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Wrote this piece with the help of a great team including @DrKevinHill. Below I'll share some of my thoughts about #opioids and opioid use disorder and how they present in #hpm and #palliative care, plus why we need to do a better job of addressing #addiction at end of life. 1/x
2/x Training in #KY gave me a front row seat to the #opioidcrisis. With an interest in #hpm I kept wondering what would happen to these individuals who developed an OUD and years later were prescribed opioids. How would I keep those patients safe and manage their pain?
3/x I continue to think that our field will struggle in years to come when survivors of the #opioidcrisis age, develop serious illness, and develop pain. Thinking about this, and reading @jeff_deeney article in @TheAtlantic theatlantic.com/health/archive… made me want to do more.
4/x So since then I've made the decision that I was going to be proactive about understanding the complexities of substance use and serious illness, work to better understand patient's experiences, and figure out a better way to care for these folks.
5/x Without a doubt, it has been one of the best experiences of my young career. To other #HPM providers out there, caring for individuals with substance use disorders can be challenging, but has also been rewarding as anything else I've done. So, this is what I've learned.
6/x 1. All #HPM providers should @GetWaivered. We are experts in pain management, and #buprenorphine is underutilized by our field. #buprenorphine can be an effective option for those with pain and misuse, can be used with full agonist opioids, and can help #harmreduction.
8/x As a reason not to prescribe in hospice. Or worry that someone who is dying will be reversed accidentally. All deaths arent equal. Dying from cancer is a different family story than an OD. I think its only fair that we prevent these deaths on hospice. @RyanMarino
9/x 3. Simply performing UDS or risk stratifying patients isnt enough. #palliativecare needs a lot more research on what works for this unique patient population. Simply saying you won't prescribe to someone with a terminal illness + pain should really be the last thing we do.
10/x For many patients I wind up tolerating a lot of misuse of substances, if it looks like we can make improve things over time. It makes for some uncomfortable prescribing at times, but it also feels a lot more right than cutting someone off.
11/x 4. Our research needs a lot more input from pts. I recognize that when I see someone in PC clinic weekly, its a tremendous burden. Existing research and practice doesnt address the fact that these pts face numerous barriers, and thats before adding a life limiting illness.
12/x So what would a home based addiction+palliative care clinic look like? Or doing #telehealth visits to limit burden?
13/13 Finally, I think as a field #medtwitter we owe it to pts to try everything to meet pts where they are at and work with them, leading with compassion. I had one pt who came to clinic and said it was the first time in his life he wasnt treated like a junky. We can do better.
