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Dr. Viviana Horigian Receives Grant from the National Institute on Drug Abuse to Launch an Opioid Treatment Program

According to the Substance Abuse and Mental Health Services Administration, only 15.3 percent of people with opioid-use disorder sought medication-assisted treatment in 2018. While the treatment has been the most effective for treating the disorder, primary care clinics, for instance, did not offer it – health system leaders and clinicians were hesitant about treating OUDs in primary care settings. Now, thanks to an implementation grant supported by the National Institute on Drug Abuse (NIDA), there are six health systems throughout the United States that do, including the University of Miami Health System (UHealth).                                              

The implementation grant, called the Primary Care Opioid Use Disorder Treatment (PROUD) Trial, began in February 2018 and has enabled participating sites to implement office-based addiction treatment programs within their health systems. The goals of this grant are to increase the number of patients who seek medication-assisted treatment, as well as to help guide health system leaders with information when deciding on treating opioid-use disorder in primary care.

Beginning with Florida, UHealth has been committed to becoming a part of the solution in addressing the opioid epidemic. In 2017, there were 3,245 reported overdose deaths involving opioids in Florida, which led the state to declare opioid abuse as a public health emergency. When Viviana Horigian, MD, MHA, associate professor of public health at the University of Miami Miller School of Medicine, heard of PROUD, she applied for and received the NIDA grant that enabled UHealth to participate in the trial.

“As a health system, it was really important to be at the forefront of the implementation of collaborative care models that could facilitate the provision of treatment for patients with opioid use disorders in primary care," Dr. Horigian said. "Historically, it has been difficult for primary care providers to support the treatment of patients with opioid use disorders in primary care."

Implemented by the Miller School’s Department of Family Medicine and the Department of Medicine’s Division of Internal Medicine, the OBAT program opened its doors on November 2018 and is now located in two primary care clinics at the Miller School’s medical campus. With the support of and in collaboration with a nurse care manager, providers can effectively diagnose and prescribe evidence-based medications for patients with opioid use disorders. The nurse care manager, in this collaborative care model, supports, tracks and connects patient with other important resources needed in recovery. 

“Overdose deaths are greater than deaths caused by car accidents or by gun violence. To address this epidemic, the U.S. Department of Health and Human Services has launched a five-point strategy. The first and foremost important approach is increasing access to prevention, treatment and recovery service," Dr. Horigian said. "Providing treatment for patients with opioid use disorders in primary care is in line with this key strategical point. Medications for opioid use disorders, such as buprenorphine and naltrexone, have proven to reduce mortality and are life-saving options for our patients.”  

Offering treatment in primary care clinics is more convenient for patients, as it helps in removing the stigma surrounding opioid addiction. Besides providing the medication-assisted treatment to treat the opioid-use disorder, the program provides various other resources for them, such as with evaluating their opiate use disorders, providing them with patient-centered care, as well as with Narcan, which rapidly reverses opioid overdoses, and with overdose education and training. 

“In most instances, patients prefer to obtain treatment in the same setting where they receive care for other medical conditions such as asthma, diabetes or hypertension. Patients prefer the convenience of receiving treatment in primary care. We have a long way to go in battling stigma for this chronic mental disorder, but providing treatment in primary care for cases that qualify is a huge step forward in this battle," Dr. Horigian added. 

Written by Amanda Torres
Published on July 2, 2019