Transcription:

Melanie Cole (Host): Welcome to Expert Insights with the Carle Foundation Hospital. I'm Melanie Cole, and I invite you to join us as we're discussing the opioid treatment fellowship with Dr. James Besante. He's an addiction medicine physician with the Carle Foundation Hospital. Dr. Besante, welcome back to the show. Before we get into the treatment fellowship, tell us a little bit about the current state of the opioid epidemic in the country as we see it now.

Dr James Besante: Well, unfortunately, since the last time we spoke, things have not improved. In 12 months during the pandemic, data shows that over 100,000 Americans died of overdose. That is an over 30% increase from the overdose numbers the preceding year. So in fact, things have worsened. More individuals are dying of overdose and more of our patients are being affected.

Melanie Cole (Host): Wow. That's quite a statement to be made and really sad to hear. I mean, the pandemic caused such a mental health crisis anyway, and the addiction combined with that is really a difficult nut to crack, right? So tell us a little bit, as you see it now, some of the strategies that you are looking at as an expert in this to help training practice providers to treat opioid addiction, things that they should be looking for, whether it's been the originator of pain management. Tell us what you're doing as far as this is concerned.

Dr James Besante: So what we've identified are that for many patients, who may meet this criteria of having an opioid use disorder or concerned about their opioid use, who are at risk for overdose, they can not access evidence-based treatment. There are many reasons for that. Oftentimes the right information doesn't exist with the right person at the right time. Most providers are not familiar with how to treat opioid use disorder. They are not familiar with the medications that we prescribe to treat the disease. And so the goal of the fellowship is to empower practicing providers to offer this service to their patients. And we're trying to do more than just have the right doctor prescribe the right medication for patients. We're also trying to combat stigma because what we know is that less than one in ten individual, who could benefit from addiction treatment, are accessing services in a given calendar year. So the people who are coming to us, looking for care, that's the tip of the iceberg. We're really only talking about 10% or less of people who would benefit from addiction treatment.

Why are people not accessing care? Well, there are many reasons for that. A big reason is stigma. People are ashamed of their addiction, and they're not reaching out for help when they need it. So part of our program is also to help train providers, how to combat the stigma in their clinic. We've created a community outreach team, a three-person community outreach team that's going to communities, meeting with shareholders, stakeholders, and helping to support the community, especially the communities that are being most affected by the overdose epidemic, which happened to be rural communities in the Carle service area.

Melanie Cole (Host): Well, I certainly agree with you. Many of the treatment options that we have available have been really underutilized and getting more people into them. But I think also besides that stigma is the fear of that change, the fear of how difficult something like this is. As you mentioned, rural areas like the Carle Foundation Hospital area, what are some of those barriers for treating the addiction? Is it outreach? Is it the travel? What have you seen?

Dr James Besante: Well, it's multifactorial. One of the most powerful weapons we have in this fight is a drug called buprenorphine. It's a game-changer. It's a life-saving medication. If we treat three patients with buprenorphine, we have a positive outcome or a change in an endpoint we don't like. So the number needed to treat is three, and that's amazing. When physicians talk about number needed to treat, when you may be talking about a statin to prevent a heart attack, well, you need to treat 35 to 37 individuals with a statin to lower their cholesterol in order to prevent one heart attack. When it comes to drugs like buprenorphine to treat opioid addiction, our number needed to treat is three. These drugs are amazing. There are few medications that exist in Western medicine as efficacious as a drug like buprenorphine as it treating opioid addiction. When I start a patient on buprenorphine, I've reduced the odds of that person dying by overdose by six fold in six months. That's amazing. I will stand that up to statins any day of the week.

Unfortunately, prescribing these drugs is complex. Providers need a waiver or a special DEA number to prescribe this drug to treat patients. Previously, providers needed to complete a training course before being able to prescribe it. Changes in federal laws and regulations that govern the prescribing of these drugs have made it somewhat easier to prescribe.

Now, providers can create a notice of intent to prescribe, but the training and the comfort and clinical support that providers need to offer this type of treatment does not exist in many communities. So part of the treatment fellowship is that we're training the providers or providing them with technical and clinical support in their clinics to offer this treatment, this life-saving treatment to their patients. We're helping them develop protocols and policies within their clinic. And we're also looking at expanding training for other staff in the clinic, from nursing staff to medical assistants, even the front desk staff can have a meaningful impact in patient's comfort with accessing treatment to treat something like opioid addiction.

