Summary
Kentucky has one of the highest rates of opioid prescription and addiction. High levels of opioid-based coping patterns co-exist with high levels of health disparity and lack of access to healthcare in disenfranchised populations with a high rate of co-morbid trauma. Patients present in primary care with a complex interplay of medical, dental, and mental health problems that create treatment obstacles, increase provider burnout, and lead to poor outcomes. Assessing and addressing all concerns simultaneously from a multi-disciplinary approach is critical. Differential diagnosis between clinical pain and opioid- seeking behaviors is challenging and not mutually exclusive. This is complicated by neurologically-based pain sensitivity, which increases with long-term opioid use as well as with trauma-related psychopathology. Refinement of integrated team approaches mitigates many of these concerns. Reduction of stressors and increased adjunctive supports allow patients to focus on acquisition of more adaptive coping skills while experiencing a reduction in emotional distress. Additionally, peripheral supportive services reduce the shame and guilt cycle that contributes to relapse. Shared responsibility across a healthcare team with complementary competencies reduces patient burden on individual providers and increases problem solvability, thereby reducing provider burnout while improving health outcomes. Eliciting community support and inter-organizational collaboration is key. A multi-disciplinary team that strategically coalesces can help patients and providers effectively navigate a network of peripheral services which often includes intersecting with law and government entities. A model of addressing the opioid crisis within integrated primary care resulting from a HRSA-funded behavioral health training program is highlighted, in which psychologists, physicians, dentists, nurse practitioners, physician’s assistants, nurses, and social workers collaborate in underserved communities with elevated risks.
Objectives
- Identify the complex and intersecting issues associated with opioid use among dual diagnosis patients in disenfranchised communities with barriers to accessing care that also have comorbid trauma.
- Describe how these challenges uniquely present in primary care and how they can uniquely be met by an integrated approach.
- Discuss the numerous benefits of adopting an integrated approach to assessing and addressing opioid use in primary care for both patients and providers.
