Tools for Medical Providers: Coping With Addiction
and Chronic Pain

In our last issue, we discussed the state of pain at UW Medicine — with a focus on the ground-breaking work being done by Alex Cahana, M.D., DAAPM, FIPP, and the Division of Pain Medicine. Cahana was deeply involved in the Washington State Opioid Reform Initiative, which seeks to reduce the over-prescription of narcotics.

Since then, we’ve learned of two initiatives to help providers grapple with the disparate problems of addiction and pain management. ROAM (the Rural Opiate Addiction Management) Collaborative seeks to help manage the widespread issue of opiate addiction in rural Washington. COPE (Collaborative Opioid Prescribing Education) is an online educational tool that helps providers communicate to patients about how best to manage treatment of chronic, non-cancer-related pain.

ROAM and ECHO: Defeating Opiate Addiction in Rural Washington

Roger Rosenblatt
Roger Rosenblatt

Until recently, rural physicians have had few tools to help their patients escape opioid addiction — an epidemic health issue in rural areas, with large numbers of unintentional overdoses, even deaths. Methadone maintenance therapy, the most common treatment for opioid addiction, is often unavailable. However, a federally approved medication called buprenorphine (also known as Suboxone or Subutex), is more readily available, and it’s a viable, office-based alternative to methadone.

Despite the potential advantages of buprenorphine as opioid replacement therapy for addicted patients, however, few physicians have taken the eight-hour course that allows them to legally prescribe this medication. As of 2010, only 32 rural doctors in Washington had received the federal waiver that allows them to prescribe Suboxone.

In late March, Roger A. Rosenblatt, M.D., MPH, UW professor and vice chair of the Department of Family Medicine, and UW Medicine’s ROAM (Rural Opiate Addiction Management) Collaborative helped remedy the situation by offering the course to rural physicians and members of their practice staff in Spokane, in conjunction with the annual Regional Rural Health meetings. Physician participants are then eligible to receive a waiver from the Drug Enforcement Administration to allow the prescription of buprenorphine to treat addiction. If they wish, they can also receive further mentoring and instruction from Project ECHO (Extension for Community Healthcare Outcome), a bi-weekly video-conferencing program that covers issues such as patient management, staff training and clinical protocols.

For more information on ROAM — a collaboration between Washington State University and the University of Washington, funded by the state’s Life Sciences Discovery Fund — contact Rosenblatt at 206.685.1361 or rosenb@uw.edu.

COPE: Online Education for Chronic Opioid Therapy

COPE

UW Medicine has launched an online medical training tool for doctors and other prescribing providers who treat chronic pain. Known as COPE — Collaborative Opioid Prescribing Education — the tool is designed to improve interactions between prescribers and patients as they make shared decisions about chronic opioid therapy.

COPE was developed over the past six years by Mark Sullivan, M.D., Ph.D., a professor in UW Medicine’s Department of Psychiatry and Behavioral Sciences and adjunct professor of bioethics and humanities, and it has been clinically tested and peer-reviewed. It’s a comprehensive program, one that goes beyond typical factual content by using videotaped clinical scenarios to train providers about goal-setting and communications skills. Tutorial models are in development for nurses and for patients and families to help enhance their engagement in decision-making.

COPE focuses on the management of chronic, non-cancer pain, and its interactive modules are a timely response to legislative changes concerning chronic opioid therapy. Recently, Washington state adopted a bill that requires mandatory education and use of a prescription-monitoring program and clinical tracking tool. In addition, the U.S. Food and Drug Administration intends to issue a Risk Evaluation and Mitigation Strategy (REMS) which likely will call for a coordinated risk management plan for patients taking long-acting opioids. COPE will help prescribing providers nationwide to meet this challenge.

For more information on COPE, contact Sullivan at: sullimar@uw.edu.

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