Project Description Narrative:
Until recently, the use of opioids for pain management was a common practice in the U.S. Increasing incidence of chronic pain, life stressors, and access to opioids in combination with comorbidities and past substance use are leading to the opioid epidemic. Opioid use disorder (OUD) causes a decline in the patient’s quality of life and increases healthcare costs to the individual and the system. The vast majority of individuals with OUD in the U.S. do not receive treatment. Wisconsin has experienced a significant increase in opioid-related overdoses and deaths each year. Milwaukee County experienced over three times the national average for opioid deaths, with a 75% increase in nonfatal overdose incidents since 2019 and a 53% increase in fatal overdoses from 2019 to 2021.
In Wisconsin overall, there are higher rates of opioid overdose deaths among male residents, younger (18-44) residents, and American Indian or Black residents; death rates are comparable between Hispanic and non-Hispanic residents. However, there are differences among counties. In Milwaukee County, there were higher rates of overdose deaths for men, people who were 45-64, Black, and non-Hispanic individuals. In Racine County, there were higher rates of overdose deaths for men, people who were 18-44, Black, and Hispanic individuals. Milwaukee County is approximately 26% Black/African American (non-Hispanic) and 15.4% Hispanic. Milwaukee and Racine Counties in the proposed catchment areas are the two most diverse counties in Wisconsin. Milwaukee is one of three counties that have statistically significant higher rates of poverty when compared to the rest of the state (17% vs. 10%). Wisconsin imprisons one of every 36 Black adults, the highest rate in the country.
As the county with the highest Black population, Milwaukee is home to many of this underserved population. Opioid agonist/partial agonist treatment with medication, including methadone and buprenorphine (BUP), is the most effective treatment for OUD and is associated with individual and societal benefits. While providers have been successful in establishing programs for induction (initiation) of treatment/medications for OUD (MOUD) with BUP in acute care settings of the emergency department and inpatient at Froedtert Hospital, they continue to struggle with finding appropriate contexts of care for MOUD after discharge. Additionally, treating patients with certain conditions, such as chronic pain increases complexity of the issue.
Although some types MOUD (e.g., BUP) have a growing evidence base as safe therapies those who suffer from chronic pain and OUD, the addictive nature of opioids and increased stringency of CDC guidelines surrounding prescribing of opioids for patients with chronic pain require healthcare teams to engage in evidence-based models for pain management. OUD is a chronic and relapsing disease. Additionally, clinician comfort and skills with BUP are limited, requiring novel and collaborative decision-making models for clinical care. So-called “adaptive” interventions rely on information from multiple sources to generate personalized treatment and decision making based on the patient’s needs. A multi-disciplinary disease management approach involving physician-pharmacist collaborative practice models (PPCPM) can improve pain, depression, and disability scores in opioid-treated chronic pain patients. This is currently not being utilized within the current system for pain management or OUD. This project will investigate the feasibility of establishing such a model.