AETNA

2017-0310 Yale Opioid Panel

TAPE: 2017-0310 Opioid Panel_02

[ 00:00:00 ] DR. HAL PAZ
My name is Dr. Hal Paz and I’m Executive Vice President and Chief Medical Officer of Aetna. I’ll be moderating this panel on the critical role of emergency room physicians and addressing the opioid crisis. The opioid epidemic is the leading public health issue facing our nation negatively impacting the lives of thousands of American families. The Centers for Disease Control and Prevention has estimated that in 2016, 64,000 Americans died of drug overdoses, 00:00:29 three times the rate in 1999 and up 21% from 2015. Furthermore, America’s addiction crisis has led to a two year consecutive decline in our country’s life expectancy. An alarming demographic trend we haven’t witnessed since the 1960’s.

While there is no silver bullet solution emergency department physicians are clearly on the front lines of this crisis. I have four experts here with me today to discuss how to best use ER visits as an opportunity for intervention. 00:01:04

First, Dr. Michael V. Pantalon, is a clinical psychologist and Senior Research Scientist in the department of Emergency Medicine who has been an addiction researcher at Yale School of Medicine for the past 20 years. He’s worked to define, develop and test brief negotiation interview, an ultra-brief adoption of motivational interviewing which has been the focus of several large scale federally funded projects. 00:01:30

Next, Dr. Gail D’Onofrio, is Professor and Honorable Chair of the Department of Emergency Medicine at Yale University and Physician and Chief of Emergency Services at the Yale New Haven Hospital. She’s international known for her work in substance youths disorders, women’s cardiovascular health and mentoring physician scientist in developing independent research careers.

Dr. Wilson M. Compton serves as the Deputy Director of the National Institute on Drug Abuse of the National Institutes of Health. In his current role, Dr. Compton works with the Director to provide scientific leadership in the development, implementation and management of NIDA Scientific programs. 00:02:10

Finally, Dr. Sandra Schneider, is currently the Associate Executive Director for Policy Practice and Academic Affairs at the American College of Emergency Physicians. She’s also Professor of Emergency Medicine at Hofstra University in New York.

Thank you all for joining me here at - this morning. Let’s begin with the first question. What’s the current state of the opioid crisis in the United States and what are the implications for emergency medicine? Maybe I’ll start with you Dr. D’Onofrio.

[ 00:02:41 ] DR. GAIL D’ONOFRIO, MD
Well, the current state is that we’re in a major crisis and as you have previously denoted that there are many patients that present with overdose and particularly overdose deaths. The rate of overdoses have increased 30% in the last year as reported by the CDC. And these patients come to us as well as people seeking treatment and for any other types of complications of opioid use disorder. So, it’s really important that we’re able to step up to the plate, recognize them and treat them.

[ 00:03:19 ] DR. HAL PAZ
Thank you.

[ 00:03:20 ] DR. WILSON M. COMPTON, MD
When we think about the opioid crisis it’s important to keep in mind that this is an evolving issue. Opioids are a broad class of substances. They include the legal substances, the prescription opioid medications and that was the hallmark of this epidemic from its early days in the 1990’s to about 2010. But, starting in about the late early 2000’s, up until the current day, heroine started increasing in - in its importance in terms of the overdose deaths. And then in the last two years we’ve seen illegal, illicit Fentanyl coming from clandestine factories overseas and then shipped directly to the U.S. 00:03:55 And because of its potency the number of deaths associated with Fentanyl have just skyrocketed in the last couple of years. So, that that’s the number one opioid killer in the U.S. right now.

[ 00:04:06 ] DR. HAL PAZ
Why is the emergency department a good place to engage patients with Opioid Use Disorder in conversations regarding treatment, Dr. Pantalon?

[ 00:04:14 ] DR. MICHAEL V. PANTALON, PH.D
Well, as a psychologist I - I like to meet patients where they are in terms of their motivational readiness to change, but in terms of reality, where they present, that’s the ED. And so we need to treat them right where they present. So, that’s from my perspective why that’s critical.

