>> KOPELOW: So, if we talk about professional practice, because our CME providers are focused on enhancing the professional, the practices of the people. And they focus on the gaps that these professionals have. And the majority of our providers are working in support of physicians. Alright, so if you, if we, so if we think of, of, the physicians, who are, who are seeing the patients, who are, are using substances that they shouldn’t be using what are the kinds of things that, that that the professionals can do in order to raise awareness, give insights to the patients, detect the patients just from turning this from people who haven’t been previously been recognized to being recognized?
>> MINETA: Sure, you know, one of the things that we thing is really important is something called screen and brief intervention referral to treatment. SBIRT. And it’s shown to be, you know, very effective in health care settings. And this is, actually, early identification of someone with a substance abuse issue and possibly a brief intervention and if it’s more serious and more involved, then a referral to treatment. To some kind of specialty care or, you know, community provider. What this has shown nationally is that, you know we’ve looked at studies, one on the human toll on the human side is that you know you’re able to reduce and change the trajectory of someone’s use early on. You identify then early and you can change that trajectory. The other part is we’ve shown through different studies that actually it reduces cost as well. So, on these two
>> KOPELOW: The cost of health care down the line?
>> MINETA: Yup, yeah, absolutely. Cost of health care down the line. So, that on both of those areas it’s shown to be very effective. We want to make sure, that that it’s not, it’s the docs, it’s nurses, social workers, it’s essentially that whole health team is, you know, trained in SBIRT and you know can be skilled in actually you know, in providing this very necessary screen and then all the
>> KOPELOW: Now the screening tools are check lists, right?
>> MINETA: I mean they’re very, very quick, I mean you know it’s like
>> KOPELOW: Tell me about them.
>> MINETA: The key is that they are not onerous for the provider. I mean that’s that would be the worst and it would lead to being not effective, we think. So, any of these, the studies have been very helpful because they are quick screens.
>> KOPELOW: So, a short list of questions, that the the responses from the patient from the person
>> MINETA: Well, key actually a series of and follow-up questions and then from that then the doc is, or the nurse or the social worker is you know able then to say, You know, maybe you need to look at this, have you ever thought about this sort of brief intervention? And then again if further treatment or intervention is necessary then they’ll, they’re moved on to some kind of referral treatment.
>> KOPELOW: It would seem to me that that those would be applicable, especially useful for physicians who say, I have no patients with substance abuse in my practice?
>> MINETA: Right
>> KOPELOW: Isn’t that right? Because isn’t like one in 10, 12 of us using something we’re not supposed to?
>> MINETA: Right. I mean here’s the, you know one of the things that’s in the strategy, I mean one of the data points, is that about 23.1 million Americans needed, met the diagnostic criteria for some kind of treatment, for substance abuse treatment. And of that only 2.6 million actually received treatment.
>> KOPELOW: So one in 10
>> MINETA: That’s a gap
>> KOPELOW: of the people who needed it.
>> MINETA: So, you think about it. That’s 25.5 million Americans, who needed treatment, whose treatment needs were left unmet.
>> KOPELOW: And if you
>> MINETA: I mean 25 million
>> KOPELOW: And if you turn those into someone’s individual practice, if there’s 2,000 people in
>> MINETA: Right
>> KOPELOW: a practice you’re talking about 200 people in this practice according to the national data are likely to
>> MINETA: Right.
>> KOPELOW: to be abusing something or using something more than they should.
>> MINETA: Right.
>> KOPELOW: Does that 1 in 10 include alcohol and drugs or is it just
>> MINETA: Yeah.
>> KOPELOW: it includes both
>> MINETA: Right. And again that that that’s for a you know, in a for a provider physician in their practice. Now, looking at it large scale, think about this, what actually would that cost? What is this?
>> KOPELOW: You mean cost downstream?
>> MINETA: For the entire society I mean because we know
>> KOPELOW: about the burden of this abuse?
>> MINETA: Yeah, yeah. So, for health care cost, crime, work, productivity loss, you know our figures show, the estimate, we estimate about 193 billion dollars in 2007 - one hundred and ninety-three billion dollars.
>> KOPELOW: That’s what substance abuse costs the economy. The other way that I’ve hear about the burden of this the cost of this is that is about co-morbidity. Is that that that one of the physicians’ biggest challenges is to treat chronic disease, and people with multiple diseases? And isn’t it true that that this this this is the cause of disease? And because so many people have it it’s the cause of the inability to resolve it
>> MINETA: Right.
>> KOPELOW: to treat
>> MINETA: Effectively treat. And that’s you know, again why it shines a spotlight on effective practices that we have at hand that people don’t know about and we need further education and training in this area. And that’s why, you know, continuing medical education is so key in this to be able to be part of this solution. Because again if people don’t know about it and haven’t been trained on it, you know, what’s the expectation that we can actually change in large measure this, this enormous problem?
>> KOPELOW: So, this we’ve talked about this this these stages of professional practice and you talked about SBIRT, so we can say that that in in both of these stages of fitting in and breaking in people can learn SBIRT and suddenly they get some yeses to these questions. They, they that now they know these people have a problem or an issue. What kind of skills and, and strategies do they need in order to intervene? Like what do you after you get some yeses?
>> MINETA: Sure.
