July 20, 2017

One small, rural Alaskan community known for its famous fishing along the glacial-fed Kenai River, like so many other regions of the country has been struggling with a growing heroin crisis that has left clinicians scrambling for solutions.

Central Peninsula General Hospital is a 40-bed facility located south of Anchorage that has seen a marked increase in the number of opioid-related cases. Clinicians are overwhelmed and have realized they are unprepared to treat the high influx of cases. With little background in treating opioid use disorder (OUD), clinicians knew they needed specialized training. Shari Conner, intake coordinator for the hospital’s behavioral health department, reached out to PCSS for help.

The heroin problem was “overwhelming our system of care,” Conner said. With a new 16-bed facility dedicated to treating substance use disorders about to open, Conner recognized the group needed some expertise. PCSS asked one of its mentors, Melissa Weimer, DO, MCR, an expert in opioid prescribing practices for chronic pain and treating OUD with medication assisted treatment (MAT), to work with Connor’s clinical team.

Ms. Connor reached out to Dr. Weimer and hired her as a consultant to work with them. Dr. Weimer recently spent two days in Soldatna, AK, a community of just over 4,000, training clinicians, therapists, and social workers on evidence-based opioid prescribing practices and MAT.

“One of the mysteries, said Dr. Weimer, was how heroin could have found its way to such a remote area of the state.” In a way, the region is a microcosm of what has happened throughout the country: excessive opioid prescribing, increased instances of OUD, increased heroin use, and increased overdoses.

“It’s an example of how devastating it can be for a community with prescribers who are not being careful,” Dr. Weimer said.

Excessive opioid prescribing practices opened the door to the higher potency and cheaper heroin that flooded the isolated area from Anchorage. Dr. Weimer described some of the opioid prescribing practices in the area as “rogue.”

Now, clinicians are trying to address what is now a serious problem of overprescribing opioids. During her visit, Dr. Weimer discovered what she called “loose” prescribing practices of buprenorphine, one of three medications the FDA has approved for the treatment of OUD. She found that clinicians were frustrated that patients were not responding well to treatment using buprenorphine. The reason? They were not following protocol and were prescribing at rates far below recommended levels.

Clinicians met Dr. Weimer’s trainings with enthusiasm, Conner said. Nearly 70 clinicians attended the two workshops presented by Dr. Weimer. One of these trainings, “Comprehensive Pain Treatment Options,” focused on how to better evaluate pain in order to choose appropriate therapies, with non-medication therapies and non-opioid therapies; and the second training “Health System Changes to Improve Addiction and Chronic Pain Care” described the successes of work in the Tri-County area around Portland, OR where Dr. Weimer had previously worked at the Oregon Health & Science University. At their program they wanted to change the community standard around opioid prescribing and increase access to effective treatment for OUD.

Ms. Connor noted that in an area with limited resources, PCSS can be useful to training clinicians in evidence-based practices, and the in-person training Dr. Weimer conducted was critical to meet our specific needs.

Now that Dr. Weimer is back in Albany, NY, she will keep in touch with Central Peninsula and continue to assist in their efforts to develop an evidence-based treatment facility. She has supplied the organization with treatment protocols and suggested the clinicians participate in PCSS and the clinical coaching/mentoring program.

“They have clearly committed to helping improve the health of their community and are on the right track to improving care for people who are struggling with opioid use disorder,” Dr. Weimer said. “Additional expertise, services, and funding will help them get there.”

For more information about PCSS-O and PCSS-MAT, go to www.pcssprojects.org.