Palliative Care as First Responders in the Opioid Epidemic: A Toolkit for Harm Reduction and Treatment (FR404)

Abstract

•Diagnose opioid use disorder and discuss the use of medications for opioid use disorder.•Describe the key components needed to start a medications-for-opioid-use-disorder treatment program.•Review the unique competencies of palliative care providers that make them ideal to be first responders to the opioid epidemic. The United States continues to face a public heatlh crisis of epic proportion, with over 500,000 deaths from opioid overdoses since 2000. Medications for opioid use disorder, like buprenorphine, offer patients an effective approach to cessation. Unfortunately many barriers to use of medications for opioid use disorder exist, including insufficient number of programs offering medications for opioid use disorder, inadequate number of addiction specialists to provide these medications, and stigma surrouding patients with opioid use disorders and the medications used to treat them. Palliative care providers are in a unique position to be first responders to this health crisis by providing medications for opioid use disorder. Many palliative providers are comfortable and competent in the pharmacology and clinical use of buprenorphine and methadone as analgesics, both of which have been shown to reduce mortality in the setting of opioid use disorder. In addition, palliative providers are trained in advanced communication skills and must be open to working with vulnerable patient populations, such as patients with opioid use disorders. This presentation will focus on the use of buprenorphine in patients with opioid use disorders, including a review of the pharmacokinetic properties of buprenorphine in patients with opioid use disroders, guidance on avoiding preciptated withdrawal during induction, and management of acute and chronic pain with opioid use disorder. Through audience polling, didactics, and case review, partipants will be given the building blocks to consider induction of buprenorphine in the hospital and transition to care in the outpatient setting. We will highlight two programs, an inpatient burprenorphine induction program at Dell Seton Medical Center University of Texas at Austin, and an outpatient palliative program offering medications for opioid use at Dartmouth Hitchcock Medical Center.