Psychiatry Resident Training in Buprenorphine and Office-Based Treatment for Opioid Use Disorder

1. Psychiatry Resident Training in Buprenorphine and Office-Based Treatment for Opioid Use Disorder Sara Olack, MD, PhD Cecilia Lau, MD Advisor: Jane Gagliardi, MD

2. Outline • Background • Barriers to clinical use of buprenorphine • Aims of our project • Results • Conclusions

3. National Overdose DeathsNumber of Deaths Involving Opioids

5. Opioid Abuse in North Carolina Source: North Carolina Health News

6. Goals of treatment

7. FDA Approved Medications • • Buprenorphine – partial agonist at μ‐opioid receptor • • Methadone – full agonist μ‐opioid receptor • • Extended-release naltrexone – antagonistat μ‐opioid receptors

8. Evidence for buprenorphine

9. Barriers to Use of Buprenorphine Financial • High out-of-pocket costs • Medicaid coverage across states is variable • Pre-authorizations Regulatory • DEA waiver (8 hr training for physicians) • Limited number of patients • Geographic • Lack of waivered providers, especially in the South, Midwest, and West Sharma et al. 2017

10. Physician Supply Knudson 2015.

11. Psychiatry Residency Training and Buprenorphine Residents who receive training may be more likely to prescribe in future practice • 38% of trained residents vs. 0% of non-trained residents in one study Suzuki et al. 2014

12. Barriers to resident training Suzuki et al. 2016

13. Resident Education Project: Aims • To increase psychiatry residents’ knowledge about buprenorphine • To increase the likelihood that residents will consider incorporating buprenorphine into their future clinical practice • To encourage resident completion of waiver training

14. Methods • Residents were offered two optional hour-long educational sessions on office-based opioid treatment • Based on APA’s online waiver training • An optional, anonymous pre- and post- assessment to with multiple-choice questions • Offered before and after the sessions • Assessed knowledge and attitudes • Duke IRB exemption and waiver for consent was obtained

15. Results • Participation • 30 residents (55%) completed a pre-session assessment • 28 residents (51%) completed a post-session assessment

16. Multiple choice questions unless specified (T/F)

17. Multiple choice questions

18. Knowledge Assessment

19. Attitudes Assessment

20. How do attitudes change? ≠

21. Conclusions • Residents are interested in learning about buprenorphine for OUD • Targeted teaching sessions increased knowledge about buprenorphine, but overall attitudes regarding use of buprenorphine in future practices remained the same • Without robust clinical and educational opportunities, residents may be less likely to use buprenorphine in future practice

22. References Knudsen HK. The Supply of Physicians Waivered to Prescribe Buprenorphine for Opioid Use Disorders in the United States: A State-Level Analysis. Journal of Studies on Alcohol and Drugs. 2015;76(4):644-654. Mattick RP, Breen C, Kimber J, Davoli M. Buprenorphine maintenance versus placebo or methadone maintenance for opioid dependence. Cochrane Database Syst Rev. 2014 Feb 6;(2). Sharma, A., Kelly, S.M., Mitchell, S.G. et al. Update on Barriers to Pharmacotherapy for Opiate Use Disorder. Curr Psychiatry Rep (2017) 19:35. Suzuki J, Connery HS, Ellison TV, Renner JA. Preliminary survey of office-based opioid treatment practices and attitudes among psychiatrists never receiving buprenorphine training to those who received training during residency. The American journal on Addictions. 2014;23(6). Suzuki J, Ellison T, Connery HS, Surber C, Renner JA. Training in Buprenorphine and Office-Based Opioid Treatment: A Survey of Psychiatry Residency Training Programs. Acad Psychiatry (2016) 40:498–502.