Webisodes: Resources for Providers Who Work at Opioid Treatment Programs

I’m pleased to announce new resources for providers who work at opioid treatment programs. The Governor’s Institute of North Carolina and our state’s Department of Health and Human Services sponsored this work, which is a series of webinars addressing various topics encountered at opioid treatment programs. These webinars can be found here: https://addiction-medicine.org/training/otp/

Here are the topics:

Webisode 1: Safe Standard Inductions

Webisode 2:  8-Point Take Home Criteria

Webisode 3: Exception Requests

Webisode 4: Split Dosing

Webisode 5: Effective use of the NC CSRS (North Carolina Controlled Substance Reporting System)

Webisode 6:  Benzodiazepines, Alcohol, and Opioids

Webisode 7: Reinstatements

Webisode 8: Drug Testing

Webisode 9:  Standing Orders and Scope of Practice Issues

Webisode 10:  Admission Criteria and Exceptions

Webisode 11: Pain Management for Patients on Methadone or Buprenorphine

Webisode 12: Methadone vs. Buprenorphine

Webisode 13: Duties of an OTP Medical Director

Webisode 14: Interpreting Drug Screens

Webisode 15: Methadone, EKG testing and the QT Interval

Webisode 16: Medical Conditions that may Mimic Opioid Withdrawal

Webisode 17: Hospitalized Patients Returning to an OTP

Webisode 18: Special Dosing Orders for Tapers

Webisode 19: Neurobiology of Opioid Use Disorder

These webisodes were written by Eric Morse, MD, Lisa Wheeler, PA, and…me. We picked topics and wrote brief essays that became the scripts that Dr. Morse read on the Webisodes. Each time after one of us completed an essay, we emailed it to others for critique and adherence to current evidence-based literature.

Did we agree on everything? No, but we only disagreed on fine points, not on the underlying principles of good patient care. I’m pleased with the final product, as it represents our best efforts.

A few of the webisodes are dated because they were written pre- COVID. We’ve had changes in our state, allowing many more take homes under COVID exception provisions, so Webisode 2 is a little dated.

Dr. Eric Morse did the recorded presentations. I am allergic to video presentations, so I am very grateful he was willing to do these. Dr. Eric Morse is a fellowship- trained addiction psychiatrist, with over eighteen years’ experience working in this field. Dr. Morse did a wonderful job on camera, and the graphics that accompany the verbal information were clear and simple. These are short and concise webisodes, lasting between five to eight minutes.

I wrote about half of the webisodes and was surprised that I still learned much as I was writing.  I would write a paragraph, then wonder if there was newer data available, and I’d go back to do an internet search just to make sure. Sometimes I did find new data to include, improving my essay.

Nearly twenty years ago, when I first started working at an opioid treatment program, I was woefully underprepared. I did get a facility tour and several hours of information from a physician who was medical director at the time, which was great so far as it went. I could have used a manual to help me, and webisodes such as these would have been a godsend.

These days, we have all sorts of informational media: SAMHSA has published books, downloadable for free from their website, containing the basic information needed. TIP 63 is the latest iteration of this data. ASAM (the American Society of Addiction Medicine) has published guidelines for treating opioid use disorder with medications.

There’s the PCSS forum, sponsored by APPP, where providers can get a mentor to help guide them when using medications to treat opioid use disorders.

These webisodes are the latest educational supports available for free to any OTP providers and need to be watched if you are new to the field. Maybe they need to be watched even if you are “old” to the field like me. Sometimes I think I know something, but what I remember turns out not to be quite accurate

I am grateful to the Governor’s Institute and the NC DHHS for identifying this educational need and their support to fill the need. I especially appreciate Dr. Morse’s willingness to do the on-camera work.

Check out these webisodes and let me know what you think!

5 responses to this post.

  1. Posted by Tony Keen on November 18, 2020 at 11:10 pm

    Not so much a comment for this particular article, although it was good. I just wanted to say thanks for continuing the Blog and continuing to advocate for addicts everywhere. I have followed you through the beginning of my recovery which I didn’t take serious at all, all the way through the years to my now hopeful defeat of active addiction. The most powerful was your blog about Sublocade, which saved my life, job, and marriage. I appreciate all you do and there are probably hundreds of us out here that have gotten through addiction with you while you didn’t even realize it…keep up your great work and I would love to meet you one day

    Reply

  2. Posted by LynnAPRN on December 12, 2020 at 10:08 pm

    Wonderful job on the educational tools, as they will be a huge benefit for healthcare providers! As a nurse practitioner in recovery (two years and counting), I overcame my addiction to Percocet that I developed as the result of a spinal injury while working as a critical care nurse. I do not work with MAT patients (currently working in clinical research and working on my PhD), but love keeping up with the latest research and evidence based practice.

    Thank you for doing what you do, and your dedication to help others get better. Unfortunately, where I am located (not far from you — in the “bluegrass” state), the majority of providers working in this space are doing it for “the money”, as now word has gotten around that “there is money in addiction treatment”. I feel fortunate to have found my provider, who is board certified in addiction medicine, but Physicians like you are few and far between. One of my favorite addiction medicine physicians left my state a few years ago to practice in another state (Indiana) a short drive away, as he felt unsupported largely by the medical community here. I hope this changes! A little education can go a LONG way!

    I hope you have a wonderful holiday! Enjoy our blog immensely!

    Reply

  3. Posted by Evie Murphy on December 14, 2020 at 1:37 am

    I’m in a clinic in Danville, VA which is my 7th clinic since 2009. Methadone has been what saved my life, and as someone with mental health issues, and systemic damage from my drug use (liver, kidney and heart) I also deal with doctors regularly who aren’t as informed nor approving of methadone treatment. One thing that I am often surprised with, since it has been suggested to me by most of my treatment center physicians, is that it is recommended that some patients remain on medication assisted treatment indefinitely. It feels intuitively right for me, and compared to what I lived as an addict the restrictions placed on my life by the clinic’s take home responsibilities, the attendance and so on are unquestionably worth the commitment. I have been blessed with amazing counselors over the years (though not always, I’ve had some nightmares too) who care deeply and want for their patients to succeed to a degree that isn’t required. I’m not always sober, I lose my ‘phases’ from time to time and have to earn them back, but I no longer have a death wish, I pay rent and have both water and electricity. I live in a home with a lease rather than an abandoned house with a fallen in roof. I don’t wake up in pain, I don’t sell my body or my possessions for a hit just to feel normal. I don’t have outstanding warrants. I’m in a stable relationship, I take my psych meds. I’m not only employed, I have my own successful business.

    All that I am and all I have achieved is owed in part to people like you, doctors who have taken a difficult path. I can’t think of another physician’s track that has the potential for more visible success. Maybe oncology? Patients going from suffering, fear, sadness, loss…and seeing them regain life in a fight that you help facilitate. I can thank you for what you do, because you have undoubtedly saved people’s lives the way mine was. Thank you for choosing such a complicated path and a patient population whom many can’t or won’t sanction and support.
    Evie

    Reply

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