[ 00:04:30 ] DR. WILSON M. COMPTON, MD
I think I’ve been so excited to see Dr. D’Onofrio and her teams work at Yale as sort of the - the - the entry point into treatment for so many people that have an addictive disorder. The idea is that emergency departments unfortunately have begun to serve as primary care settings and indeed their - their - their - this role has been reflected in the work where if you’re going to be a primary care setting you - you better get people into treatment for their condition.

[ 00:04:58 ] DR. SANDRA SCHNEIDER, MD FACEP
It’s a fact that emergency departments are where the people come. When people in distress, regardless of whether it’s a medical emergency or even just a food emergency they come to our doors. And sometimes people say, well, that’s not an emergency, but it is to them. So, the reason that the emergency department is a good places, (sic) that’s where they are.

[ 00:05:21 ] DR. MICHAEL V. PANTALON, PH.D
And they come asking for help. That’s one of the best times to present a range of options that we think could be helpful. Whether they’re fully ready to accept all of them or not it’s up to them, but it’s a great time to ask.

[ 00:05:38] DR. HAL PAZ
Terrific. So, what are the challenges in motivating emergency physicians to detect patients with OUD and initiate Buprenorphine treatment?

[ 00:05:45 ] DR. SANDRA SCHNEIDER, MD FACEP
I think there are two main challenges. The first is that emergency physicians only see patients on their worst day. We only see them at their worse and we never see the success stories. The only people we see are people who have failed rehab or haven’t been motivated to get into rehab, and we never see the success stories. And so it becomes very frustrating to us that this is just another person because they keep coming back and back and back. 00:06:15 But, the ones we don’t see are actually the ones that are the successes.

The second thing is, we don’t often have the resources to do - to start medication, assisted therapies. We don’t have some - we don’t have social workers. Many of our emergency departments don’t have psychiatrists or even psychologists available to them. And so you have someone who you recognize the disease, you know what to do, but there’s no way to start it, there’s no way to get them into treatment. So, I think that’s the frustration.

[ 00:06:49 ] DR. GAIL D’ONOFRIO, MD
So, we’re trying to give them the tools to be able to do that. So, as Dr. Schneider said, that sometimes emergency physicians do not think it’s their job. But, just like other major life threatening illnesses, stroke, heart attack, we jump on them right away. And we have all kinds of procedures in order to get patients plugged into the right care. And Opioid Use Disorder is really no different. It’s a life threatening illness as we’re seeing so that we need to step up to the plate. 00:07:16 And if the emergency physicians have the right tools and understand how to do it, they can really start a whole new paradigm where they’re initiating treatment and accessing patients to care right then and we can show them how well that they’re doing.
Most of the time emergency physicians don’t understand that treatment does work. And so if we can explain that to them, if we can make it easier for them from the very process, from beginning at triage to back and see the doctor, to start and initiate treatment just like they would for someone who came in with horrible hypertension or someone with horrible hypoglycemia, we initiate treatment and we refer in a very well warmed handoff type of way. 00:07:57

So, now we’re trying to show doctors how they can do that. They can initiate Buprenorphine in the emergency department and they can then create a warm handoff. There is a huge problem in that there are sometimes not places to hand those patients off to. So, we’re actually helping them to partner with places in the community, actually in a lot of different initiatives from SAMHSA and other agencies or are getting money to those communities so that they can start treatment.

[ 00:08:23 ] DR. SANDRA SCHNEIDER, MD FACEP
One of the things the American College of Emergency Physicians is trying to do over this next year is to partner emergency departments with addiction treatment centers and [ clears throat] we’re looking at various models. I think Gail’s is an amazing model, especially in places that have resources. But, there are other models for places that don’t have resources, that don’t have people available to them and we’re trying to work with those communities to find - just link people. 00:08:51

You can’t imagine a person coming in with appendicitis and not being able to find a surgeon, but where I’ve worked I’ve had a person with a Substance Use Disorder and I haven’t had a referral.

