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The Rural Opiate Addiction Management Project for Rural Washington Physicians

Register for our CME courses in Buprenorphine and
Office Based Treatment of Opiate Addiction under Training.

Roger A Rosenblatt MD, MPH, MFR
Vice Chair, Department of Family Medicine

Project ROAM emerged to address four key problems:

• the epidemic of deaths from prescription opioid overdoses
• the need for patients to have safe and compassionate treatment for pain
• the lack of effective tools in rural areas for providers to treat opioid addiction
• the lack of community-wide plans to prevent both harm to lives and harm from drug seekers defrauding family practices and emergency rooms

We now know that once a person becomes addicted to opioids, the brain changes physically and permanently, developing more opioid receptors that crave opiods. Despite the desirability of complete withdrawal from opioids, data shows that few individuals are able to successfully withdraw completely. Long term therapy can help people resume productive lives but methadone, the most common maintenance therapy for opioid addiction, is unavailable in rural areas.

Fortunately, in 2000 the federal government approved buprenorphine/naloxone (Suboxone®) or buprenorphine (Subutex®) for the office based treatment of opioid addiction. But despite its improved safety and availability in physician offices, very few physicians took the 8-hour course that allows them to legally prescribe this medication for the treatment of addiction. As of fall of 2010, only 35 doctors in rural areas of Washington State had received the federal waiver that allows them to prescribe buprenorphine/naloxone.

PROJECT ROAM’s goal is to decrease the rate of overdoses from prescription opiates by increasing the availability of evidence based treatment in rural areas. Project ROAM has a tri-part strategy:

1. Train rural physicians in opioids and help them apply for the waiver to legally prescribe buprenorphine.
2. Collaborate with Project ECHO. This Robert Wood Johnson Foundation/ Institute for Translational Health Sciences funded research project uses video conferencing to link rural clinicians to UW specialists for the care of complex patients with chronic pain, hepatitis C, and/or addiction. After Project ROAM trains clinicians, Project ECHO’s interdisciplinary, experts mentor them as they begin to treat addiction in their practices. Psychiatrists, addiction medicine physicians and expert family practice physicians are available to new practitioners weekly by video conferencing to help solve both clinical and practice based questions. CME is available per hour of participation. Informatics experts from Project ECHO are available to create convenient linkages – many physicians join Project ECHO their laptop over lunch.
3. Project ROAM also helps community practices address the non-clinical issues that may impede care for addiction. After training, physician mentors are available by phone or e-mail to discuss questions that arise with new prescribers. Project ROAM staff participate in community consultations so partners addressing addiction can communicate and work together to develop a common strategy. For example, community groups around the State are discussing values around the care of addicted infants, planning to reduce the total number of opioid doses prescribed in the community, having region-wide Emergency Department strategies to avoid unnecessary opioid treatment of chronic pain, and introducing new methadone clinics.

We welcome your participation.

For more information contact Dr. Roger Rosenblatt at rosenb@fammed.washington.edu , 206-685-1361, or Mary Catlin at 206-604-2403 mccatlin@uw.edu. For information about Project Echo, (PI Dr. John Scott), contact Kent Unruh at unruh@uw.edu or 206-724-1794.

Project ROAM gratefully acknowledges financial support from the Life Sciences Discover Fund, the Institute of Translational Health Sciences and the training support from SAMSHA.