Efforts to curb the opioid epidemic include increasing access to care and reducing stigma, goals officials say a $1.6 million National Institutes of Health-funded, three-year study of pharmacy-administered, medication-assisted opioid addiction treatment promises to achieve.
The study is a collaborative effort between Rhode Island Hospital, CODAC Behavioral Healthcare and Genoa Healthcare, seeking the effectiveness of pharmacist-delivered, medication-assisted treatment, or MAT, the least-intrusive level of care for the condition, said Linda Hurley, president of CODAC, Rhode Island’s oldest, largest nonprofit outpatient provider of treatment for opioid use disorder.
The study’s success could lead to national adoption, said Traci Green, co-director of Rhode Island Hospital’s new NIH-funded Center of Biomedical Research Excellence on Opioids and Overdose.
Green, a senior research scientist at Rhode Island Hospital and The Miriam Hospital, wrote the grant application. She said she’s been interested in using this approach to opioid-use disorder for at least 10 years.
“It’s been a long time in coming,” Green said.
The medication in this study will be buprenorphine, Hurley said.
Typically, medication-assisted treatment requires patients to meet with an approved physician before being placed on an evidence-based treatment plan, Hurley said. The Drug Abuse Treatment Act of 2000 requires physicians to apply for a waiver to prescribe medications such as buprenorphine.
Under this study, Rhode Island is the only state in the country allowing pharmacists to manage patients with buprenorphine, an opioid used to treat opioid withdrawal.
“We’re happy to help with this study because part of our mission is to make sure people can receive care,” Hurley said.
The study will enroll 250 patients, with 125 of them receiving care from a pharmacist trained in addiction care, authorized under a Drug Abuse Treatment Act waiver.
‘We anticipate this will help them stay in therapy longer and relapse less often.’
KEVIN O’CONNELL, Genoa Healthcare director of operations in New England
CODAC will issue patients their initial prescription, and some may become eligible for continued care by a pharmacist if they are considered “stable” by their doctor. Hurley estimated about 10 would progress to pharmacy care, receiving treatment at one of six Genoa Healthcare pharmacy locations in Rhode Island. Genoa, a national pharmacy, outpatient telepsychiatry and medication-management provider, has locations in 48 states, serving more than 800,000 people. Partnering with Genoa makes sense, Hurley said, since their locations are often within existing health centers, where people are seeking other routine care, such as the Providence Center.
“MAT, along with psychosocial therapy, is considered by most experts to be the gold standard for treating substance use disorder,” said Kevin O’Connell, Genoa Healthcare’s director of operations in New England. “We’re excited to be part of the Rhode Island study because it promotes a greater role for pharmacists in the treatment of behavioral health issues and medication-assisted treatment. This approach expands access to much-needed treatment for the opioid epidemic.”
The routine part of the approach in the study is crucial, Hurley said, since the point of the study is to test the effectiveness of treating opioid-use disorder in the same way you would for high blood pressure.
That reinforces the idea that addiction is a treatable, long-term condition, such as diabetes, Hurley said.
That level of care, what Hurley describes as the lowest level of care, isn’t for every patient being treated for addiction. The people selected to receive treatment have been assessed as ready to manage their care with minimal supervision.
“That makes going to your pharmacist for a prescription a very logical step,” Hurley said. She added that it’s likely a few thousand opioid-use-disorder patients in Rhode Island are ready for such a maintenance level of care.
Green said the opioid epidemic is such a widespread problem that it makes sense to make treatment for opioid use disorder as smooth a process for as many people as possible.
“We want to break down as many barriers as possible,” Green said.
“It’s really, I think, the simplest way I’ve ever seen of doing it,” Hurley said.
Green said the study’s potential to show how addiction is a manageable disease promises to help reduce stigma that lingers in medical offices. Some medical professionals are still reluctant to welcome people being treated for addiction into their offices. The success of the study has the potential to change that in people’s minds, “making this condition just like any other,” Green said.
O’Connell said he agrees the study has the potential to improve access to care and lessen the stigma people experience while being treated for addiction.
“We anticipate this will help them stay in therapy longer and relapse less often,” he said.