[ 00:09:03 ] DR. MICHAEL V. PANTALON, PH.D
I think it’s also important when working with ED physicians to motivate them to combat their attitudes about Substance Use Disorder treatment that may have come from earlier training or just early life experiences. What we’re doing in the ED at Yale is different from what is traditional addiction treatment. Its evidence based approaches in terms of medication and counseling and that may be different than what they’re used to.

[ 00:09:30 ] DR. WILSON M. COMPTON, MD
Our role at the National Institute of Health is to support research that can test some of these really novel ideas. So, how can we take the ideas that come out of the Yale Emergency Department and test them in other emergency rooms. Even trying to adapt them to rural settings where the resources may be quite absent. And so we need to be thinking about Telehealth. We need to be thinking about sort of hub and spoke models for providing addiction treatment in those more rural areas. This is the kind of research that we’d like to support at NIH and NIDA.

[ 00:09:58 ] DR. MICHAEL V. PANTALON, PH.D
Yeah, when you look at a - a national heat map of opioid addiction and overdose and death, there’s a six-fold difference in different parts of the country between communities. So, I suspect, really in rural communities, those are issues that it become really an opportunity for trying to scale what’s being done. And in areas of the country where there’s, I guess, more experience than addressing the opioid epidemic, it’s really urban areas.

[ 00:10:21 ] DR. WILSON M. COMPTON, MD
What’s interesting because it’s hard enough to get treatment sometimes in New Haven, but if you can imagine how much more difficult that could be when they’re - when they’re no clinicians around, when there are no other resources available.

[ 00:10:30 ] DR. SANDRA SCHNEIDER, MD FACEP
When you have a single nurse and a single physician working in an emergency department and someone comes in and you realize there are no resources, you - you know, you’re going to spend hours on the phone maybe coming up with a phone number that that person can call the next day. That’s not appropriate and that’s why we want to try to make that warm handoff the same as if it was appendicitis.

[ 00:10:52 ] DR. WILSON M. COMPTON, MD
And I wonder if we can build on models, you know, from cardiology or diabetes care where we don’t have the resources for specialized care in many parts of medicine in - in - in these situations. So, how can we learn from how those problems were solved to solve this for emergency rooms?

[ 00:11:07 ] DR. SANDRA SCHNEIDER, MD FACEP
And that’s exactly what ASAP is doing over this next year, because that’s one of our chief initiatives.

[ 00:11:13 ] DR. GAIL D’ONOFRIO, MD
So, we’ve been really luck in the fact that we have received funding’s from NIDA and the NIH too, to sort of test some of these like the initial study that we did at Yale and then we’re looking at other places around the country. Now, we’re trying to see if we can implement it and for large cities around the country. We’re also looking at another study at how we can really sort of institute and test the feasibility in New Hampshire or in places that don’t have as many resources as we do in large cities.

00:11:44 So, we’re kind of working all that out. And in addition we’ve been able to create this tool base to help physicians and that’s partly by - as you have it, Aetna helped us create these videos on the brief negotiation interview. We have tools and algorithms and all kinds of things that we’re going to do and an interactive website, both that will sit both on the ASAP server and on the NIDA server so the emergency physicians can very quickly just tap on something and within a second retrieve the information that they need.

[ 00:12:15 ] DR. MICHAEL V. PANTALON, PH.D
I think it’s also helpful to keep in mind that the vast majority of Opioid Use Disorder patients do not necessarily need specialty care. Primary care based models of treatment - now my phycologist college will kill me [ laughter] for saying this.

[ 00:12:29 ] DR. SANDRA SCHNEIDER, MD FACEP
Right.

[ 00:12:30 ] DR. MICHAEL V. PANTALON, PH.D
But, as someone who has been involved not just in the emergency department, but in primary care, your internist with the correct training and our algorithms could effectively treat most of these patients who come out of the ED.

[ 00:12:43 ] DR. HAL PAZ
So - so, how do you motivate patients to accept treatment? So, we have the issue of resources in the community, let’s assume we have the resources, but now we have to engage with the patient and really motivate them to use those resources. How do you do that?

