It will take a cross-discipline approach to halt the opioid crisis, experts at IPE Day say

Cross-discipline and inter-agency efforts are likely to have the greatest impact on the current opioid epidemic. That was the take-away message at this year’s USF Health Interprofessional Education Day, focusing on the opioid crisis and held Nov. 13.

To a capacity crowd in the USF Marshall Student Center’s Oval Theatre, experts and advocates from across the region offered insight on the impact opioids have on our communities and how health care teams can work together to offer better identification, better treatment and better outcomes.

IPE Day is meant to help professionals across multiple disciplines work more effectively together to improve the outcomes of patients, said Haru Okuda, MD, FACEP, FSSH, Executive Director, USF Health, CAMLS; Executive Director, USF Health Interprofessional Education and Practice.

Dr. Haru Okuda.

“Today’s theme is really about getting to know each other,” Dr. Okuda said. “Traditionally over the years, many of our health care disciplines worked in silos. Working together is the only way we can truly have an impact.”

Dr. Okuda, along with Terri L. Ashmeade, MD, MS, CPHQ, Chief Quality Officer and associate dean for Continuing Professional Development for USF Health, moderated panel sessions with experts who offered a range of expertise and experience.

Charles J. Lockwood, MD, MHCM, senior vice president of USF Health and dean of the USF Health Morsani College of Medicine, offered welcoming remarks and set the stage for the day’s interaction.

Dr. Charles Lockwood.

“At USF Health, we have named interprofessional education a core value, because we truly believe that every person, regardless of their discipline or unique expertise, benefits by learning together and working alongside colleagues from other professions,” Dr. Lockwood said. “Teams perform much more effectively than individuals do, and the more diverse the teams, the more effective they are. A more comprehensive, team-based approach is needed to eradicate opioid addiction once and for all. We owe it to all of the victims and all of the families that are affected to do everything we can.”

City of Tampa Mayor Jane Castor gave the keynote address. Her 31 years in local law enforcement and experience as Tampa police chief gave her a unique perspective of the overall law enforcement system, learning early on that the system could not handle drug crime alone. After sharing harrowing stories of drug crime since the 1980s, Mayor Castor said the takeaway was “clearly, trying to arrest our way out of this problem was not the answer.”

City of Tampa Mayor Jane Castor.

“Law enforcement, USF and other community partners will have to work together from a variety of approaches in order to make progress in this issue,” Mayor Castor said. “We must approach addiction in a variety of ways, identifying physiological and psychological causes, as well as taking steps to avoid putting people in addictive situations. Interprofessional education is the key if we want to make a difference in this community. Events like IPE Day bring professionals and experts from across disciplines together, so that we can tackle the opioid crisis in a meaningful way, from a 360 degree approach. We must all recognize that opioid addiction is a national crisis and it does not discriminate between race, sex, or socioeconomic class. Drug addiction destroys families and lives. In the final analysis, effectively addressing the opioid crisis is going to take our entire community.”

The morning session included two panels. The first included experts giving insight into the current crisis. A local judge, a former nurse who was addicted to drugs, a mother whose son accidentally overdose, and a supervisor of health services for the school system.

From left, Jack Stem, Dr. Maria Russ, Judge Thomas Palermo, and Cindy Grant.

The second session delved into how professionals across multiple, varying disciplines can pool their talent and resources to take this crisis head on. See below for an overview of panelists’ remarks.

Kenneth Petrillo, Dr. Troy Quast, Dr. Belinda Hurley, Katherine Drabiak, and Dr. Maya Balakrishnan.

A pharmacist and an attorney, Sarah Steinhardt, PharmD, JD (Esq.), MS, assistant professor in the USF Health Taneja College of Pharmacy, provided an overview of how current and pending law affects how effectively interdisciplinary teams can impact the opioid epidemic, as well as guidance on best practices for working in interdisciplinary teams.

Dr. Sarah Steinhardt.

“Keep in mind that the patient is your most important concern,” Dr. Steinhardt said. “You have to think about the patient first, and what is the best thing to do for the patient. In terms of collaborative leadership, we want everyone to take responsibility with your place on the team. Know that you have an important role. And know who’s on your team, what they can do… I challenge you students, I want you go out into your practice settings to be good role models. Be someone so that when they look at you, they’re going to say ‘this person understands what I do. This person values me and respects my feedback. This person is open to new ideas. This person is intellectually intelligent and emotionally intelligent. And this person came from USF.’“

USF President Steven C. Currall, PhD, urged the audience of more than 1,000 to take immediate action to work together to help quell the tragic impact of opioid addiction.

Dr. Steve Currall.