Melanie Cole (Host): That was so much great information about the medications and about providers and what they have to do as far as insurance, because obviously that's a big barrier. So how are the outcomes when you're doing this type of training? How are the providers responding to this and taking it forward to their practices?

Dr James Besante: Well, the numbers are amazing. So this type of training program was first implemented in New Mexico. That's actually where I was born and raised, was in New Mexico. I went to medical school in Albuquerque, New Mexico. And one of my research mentors when I was in medical school was a liver specialist named Sanjeev Arora. And Dr. Arora wanted to help treat patients in rural communities with hepatitis C, viral hepatitis C. And he found that he could train providers, rural primary care providers, sometimes many years out of their medical training to treat hepatitis C infection just as well as a liver specialist in an urban academic center. And he published several papers to that effect, that with the right training and right support, you could empower any health care provider to provide the level of care that a specialist could in a resource-rich academic institution.

They then took that model, this idea that you could connect a community of practicing providers and empower them to treat their patients, and they applied it to many other diseases, including behavioral health illnesses, including substance use disorders. And so, many places around the world now utilize similar training programs here in the state of Illinois. Rush was leading similar fellowships for several years. I was one of the content experts on the Rush Fellowship Training Programs. And we were fortunate at Carle to receive a large grant, the State Opioid Response Grant. And with that money, we put together a team to create a similar training program that's been used around the world and already in Illinois through Rush and developed that at Carle. We are currently training our first cohort of fellows. These are primary care providers, OB-GYNs. We even have a palliative care doctor and a physical medicine provider on these calls. It's a diverse group of providers, mostly advanced practice providers like nurse practitioners or PAs. Many of our fellows are also physicians and we've been running this for several months now. We're really excited about our results. We're showing clearly that more providers are offering these types of services to their patients.

And more importantly, when we look at provider self-efficacy, the providers feel empowered. They feel a new sense of duty and connectedness to their community. They enjoy the work they're doing, and they love offering the service to their patients. So we've had really incredible responses from the providers involved in the program.

Melanie Cole (Host): What an excellent model and so desperately needed not only in Illinois, but all around the country. Final thoughts, Dr. Besante, and what you'd like other providers to know, and really how you'd like them to get in touch with you if they are interested in exploring the opioid treatment fellowship model.

Dr James Besante: So my final thoughts on this topic are these: the opioid epidemic, the drug epidemic, as it exists in America today could never have happened without healthcare providers and their prescription pads. Prescribed opioids beginning in the late 1990s and early 2000s exploded across this country and are largely responsible with our current situation. And I say that because healthcare providers, organized medicine, our healthcare systems in general have to be part of the solution moving forward. It is going to take all of us working together to address this issue. There will never be enough of me. There will never be enough addictionologists or fellowship-trained addiction doctors working in this realm, and that will never address the problem. The scale is too large. It's going to take a lot of healthcare providers biting off a piece of this. And through our combined efforts, we are going to turn around the overdose epidemic and the task at hand is large. I'm really excited about collaborating with more institutions, shareholders to come up with creative solutions to confront the drug epidemic.

If you're interested in this type of a training program, I encourage you to reach out to us. We have a website that's gone live with more information and the application to fill out if you'd like to join our next cohort of fellows. That weekly seminar is one-hour long. It's Wednesdays at noon. We get together, all the fellows, a team of kind of renowned experts in the field, we bring together people from all over, not just in Illinois, but we'll have visiting experts from outside the state join the calls. It's collaborative. It's case-based. We're helping fellows take care of real patients they see in their clinics. We meet for one hour a week. It kicks off with an entirely online interactive weekend immersion course, that will be May 14th and May 15th. And then the weekly fellowship will start June 22nd. If you're at all interested, I'd love to forward out the link to our website and to the application to fill out. And if you have any questions, please reach out to me. My email is james.besante, that's B-E-S-A-N-T-E at Carle.com. I'd be happy to send you the flyer, answer any questions, and there'll also be a link to the website available. So please reach out to us. We look forward to answering your questions and having more people join the program.

Melanie Cole (Host): Well, I certainly hope so too. And thank you, Dr. Besante, for all the great work that you're doing and for the great information you gave us here today. For more information and to get connected with one of our providers, you can visit carle.org or for a listing of Carle providers. And to view Carle-sponsored educational activities, please visit our website at carleconnect.com.

That concludes this episode of Expert Insights with the Carle Foundation Hospital. I'm Melanie Cole.