[ 00:12:59 ] DR. MICHAEL V. PANTALON, PH.D
A little at a time. That’s - but, the brief negotiation interview which is our counseling approach which anyone can use and you don’t have to be a psychologist or a therapist or an addiction specialist and in fact I think you might do it better if - if you’re not one of those because you’re trying to use motivational interviewing to help patients come up with their own reasons for change. So, a little at a time and focused on their reasons versus a more didactic approach where I’m telling the patient why they should change.

[ 00:13:31 ] DR. GAIL D’ONOFRIO, MD
In addition, we’re really focused also on harm reduction so that we know particularly in the patient that overdoses they can be very dis- dysphoric after they received a Naloxone rescue, they could not want to accept treatment. And so if we start the conversation and that doesn’t go that way, we also speak to them about harm reduction and that means making sure that they’re using in a safe place. We distribute Naloxone for them, we make sure that they have access to that or their friends have access to that. 00:14:02 And so we can do some education around harm reduction and then hopefully they’ll want to accept treatment at a later time.

[ 00:14:10 ] DR. WILSON M. COMPTON, MD
Dr. D’Onofrio’s raising a really important issue which is, what do we do with overdose patients who have been resuscitated that may not be interested in treatment? And that’s been a - a real problem all across the country. We’re conducting and supporting research now to test new models, whether that’s sending, you know, outreach workers after the fact to try to encourage people into treatment a day or two later when they may have - be in a different mindset than they were right at the time. 00:14:35

Or, can we do something of a - a - not just a warm handoff, but a more active handoff even in an emergency department or from other emergency medical services? These are the kind of promising models we’d like to test.

[ 00:14:47 ] DR. SANDRA SCHNEIDER, MD FACEP
And ASAP has been very much advocating for patients to go home with Naloxone, not just the patients that overdose, but to have Naloxone available and perhaps available as part of a - a sort of a save a life kit. You know, we have these AED’s all around the country, the idea would be putting Naloxone and a tourniquet in those AED’s so you have a whole sort of kit to save a life, because if you save that life you can then come back later when the patient is ready to take treatment.

[ 00:15:18 ] DR. MICHAEL V. PANTALON, PH.D
If I may add, I think two other issues are important here. I think when patients are resuscitated the staff has a sense or perhaps an expectancy that the person will of course accept treatment. This is the person who’s most likely to realize they almost died and they should go to treatment. And I think while dysphoria plays a part, treatment resistance plays a part, the difference between the expectation of the - of the physician and the patient may sometimes demote a person. 00:15:44 So, I would say, let’s not expect that they will as a matter of course accept treatment.

The other thing is that we’re - we’re testing tablet based brief negotiation interviewing other substances and I think that’s a promising tool down the road for people who, you know, need more support once they leave.

[ 00:16:05 ] DR. GAIL D’ONOFRIO, MD
And when you were talking about barriers, the other big barrier is around the administration and - and prescribing of Buprenorphine. So, you know, as you probably know you need a waiver in order to prescribe it which is eight hours, either four hours in a classroom, four hours online, and then, you know, you have to submit something to the DA. So, we’re really - we are trying to see whether we could somehow change that, but that’s a regulatory issue through - through ASAP, through other legislators, trying to see whether we could change that, 00:16:39 because an emergency physician doesn’t really need all that. They - they are able to under a 72 hour rule, they are able to administer a dose in the ED and that patient could come back two subsequent days for doses, but that’s difficult as you know, and it cost the healthcare system something to bring them back to the emergency department.
00:16:59 So, we’re not take - in general, emergency physicians may not be following patients routinely, a need to know everything that you have to know a part of that waiver course. But, if we were to be able subscribe for like a week or two weeks that would give us a better buffer to try to bridge people into some other clinic. So, that’s a huge barrier and we need to work on that in all different fronts.

