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.
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