the Emergency Department Addiction Pathways (EDAP) "bridge" innovation in a rural area.
This program has since launched (photograph above of addiction medicine prescriber education resources hub in the ED) and ensures patients can receive buprenorphine and naloxone sublingual film (BUP/NX SL) induction based on the Clinical Opiate Withdrawal Scale (COWS). All patients are discharged with a prescription; follow-up appointment for continued care in an outpatient addiction medicine setting; and health communication, focused on home induction guidance, education on all forms of opioids and harm reduction strategies, and SDoH resources. Bridge to methadone treatment is also available.
Together, we strategized and envisioned the compendium of clinical and educational resources. These resources consist of prescriber education and destigmatizing health communication written by the addiction medicine physician leadership team and I, from clinical and peer perspectives, and that I developed and designed. SmartPhrase templates are also created for various EMR.
After preparing and implementing the EDAP hub and promoting its launch, our prototype continues to be iterated and disseminated across statewide and national clinical networks. The project team is also pursuing funding to support alternatives to opioids for acute pain management in the ED.
Several factors underlie the development of OUD and the difficulty that patients can experience in meeting and maintaining abstinence: short-term direct and indirect mu–opioid receptor (MOR) agonist effects; neuroplasticity; and genetic, developmental, and environmental factors including the effect of stress on the hypothalamic–pituitary–adrenal axis (HPA).
MAT medications bind to MOR in the central nervous system (CNS) and peripheral nervous system (PNS), gastrointestinal (GI) tract, and vascular system. In the brain, MOR mediate opioids’ analgesic and other effects including euphoria, respiratory depression, and meiosis. Thus, through modulation of MOR, MAT medications are therapeutically effective in treating OUD.
From our Comprehensive Overview of MAT CME course for licensees, part of OMEP.
I'm immensely grateful to be helping drive this work—towards a future of dignity and respect for all patients living in pain and those with substance dependence or SUD, and/or other addictions/disorders. No shame, no stigma. A paradigm shift is needed and my hope is that our collective work influences tangible improvements across addiction and harm reduction policy—and that, in the very near future, the "X-waiver" is eliminated, and the full range of harm reduction services are widespread funded, sustained, and destigmatized.