[ 00:17:22 ] DR. SANDRA SCHNEIDER, MD FACEP
Yes, in fact, ASAP is working on that. The 72 hour rule is actually in place federally, but not recognized by many states. So, again this year one of our - one of the things we’re looking at is to take - look at those states that won’t allow us to do 72 hours and work within that state to try to change that regulation. And then in the states that do have the ability to do 72 hour administration, to promote that to the emergency department physicians. 00:17:54 But, again, the problem is if you do it for 72 hours and there’s no place…

[ 00:17:58 ] DR. GAIL D’ONOFRIO, MD
Nothing else.

[ 00:17:58 ] DR. SANDRA SCHNEIDER, MD FACEP
…for them to go in 72 hours, it takes two weeks to get into the clinic, the emergency physicians just going to get frustrated.

[ 00:18:05 ] DR. HAL PAZ
Right.

[ 00:18:06 ] DR. WILSON M. COMPTON, MD
We think there may be some useful scientific solutions to this by working with the manufacturers of these substances to create longer lasting formulation so they’re recently approved, longer lasting formulations of Buprenorphine that might play a role in emergency departments, because this may give you a way to administer the medication where it will last for a week or even a month at a time which allows a little better buffer in terms of getting access to care.

[ 00:18:31 ] DR. HAL PAZ
So, what are some of the ways that ED clinicians, physicians, but others in the emergency department can work to reduce the stigma of addiction?

[ 00:18:39 ] DR. SANDRA SCHNEIDER, MD FACEP
Right.

[ 00:18:41 ] DR. MICHAEL V. PANTALON, PH.D
Using the right language, so Substance Use Disorder versus substance abuse. A patient with a Substance Use Disorder versus and abuser or addict. I think that’s - that’s a key one.

[ 00:18:54 ] DR. MICHAEL V. PANTALON, PH.D
There’s some important work coming out of John Kelly’s group at Harvard where they’ve looked at how the use of language can really influence our attitudes towards patients. So, one of their studies provided patient vignettes to clinicians and they only changed one word. They described somebody as an substance abuser or they said a person with Substance Use Disorder. That was the only change in the description and they found [overlapping voices] the attitudes those patients were markedly different just based on that one change in language.

[ 00:19:21 ] DR. SANDRA SCHNEIDER, MD FACEP
And there may be other things we can consider. For example, we have particularly in Texas, freestanding emergency departments all over - all over the state. And one idea is to put - take addiction services to the patients in that type of setting or in another type of setting for example, going to their internist. If you’re the Mayor’s wife you don’t want to be seen going every day to the addiction center, all right? Even though you’re addiction may be to an opioid that wasn’t illicit. It may have been just to your Percocet. 00:19:53

[ 00:19:53 ] DR. HAL PAZ
Right.

[ 00:19:54 ] DR. SANDRA SCHNEIDER, MD FACEP
So, I think if we take the treatment to the patient you might see a better way and better acceptance by the patients and by the community.

[ 00:20:05 ] DR. GAIL D’ONOFRIO, MD
But, it clearly is that words matter and that we know that stigmatization is one of the reasons people don’t want to accept treatment. So, we have to be better at the words that we use and describe the patients as the person, the disease is the person, not as the disease. So, instead of saying addict all the time we’re saying it’s a person with an addiction or an Opioid Use Disorder and it’s really about not clean urines and dirty urines. You know, we don’t say that about hypoglycemia, but it’s a positive urine or it was a negative urine or that, you know, somebody returns to use. 00:20:36 And - and just - so if we can use the better terms then I think the public uses the better terms as that was a great study that showed - really made a difference instead of saying that word, abuse, like, whatever.

The other thing is that’s nothing to do - addiction is really nothing to do with willpower and sometimes people think it is. If I just will myself to it, if I have a better faith, if something happ- I would be better at - at being able to treat my addiction, which it has nothing to do about willingness or anything, that it is a neurological disease. 00:21:11 So, we need to make sure the public understands that. We need to understand that actually physicians understand that as well because many times we’re not getting people to the right treatment. We know that opioid agonist treatment is the best treatment and we need to get that and that means Buprenorphine or Methadone, those are the two best proven therapies.

And so many times people get into treatment programs that are abstinent based and we know that while that may help a few people, just like diabetes, some people can do well without medications, the majority of people cannot. So, we have to be really careful and understand that that type of program can really increase our overdose rates.