>> KOPELOW: Some yeses to this screening?
>> MINETA: And that’s a wonderful question, because, you know, so often you hear providers saying Well so fine you got a, I mean one of the things that they worry about is the actually get a positive hit on this and they don’t, they just don’t feel equipped to actually do anything and intervene. So, both the Substance Abuse and Mental Health Services Administration, the Nation Institute of Drug Abuse, and the National Institute on Alcoholism and Alcohol Abuse are all resources in this way on what to do next. And you know, one of the effective practices that people may, you know, as they go to the sites and they look you know is motivational interview, they’ll see something about motivational int, about MI.
>> KOPELOW: So that’s a new skill,
>> MINETA: Right.
>> KOPELOW: That’s a new skill that people need to learn.
>> MINETA: A new skill and, and the wonderful part is it’s the training is pretty readily available. It’s out there they can read about it. And so that’s one area.
>> KOPELOW: Does it help?
>> MINETA: I mean, what we’ve been able to see and what the studies have shown it’s very, very effective. And it’s very effective through different age groups, it’s very effective across you know, ethnicity, I think it’s shown to be effective across gender. So, it’s, you know, widely used and
>> KOPELOW: And it’s effective it’s stopping people from progressing from overuse to misuse to addiction
>> MINETA: right
>> KOPELOW: that’s the effect of this
>> MINETA: Yes.
>> KOPELOW: So, now you’ve got two things, you’ve got SBIRT just making people aware, diverts people to and when you do interventions again you multiply so there’s two things that people can do.
>> MINETA: Right. One of the areas that I think that there’s great need in improvement though, I mean you could almost say over all of it but on this last piece this referral to treatment
>> KOPELOW: yeah?
>> MINETA: Is one is particularly difficult and we need I think the system needs additional help in development in this particular area, referral to treatment is been one of the areas that has consistently shown problems of that referral of someone who needs actual treatment from the provider to specialty care. And you know often they say OK, fine you need this we’re going to refer you over here that the person never makes it to the actual to other to the next site. To the referral site.
>> KOPELOW: OK so let’s break that down a little bit. You know, before we do that, before we do that, that let’s go back to the to the issue of the treatment. You talked about SAMHSA and NIDA and there’s resources, you talked about motivational intervention what are the, are there other kinds of skills, other important knowledge, important professional tactics and strategies that you’re aware of that our CME providers could consider to be the things that they teach about? Things that they could teach the current workforce tools to use like SBIRT, like motivational that they can they can teach them to help get the professionals to intercede now with the patient?
>> MINETA: You know, one area is, you know, that we need assistance on again obviously is education on prescriptions, on proper prescribing. And education of both the prescribers but also of the patient population.
>> KOPELOW: There’s quite a range in this area of proper prescribing isn’t there? I mean there’s the what drug you choose, the, the number of pills that you prescribe, the when, how long you prescribe for, I mean there’s an art to this isn’t there? That, that if you have it might be able to preventing and if you don’t have it exacerbating.
>> MINETA: Right absolutely. And we want to make clear that on the prescription you know on for these very needed and necessary medicine you know, that’s absolutely important. In many ways you hear folks talking though about, you know we’ve gone from a situation where we were maybe under prescribing the field was under and now maybe have gone so far as we’re over prescribing at this point. Is it there some understanding that balance now and the effect of, of you know that the supply is in peoples medicines cabinets right now and we need to be moving from here on moving forward we need to cut down on that supply.
>> KOPELOW: So, that’s really the essence of the content of the FDA’s blueprint in the Risk Evaluation and Mitigation strategy. It’s prescribing properly, and monitoring properly, to ensure that patients are using properly to prevent them from progressing and abusing, right?
>> MINETA: Right.
>> KOPELOW: And that’s part of your overall strategy?
>> MINETA: And it is in working with, again, you know, one of our roles is actually working with the federal interagency particularly with the FDA on this in this area. Is you know, is that proper prescribing. is the education and again it’s one of those areas that you can see without this what it looks like nationally at this point.
>> KOPELOW: And that’s pretty basic, I mean that, proper prescribing it it it’s sort of a corollary to health care measures that that one of your other sister agencies uses to measure institutional quality is do our patients report adequate pain control? So, that that on on to get to get adequate pain control you have to prescribe properly and the CEOs of these institutions don’t like it very much when the report card of their institution says the patients aren’t comfortable. So, it would be very important to fill both of those. Both to prevent people from getting too much drug and not being monitored properly in the chronic state and patients in institutions not having adequate pain control. So, they would, learning how to use them properly will get both of these positive outcomes. So you’ve talked about prevention, you’ve talked about prescribing properly, so that that you you don’t lead or predispose people to overuse and in the FDA REMs that you monitor people properly, you’ve talked about a powerful and evidence based tool, the Screening and Brief Intervention and Referral that will bring people to the fore that the 20 million or the 2 million that will be increased to 27 million everybody will know so that they’re detected. And continuing along this continuum, that you talked about if people are detected in screening that there’s something that you can do an example that you used was this motivational therapy and interventions. There’s probably more tools and you talked about NIDA and SAMHSA got some example.
This is a transcript of How CME Can Address the Prescription Drug Abuse Epidemic: Part 2—Addressing Physician Practice.
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