“What you’ve heard this morning is a call to action,” Dr. Currall said. “Across our region and our country, the tragic realities of opioid addiction are driving us to find innovative approaches that go across all disciplines. This event is designed to break down silos, which prevent advancement of new and innovative approaches to address issues like opioid addiction. It shouldn’t take a crisis to bring us all together. Today I want to encourage you to continue to work together across professional boundaries and learn from each other to develop outstanding interventions that benefit our patients, our families, and our communities across the region.”

An afternoon session was for students from USF Health colleges and included an exercise for them to put into action some of the details they heard in the morning session. The group was divided into teams, each receiving a case study and tasked to create a systems map to offer a 3-dimensional model for showing how patients might navigate the health system and community resources.

The winning team!

 

FIRST PANEL: The Impact of the Opioid Epidemic on Our Community

“On stigma, the first thing we can do is change the language we use. Don’t call them the addict. Use person-centered language. We want to refer to them as people with a substance use disorder. They are patients, they are not addicts. They are people. They are human beings. They are your brother, your sister, your mother, your father, your cousin, your aunt. They are every-day people.” by Cindy Grant: executive director of the Hillsborough County Anti-Drug Alliance (HCADA) and serves on several Boards and Councils in the Tampa area, including NOPE of Hillsborough and MADD Hillsborough. In 1997, Grant’s son, Dan, died from an accidental overdose at the age of 19. In honor of his memory, she has devoted herself to substance abuse prevention.

 

“One of the biggest difficulties we have, there isn’t really a course of treatment for substance abuse available to me as a dependency judge…There’s not a lot of good data that any of the substance abuse treatment programs that are out there actually work…Things that frustrate me or things I wish I could do differently or better is to have some sort of tool available to me where I could more effectively help parents with their substance abuse problems, so whatever I could do to save some of the kids I’m seeing.” by Judge Thomas Palermo: Circuit Judge presiding over a juvenile dependency division, involving abused and neglected children and frequently the abuse of licit and illicit drugs, including all opioids. Prior to serving as a judge, Palermo served as a federal prosecutor and had strategic and tactical anti-opioid responsibilities as the MDFL District Opioid Coordinator. He also recently wrote an article for the American Bar Association entitled “The Opioid Crisis.”

 

“People continue writing multiple prescriptions. It’s a problem when we have 3-year-olds with opioids in school – we give out a million pills in schools…We need to look at a bigger picture with what we do…We can all get involved with the schools. They’re hungry for that…We work in interdisciplinary teams, so we’re not just working with the individual students, we’re working with families, with (USF Health Morsani) College of Medicine and Tampa General…I appeal to you that, when you go back to your communities, make sure you’re involved. Think outside just your patients. It’s bigger than just your patient. You have to reach your community because it will affect you one way or another.” by Maria Russ, PhD, APRN, CPNP, is the supervisor of School Health Services for Hillsborough County Public Schools and a visiting professor at Chamberlain University, with 25 years of nursing experience. A fellow in the National Association of Pediatric Nurse Practitioners, Russ is a published presenter on the health and safety of the school-age child and adolescent.

“One of things I discovered as a dependence counselor is that health care professionals are a pain in the butt to treat because they think they have the answers. But what I discovered is that you don’t think your way out of this disease…People need treatment. It’s a chronic disease. You don’t go into treatment for 28 days and you’re fixed. I have to do something every day to make sure I’m clean and sober. I’m 24-plus years clean. I’m looking forward to the day when we can expect people to recover…It’s a chronic, progressive disease that kills you if you don’t get treatment. There are no other options than jail or dead…This is a human issue and we need to treat people as humans.” by Jack Stem, CDCA, CRNA (Ret.), is the program manager for the University of Cincinnati Grant overseeing the Opioid Use Disorder Consortium in Highland County, Ohio. He is also a chemical dependency counselor, former emergency room nurse, and Certified Registered Nurse Anesthetist. Stem brings a unique perspective as a recovering opioid addict dealing with the disease of addiction. He is a national speaker and presenter on Substance Use Disorders.

 

SECOND PANEL: An Interprofessional Response to the Opioid Crisis

“I’m passionate about improving the care we provide mothers with substance use disorder and babies who are experiencing NAS. From a local perspective, we’ve used quality improvement and the power of interprofessional teams to address that. With quality improvement methods, locally, we’ve tried to standardize management of these infants. From an interprofessional nature, we formed a diverse interprofessional committee to address this locally, involving everyone, from physicians to nurses to occupational therapists to lactation specialists, and we have community partners on our teams. By doing that, we are able to gain perspectives from all of these different stakeholders, and were able to address in a comprehensive way how we could better the lives of these babies and moms while they were in our care…We were able to use what we learned locally and at Tampa General Hospital and USF Health Pediatrics and were able to spread it throughout the state.” by Maya Balakrishnan, MD, CSSBB, is an associate professor of pediatrics at the USF Health Morsani College of Medicine and a certified Six Sigma Black Belt, teaching statewide interprofessional health care quality improvement courses. She serves as a Process Improvement Specialist at Tampa General Hospital, director of Quality and Safety for the USF Graduate Medical Education, and associate director of Clinical and Quality Management for the Florida Perinatal Quality Collaborative.