[ 00:21:54 ] DR. HAL PAZ
So, what new research is needed to better inform practice and policy from your perspective, what can we do?

[ 00:22:01 ] DR. WILSON M. COMPTON, MD
Well, I think there’s a great deal of research needed. I think we’ve already touched on at least one key topic that we’re quite keen on which is, when an overdose is experienced how can we use that as a teachable moment? It seems theoretically like - like it should be, but in practice it - it isn’t working out that way. So, what can we do to develop models of care that can move people and nudge people towards recovery in the long run?

We’re also pretty good at starting people on treatment or we’re getting better at that, but we’re quite poor at keeping people on treatment in the long run. 00:22:30 So, what can we do to develop models, whether that’s new medications that last longer so you don’t have to take your pill every day, but you may only need an injection once a month or less frequently. So, some of the medical approaches, but also behavioral approaches to encourage adherence and long term care.

Those of some of the key models. There’s also more basic science work that can be used to understand the basic mechanisms of pain. If an over reliance on opioids and the treatment of pain is the cause of this as crisis, what can we do to use - to develop medications that don’t have that addictive potential? These are some of the approaches that we’re taking at the NIH right now.

[ 00:23:08 ] DR. MICHAEL V. PANTALON, PH.D
I do also think that we need to get to these patients where they live and I think a lot more outreach and perhaps via text base models, but also training their loved ones in the brief negotiation interview, because loved ones are confused, they’re upset and they want to push, understandably. But, with just a few moments of the right effective motivational questions a loved one could motivate an Opioid Use Disorder patient to seek treatment.

[ 00:23:38 ] DR. SANDRA SCHNEIDER, MD FACEP
And in terms of policy as Gail mentioned earlier there is the reason to - to try to make both Naloxone available to the public and also the ability for emergency physicians to prescribe longer acting Buprenorphine and other medications and getting patients into treatment without going through an eight hour course.

[ 00:24:01 ] DR. WILSON M. COMPTON, MD
We haven’t touched on the importance of primary prevention as well. So, as much as the emergency department is going to be dealing with the end stage with the problematic behaviors once this is in - in full form. We’d like to do a better job of equipping - equipping families to raise healthy children and preventing people from moving down that pathway. We’d like to change the prescribing patterns of clinician (sic). These are some of the promising areas for research that we could do today that could make a difference very quickly.

[ 00:24:28 ] DR. GAIL D’ONOFRIO, MD
Yeah. We found, too, in certain research that the more opioid that you prescribe increases the probability of you being on long-term opioids. So, it was a great article that showed if we could do like, less than three days or around three days that you would only have a 6% chance of being on that after one year. Whereas, as if you prescribe eight or more days it can be up to 13% or 14% and 30 days you can be up to it as much as 30% likelihood. 00:25:00
We also found that unfortunately a study that happened in Pennsylvania looking at the Medicaid data that even after people overdose physicians were not likely to prescribe medications for their Opioid Use Disorder and also they didn't reduce the amount of opioid they were if they were on it for long-term care. So, there’s a lot of information we need to get to physicians as well - and prescribers as well as to healthcare systems and to patients in general so they’re more informed.

[ 00:25:31 ] DR. WILSON M. COMPTON, MD
There’s a unique aspect to the prescription of opioids in that it’s not just to the patient them self, that’s potentially at risk, but we look at where people get their medications that they misuse, they often get them from family and friends. Well, why do family and friends have them? They have them because the prescriptions that were written, either in an emergency department or after surgery or after injury are much larger and for a larger number of tablet (sic) longer and a larger number of tables than they’ll end up taking. People it turns out only take a handful of pills after most acute care situations.

[ 00:26:04 ] DR. SANDRA SCHNEIDER, MD FACEP
So, one of the things that ASAP is trying to do is come up with alternatives to opioids. And we are promoting things like Ketamine, Lidocaine, injections, nerve blocks instead of sending the patient home with an opioid, instead of giving them an opioid in the emergency department. And so we will be pushing those out and have been pushing those out as - so - so that emergency physicians don’t prescribe opioids. 00:26:29 This is something that can be done in primary care as well.

