The Journal of the Arkansas Medical Society Issue 6 Volume 115 | Page 7

there are still relatively few physicians in Arkansas who provide MAT from any treatment setting. Ac- cording to research by UAMS, there are around 85 MAT-certified prescribers in Arkansas – and only about half of those are thought to be actively pre- scribing. Other states have far more certified pre- scribers – Tennessee, for example, shows around 800. (The Department of Health told The Journal that they are currently working on a better way to pinpoint exact num- bers of providers at any given time. SAMHSA shares some tracking of DATA-waived practitioners; search there to see, by state, how many practitioners are newly certified per year to provide buprenorphine treatment for opioid dependency.) practices, you have physicians who can prescribe medicine and then work with mental health profes- sionals to get patients to counseling (rather than the other way around). We must learn to better incorpo- rate MAT into primary care. I believe that’s what it’s going to take to have an impact on the opioid crisis. The opportunities are there. The goal we should be looking at is for any good-sized clinic to have one or two physicians who have taken the online training for MAT so that pa- tients can benefit from that.” Dr. Shelby isn’t alone in his thinking. In the New England Journal of Medicine editorial, “Primary Care and the Opioid-Overdose Crisis— Buprenorphine Myths and Reali- ties,” authors Sarah Wakeman, MD, and Michael Barnett, MD, encour- Dr. Shelby wants to see more aged primary care physicians to of- physicians take up this fight. As op- posed to a behavioral-health-cen- Michael Mancino, MD fer office-based addiction treatment ter-based approach, he would prefer to see more with buprenorphine and blamed federal regulations physicians adopt a primary-care-based approach to and misconceptions for their hesitations. “In part, treatment. “In a behavioral health clinic, you don’t the overdose crisis is an epidemic of poor access to always have physicians there who can prescribe the care. One of the tragic ironies is that with well-es- medication. I have a few patients in South Arkansas tablished medical treatment, opioid use disorder can who go to these centers for the behavioral health, have an excellent prognosis,” the authors said. “… but they must drive to me to get their medicine,” To have any hope of stemming the overdose tide, we he said. “In contrast, by going through primary care have to make it easier to obtain buprenorphine than Medical Board Legal Issues? Call Pharmacist/Attorney to get heroin and fentanyl … We believe there’s a realistic, scalable solution for reaching the millions of Americans with opioid use disorder: mobilizing the primary care physician workforce to offer office- based addiction treatment.” Pulling no punches, these authors debunked myths – particularly the idea that buprenorphine is simply “a replacement” and that patients become “addicted” to it. “Addiction is defined not by physi- ological dependence but by compulsive use of a drug despite harm,” they wrote. “If relying on a daily medication to maintain health were addiction, then most patients with chronic health conditions such as diabetes or asthma would be considered addicted.” Learning from the Experienced No matter the clinical setting, we can learn much from the experiences of those administering MAT. With that in mind, The Journal reached out to a handful of MAT clinics to find out more about their medicines, counseling, and practice habits. The Psychiatric Research Institute’s Center for Addiction Services and Treatment at UAMS includes both methadone and buprenorphine treat- ments. CAST incorporates individual and group therapy sessions into its treatment of opioid addic- > Continued on page 128. Give the Gift of Flight Training Pilots An Introductory Flight Lesson for only Since 1939 $99 Darren O’Quinn Perfect for Holiday Gift Giving 1-800-455-0581 Sit in the Pilot’s Seat as you Learn to Take Flight with a Certified Flight Instructor. www.DarrenOQuinn.com Since 1939 Contact Us Today and Go Fly! 501.975.9330 / learntofl[email protected] Little Rock, Arkansas 2 3 0 1 C r i s p D r i v e | L i t t l e R o c k | A r k a n s a s | 7 2 2 0 2 NUMBER 6 | c e n t r a l . a e r o DECEMBER 2018 • 127