 

“When we’re talking about substance use disorder, we have to change the conversation of how we’re looking at it, not just as a disease but as something we can recover from…We need to ask whether the policy of pushing one type of treatment for all patients is the best policy. These are questions we have to ask. Is this type of treatment best for all patients?…Are we treating with compassionate care if the treatment isn’t working?” Katherine Drabiak, JD, is an assistant professor at USF College of Public Health and USF Health Morsani College of Medicine, and a co-director of the Law and Medicine Scholarly Concentration Program in the Morsani College of Medicine. Drabiak’s teaching and research is focused on health law, public health law and medical ethics. She is a published author and consultant in the areas of research ethics and clinical ethics.

 

“Over the past seven years of working with the VA, I’ve see a lot of changes in how we approach pain and treatments. I’m coming from the conservative side of treatment… so if opioids are banned then what is the answer to treating pain? From my point I see the conservative treatment, so if the pills aren’t the answer, trying to instill veterans and patients the active coping strategies to help them get through what they’re going through. Pain isn’t an easy thing to go through…trying to instill in them that pain is normal but we need to help them cope with that in an active manner versus turning to more passive coping strategies of avoidance…I’ve seen the shift from more of a biomedical focus, the find-it-fix-it model, to the more bio-psycho-social model, trying to take into consideration everything that’s affecting their lives and how we can actively help these veterans and patients who have pain.” by Belinda Hurley, PT, DPT, OCS, TPS, is a board-certified clinical specialist in orthopedic physical therapy at James A. Haley Veterans’ Hospital. She serves as faculty for the American Board of Physical Therapy Residency and Fellowship Education accredited PT Orthopedic Residency Program, and works as the primary physical therapist on the inpatient and outpatient Chronic Pain Rehabilitation Programs interdisciplinary team.

 

“We’re not going to arrest ourselves out of this problem. You can arrest people and you can put them in jail and it’s not solving the root of the problem, and all the things your doing is making it worse for this individual…We respond out to every single overdose citywide, 24 hours a day, seven days a week… One of the biggest issues I saw, more of an internal issue, was changing the culture in law enforcement…we thought it wasn’t a law enforcement issue, it was a medial issue. So we’ve had to change the culture of law enforcement over the past couple of years to explain to new officers that this is a law enforcement issue. It’s an issue we need to be involved in and it’s an issue we need to investigate like we would investigate a homicide because, in all reality, an overdose is to some extent, an attempted homicide…so changing the culture has been one of my biggest issues, trying to educate and get it out to the street officers on how they need to respond to these types cases and that they need to investigate it as a crime and not just a medical issue. The greatest thing I’ve seen so far is the relationship that we’ve developed with a lot of the ER nurses…We’re building the interprofessional relationships with the hospitals is fantastic.” by Kenneth Petrillo is a corporal in the Violent Crimes Bureau with more than 23 years of law enforcement experience. In July 2018, Petrillo was tasked to lead the newly formed Opioid Task Force. Previously, he worked in Patrol, Juvenile Investigations, K-9, and Undercover Street Crimes, among others.

 

“In areas that higher rates of opioid prescriptions, they have higher rates of child removals…In terms of looking at data, I think that’s a big issue here. In monitoring programs and how those have been rolled out around the country, we’ve seen differing levels of success with them … So I think it’s going to be very important to use data to try to answer those questions. Unfortunately, there is not a great single measure of opioid use that we can point to and say that’s what I’m going to use. Even with death counts, there’s a paper in review right now that would say that those death counts aren’t entirely accurate. So for us to say this policy is working, this policy is not it’s important to look at an array of measures to try to get inside of that…In terms of health care utilization, the issue of well-care is why we’re seeing first-hand that resources need to be devoted to treating overdoses and also treatment programs. Keeping up with policies is definitely a challenge.” by Troy Quast, PhD, is an economist whose research interests include the impact of economic conditions on health status, Medicaid policy, and the impact of natural disasters on health status and the utilization of health services. He was awarded research funding by the National Institutes of Health to examine the treatment of children displaced after Hurricane Katrina.

Video by Torie Doll, photos by Freddie Coleman, USF Health Office of Communications