[ 00:26:32 ] DR. HAL PAZ
Right. So, actually that’s a great wrap up question and then I’ll ask each of you to maybe talk about what your organizations are doing to address the crisis and to promote best practices and we just heard a few…

[ 00:26:43 ] DR. SANDRA SCHNEIDER, MD FACEP
We just heard one.

[ 00:26:44 ] DR. HAL PAZ
…perfect example, so.

[ 00:26:45 ] DR. SANDRA SCHNEIDER, MD FACEP
[clears throat] So - oh, can I finish the rest?

[ 00:26:47 ] DR. HAL PAZ
Go on. No, please. Sure.

[ 00:26:48 ] DR. SANDRA SCHNEIDER, MD FACEP
So, the - the second thing we’re doing is trying to decrease the stigma that physicians have by providing them with examples of people who actually were successful in getting off of their opioids, again, the patients we don’t see. We’re surveying our membership to look for other barriers. We’re promoting as I mentioned the tying together of emergency departments to treatment centers and then advocating for emergency physicians to provide more - or to be able to prescribe Buprenorphine in the emergency department.

[ 00:27:21 ] DR. HAL PAZ
Terrific. Dr. Compton?

[ 00:27:24 ] DR. WILSON M. COMPTON, MD
Well, certainly the National Institutes of Health is working to use science as a solution to this opioid crisis. So, what can we do to improve the treatments that are available for people who may be at risk of overdosing, to resuscitate them more effectively? What can we do to make sure that we have better treatments for Opioid Use Disorder? And what can we do to treat pain more effectively? We just heard some wonderful examples of - of use of current technology, but we think we can do a better job by investing in - in basic research and applied research to develop new treatments. 00:27:53 That’s sort of the key model for the National Institutes of Health right now.

[ 00:27:57 ] DR. HAL PAZ
Great. Thank you. Dr. D’Onofrio?

[ 00:27:59 ] DR. GAIL D’ONOFRIO, MD
So, we’re going to try and continue to test new models of care and really push the envelope forward. In addition to that we’re trying to disseminate all this information that we have found at [ EL] and we’ve proven effectively and we’ve actually incorporated into our care. So, right now we have almost three quarters of my faculty who will the waivers and that - that involves like, just making it easier for them. So, when they are in the community and they’re working a lot of shifts I gave them a day off. 00:28:29 When they are faculty in the - in the academic part they don’t need that, but I helped get it set up by, you know, just really helping them make sure that it happens and that the courses are easily accessible.
And then we’ve - we’ve actually created processes and then trying to get this tool kit and everything embedded into our EHR’s are really important. We’re actually doing another study with NIDA also looking at how we can, in health centers, really adapt this to everybody’s EHR and then see if we can put some decision tools in place if people actually would use them. So, it - that’s exciting also.

[ 00:29:08 ] DR. HAL PAZ
That’s terrific. Dr. Pantalon?

[ 00:29:09 ] DR. MICHAEL V. PANTALON, PH.D
Sure, a few other things within our department. We’ve submitted for funding to bring screening and brief intervention, namely the BNI into our entire healthcare system and to support it with active training and follow-up. We’re also adapting the BNI to specifically have it work better with patients who have been resuscitated. And the third thing is, you know, the - the e-Health option, we’re working vigorously on that to have the BNI that they’re ready for these patients.

[ 00:29:41 ] DR. HAL PAZ
Terrific. Well, let’s stop there and let me thank you all so much for the very important work you’re doing to address this terrible crisis and to see what we can do to have an impact on the lives of so many Americans that are affected by it. So, thank you, very much, for being here this morning and thank you for your work. You’re welcome.

[ 00:30:00 ] DR. SANDRA SCHNEIDER, MD FACEP
Thank you.

[ END OF TAPE: 2017-0310 OPIOD PANEL_02: [ 00:30:01 ]