The Journal of the Arkansas Medical Society Issue 6 Volume 115 | Page 10

https://www.cdc.gov/violenceprevention/acestudy/
index.html
Additionally, search for “How Childhood Trauma
Affects Health Across a Lifetime (TEDMED2014) Na-
dine Burke Harris, MD, MPH, FAAP.”
American Society of Addiction Medicine
(asam.org)
The Substance Abuse and Mental Health
Services Administration
An accepted resource nationwide, SAMHSA.
org is a great starting point for all things opioids
in general. It contains research and information on
approved medications, statistics (new prescribers
by state, etc.) and research, training to satisfy DEA
requirements to prescribe MAT, and much more.
Hazelden Betty Ford (hazeldenbettyford.
org/education) contains an extensive amount of
documented research on both the medication and
the behavioral counseling sides of treatment.
Casey Bright
administered predominantly by MDs, with one APN
and one PA who work under the direct supervi-
sion of the MDs in their practice. The clinic has a
lower limit of allowable prescriptions per month
as mandated by the DEA. As Quapaw House con-
tinues to expand MAT throughout the state, we
welcome the opportunity to discuss MAT services
with interested physicians.”
At Quapaw House, counseling requirements
are determined by the patient’s treatment phase
– starting with more restrictive and frequent
counseling / self-help requirements and requir-
ing less as they progress. By the time they reach
their final phase of treatment, patients require
only monthly medication review visits with their
physician. “During each visit for medication re-
views, clients see a nurse, MD or APN, peer re-
covery support specialist, and a master’s-level
licensed clinician,” said Bright. “Even then, clients
are required to maintain sobriety as well as attend
community-based self-help groups and provide
proof. Clients must submit to a urinalysis during
each visit to evaluate medication and program
compliance.”
Real Challenges, Real Rewards
Society – and physicians with it – are caught in
the middle of a great challenge, as the AMA’s report
indicated. “Despite a national decline in opioid pre-
scriptions dispensed and an increase in the use of
prescription drug monitoring programs, the nation’s
opioid epidemic continues to worsen. Deaths due
to illicit fentanyl and heroin are now leading drivers
of the opioid epidemic. Now, more than ever, policy-
makers must join the AMA in not simply supporting
increased access to treatment, but by providing the
resources and effort necessary to remove barriers to
high-quality, evidence-based care.”
Is it time for you to consider offering MAT in your
clinic? The rewards can be immense. “It isn’t as hard
as it might seem. These are difficult patients, but not
any more complicated than other patients,” said Dr.
Shelby, who understands well that some physicians
may expect a large burden timewise or may fear
working with an addicted population.
Dr. Cale, who practices in Fayetteville’s Stock-
ton Medical Group, has found “nothing to fear.” The
former anesthesiologist was trained at UAMS before
practicing at St. John’s in Tulsa. Since 1978, he has
practiced in Fayetteville. Since retiring in 2012, Dr.
Cale has twice been recruited back into practice, first
in hyperbaric medicine and next in opioid treatment.
Reflecting on his 50 years in medicine, he made
quite a statement about his current work providing
MAT. “This has been the most satisfying thing I’ve
done in medicine,” he said. “It changes people’s
lives. You know, people lose their kids, their spouses,
their jobs … they’ll do anything to get their fix. They
can take this medication and live a normal life. They
can get their kids back. They can work. This changes
them immediately.”
Further Reading and Research
ARcare is currently developing a training for
PCPs and others interested in a treatment-based
MAT. For information, contact Frank Vega at (501)
322-9288.
The CDC-Kaiser Permanente Adverse Child-
hood Experiences (ACE) Study
130 • THE JOURNAL OF THE ARKANSAS MEDICAL SOCIETY
MATRIARC (Medication Assisted Treatment
Recovery Initiative for Arkansas Rural Communi-
ties), part of UAMS’ Psychiatric Research Institute,
is a resource for programs and health care profes-
sionals providing or helping others provide MAT. This
features mobile-friendly training access, weekly
teleECHO conferences with free CME, and access
via telephone. Through the program, Dr. Mancino
provides consultation to PCPs, general psychiatrists,
advanced practice nurses, physician assistants,
and mental health professionals who are providing
MAT to OUD patients. Early next year, the Arkansas
Psychiatric Society, with support from the Ameri-
can Psychiatric Association (APA), will sponsor local
trainings to allow those interested to obtain a waiver
to provide MAT without having to leave the state. Dr.
Mancino has been selected as the trainer for the
state of Arkansas. Those interested in learning more
about the benefits of in-person treatment are invited
to call Peggy Healey at 501-283-2612.
The New England Journal of Medicine (Jul
5, 2018)
Primary Care and the Opioid-Overdose Crisis
— Buprenorphine Myths and Realities
https://www.nejm.org/doi/full/10.1056/NEJMp1802741
The AMA Urges Removing All Barriers to
Treatment for Substance Use Disorder
https://www.end-opioid-epidemic.org/
Treating Opioid Use Disorder as a Family Phy-
sician: Taking the Next Step Am Fam Physician.
2018 Mar 1;97(5):302-306.
VOLUME 115