Building The Workforce To Combat the Opioid Crisis

Relying on our existing clinical infrastructure is not simply enough to meaningfully combat the opioid epidemic. Currently, only 5-percent of prescribing clinicians have the required X-waiver needed to prescribe buprenorphine, the gold-standard, CDC-recommended medication to treat opioid use disorder. To make matters worse, most providers are limited to treating only 30 patients, meaning the vast majority of patients who need treatment simply can't access it. This has not and will not lead us out of the opioid epidemic.

Expanding access to care is at the core of Ophelia's mission, and as part of that effort, Ophelia has teamed up with the University of Pennsylvania School of Nursing to launch a new training program that will prepare students in the Family Nurse Practitioner program to support patients through didactic training modules and immersive experience treating patients with opioid use disorder (OUD). This program will help clinicians complete a portion of the requirements necessary to obtain an X-waiver, a license from the federal government to prescribe buprenorphine.

The goals of this program are twofold: first, to increase the number of available x-waivered clinicians in order to keep up with the growing crisis; and second, to dispel stigma and prepare incoming nurse practitioners for the realities of the epidemic they will face.

Through the new program, students work with clinician mentors to gain first-hand experience prescribing medication, and upon completing the training course, they will have completed the live portion of the X-waiver requirement. Up to 90-percent of the program is immersive clinician shadowing, which allows the students to learn non-stigmatizing tactics for treating OUD and provides exposure to patients, so they feel compelled to continue this work in their careers.

Instead of dipping into the small pool of clinicians who currently have X-waivers, this pilot program aims to expand the number of clinicians who are able to prescribe life-saving medication for people with OUD and educate a new wave of professionals who are inspired, engaged, and ready to combat the opioid epidemic. The University of Pennsylvania School of Nursing’s terrific staff coupled with Ophelia’s leading clinicians and researchers is poised to create a truly meaningful training program that will save lives.

To better understand the breadth of the crisis and the institutional challenges that accompany it, let’s take a look at Pennsylvania. The latest available CDC data show that the state faces the fifth highest drug overdose death rate in the country –  with 38.2 deaths per 100,000 – and ranks third in the overall number of deaths per year. Driven by opioid use, Philadelphia surpassed 1,100 overdose deaths. But in spite of these staggering numbers, options for care are scarce. More than half of Pennsylvania counties have fewer than ten clinicians licensed with an x-waiver to prescribe buprenorphine to treat patients with opioid use disorder, and since the number of patients each prescriber can treat is capped, that is not nearly enough to treat all the people who need it.

This inadequate access to life-saving treatment has grave consequences – and Pennsylvania is not alone in lagging behind. Only 102,570 clinicians of the more than 1.3 million physicians, and nurse practitioners licensed to prescribe medications have x-waivers. This means that, as the growing number of Americans fatally overdosing on opioids over the most recently-recorded 12-month window surpassed 100,000 deaths, only about eight percent of available clinicians are actually licensed to provide treatment that saves lives and significantly reduces the chance of relapse.

As a harm reductionist focused on increasing access to opioid use disorder treatment, I have seen firsthand the level of intense and immersive care needed to save lives. I have seen patients get turned away from the only primary care clinic in a rural county because neither the clinic nor the provider was equipped to offer this first-line treatment. I have listened to countless stories from patients saying that their drug dealer is the only local buprenorphine source in their town. I have talked to patients who have driven six hours, in each direction, on a weekly basis, just to get to the nearest x-waiver provider. This is not sustainable, this is not equitable, and this is not good healthcare.

But most nursing schools in the country do not yet have programs to equip clinicians to deliver this kind of care for patients with opioid use disorder. As a result, for many young nurse practitioners entering the workforce, their first experience treating a patient with OUD may be jarring and clouded by existing and deeply-ingrained stigma.

The emerging generation of clinicians is going to be pivotal in turning the tide of the opioid epidemic, and it’s critical that we in the medical community prepare them with the immersive training they need to provide support for patients with OUD.

The emerging generation of clinicians is going to be pivotal in turning the tide of the opioid epidemic, and it’s critical that we in the medical community prepare them with the immersive training they need to provide support for patients with OUD. At Ophelia, we are taking this moral imperative to heart. Since the program launched in January, students have already completed over 300 shadow hours.

Still, we need more academic education, community programs, and evidence-based resources to inspire the next generation of health care professionals to create lasting change. This program reaffirms our commitment to serving even the most vulnerable communities in our city, and we look forward to a great collaboration that will provide the necessary tools that clinicians need to make a difference. We expect that this collaboration will establish a replicable model for other schools across the country.

We have the life-saving tools at our disposal to combat this growing epidemic, but the current state of access and resource distribution is simply not enough to keep up. It’s going to take a collaborative, concerted effort to eliminate barriers to care, and we are proud to work with the University of Pennsylvania School of Nursing to train and expand the reach and impact of clinicians on the front lines of the crisis.

Author of the blog post
Emily Behar, PhD MS
VP, Clinical Operations


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