MAHEC 2021 Course Menu

MAHEC RURAL PAIN MANAGEMENT SUBSTANCE USE DISORDER EDUCATION AND TECHNICAL ASSISTANCE UPDATED OPIOID EDUCATION DURING THE COVID-19 PANDEMIC: THE AGE OF DISTANCE LEARNING In response to the rapidly evolving COVID-19 situation, UNC Health Sciences at MAHEC will offer programs via a distance learning model whenever possible. Given our experience with a successful Project ECHO® distance-learning platform, we are confident that the strengths and expertise of our educators will enable us to provide the highest quality distance-learning experience. Our skilled logistics and customer service teams are prepared to set up participants to engage in our programs through our web platform. We are ready to support you and provide expert instruction through this changing time.

MAHEC is providing education and technical assistance to support healthcare organizations, residency and advance practice programs, and practicing providers with the tools they need to treat pain safely and the skills to screen and treat substance use disorders in a patient-centered, equitable, trauma-informed, and inclusive way. Program costs vary based on available funding from grants. The following trainings—which include continuing education credits—were designed to satisfy, partially or in full, the North Carolina Medical Board’s CME requirement for controlled substance prescribers.

These programs are led by Chief Education Officer, Dr. Blake Fagan, MD, and a team of expert providers trained to provide pain and opioid use disorder (OUD) care to patients and to deliver high quality education to the healthcare workforce.

PAIN AND OPIOID EDUCATION PROGR AMS Addiction medicine is a growing, dynamic field. As part of this, there has been a shift in terminology to aid in stigma reduction.

MAT was formerly known as “Medication-Assisted Treatment,” however in recent times, this has been slightly changed to “Medication for Addiction Treatment.” Additionally, the term MAT is currently being phased out and replaced with “Medication for Opioid Use Disorder” (MOUD), as it more accurately describes the use of medication for the treatment of OUD. Having said that, though the terms are currently changing, the educational content has not. Therefore, throughout these programs, the terms MAT and MOUD will be used interchangeably, but all educational material is still relevant. MAHEC is dedicated to keeping you informed on the latest updates on medication treatment for OUD. Pain Education for Healthcare Providers • Treating Pain Safely: In recognition of specific education on OUD and innovative treatment for chronic and/or acute pain, this new workshop will provide updated information on evidenced-based treatment modalities, including non-opioid alternatives to pain management. Medical providers will gain tools to reduce the risk of opioid overdose and treat pain safely as well as the skills to screen and treat substance use disorders (SUDs) in a patient-centered way. Participants will gain knowledge on: • Updated tapering recommendations for patients on chronic opioid therapy • Enhanced information on harm reduction strategies • Emerging data of postoperative pain management for patients with OUD • Addressing stigma and bias that prevent patients from receiving the best care • CBT for Chronic Pain: There is clearly evidence that pain can be treated safely and effectively while also minimizing the risks of opioid misuse. We now know that behavioral approaches are the treatment of choice for chronic pain. About onethird of our population lives with chronic pain, and most of them are not receiving adequate pain care. Behavioral health providers, medical professionals, and rehab clinicians can all be equipped with the skills needed to help people improve their quality of life despite having pain. Cognitive-behavioral and mindfulness approaches have the strongest research support for pain treatment.

This interactive and cutting-edge training will provide participants with innovative and evidence-based tools to expand their effectiveness in treating people with pain. Participants will gain skills and confidence to provide life-changing interventions to help people become more active, enhance social connections, find pleasure and meaning, and live fuller, richer lives.

• Treating Individuals with Pain and Opioid Use Disorder in the Perioperative Setting: This program will provide an overview of the collaborative efforts required to uniquely treat patients with OUD in peri- and post-operative pain management. Patients with OUD, with or without medication-assisted treatment (MAT), present a particular challenge when they require emergent or elective surgery. Due to a developed tolerance to opioids, patients with OUD require higher doses and longer postoperative

prescribing of opioids to achieve analgesia, further increasing their risk of opioid misuse compared to opioid-naïve patients.

Perioperative pain management is even more challenging for patients currently on MAT and requires a unique strategy to ensure that these patients achieve proper pain management without increasing the risk of OUD relapse. The complexity of peri- and postoperative pain management in patients with OUD suggests the need for a collaborative interdisciplinary care team composed of providers, surgeons, anesthesiologists, and inpatient nurses. Team based care will bridge the gap between acute inpatient and ongoing outpatient care to ensure that both the patient’s pain and OUD are properly managed during and after surgery.

• Tapering Opioids for Chronic Pain: This program will provide an overview and discussion of how to wean patients experiencing chronic pain who are on chronic opioid therapy to safe levels or to non-pharmacological therapy, when possible. The program will summarize the best practices of tapering opioids by reviewing evidence-based methods for initiating, evaluating, and titrating opioid dosages and/or discounting opioids for individuals with chronic pain. The program will also review alternative strategies for chronic pain.

• Non-Opioid Interventional Pain Management for Primary Care Providers: This program will provide evidence-based analysis of the relative effectiveness of medications and their side effects, recommendations on how to improve treatment of acute and chronic pain, and recognizing substance use/opioid use disorders. In addition, this course is designed to bolster your current skills in treating acute and chronic pain with alternative non-opioid treatment procedures and techniques. Despite the surprising lack of medical evidence to support the use of opioid medications to treat individuals with arthritis, lower back pain, nerve pain, and migraines, many physicians continue to prescribe opioid medications as the primary treatment for pain. When patients are prescribed opioids, they bear the risk of developing unpleasant side effects, including sedation, chronic constipation, addiction, and overdose leading to accidental death.

There are many overlooked and underutilized pain management techniques that offer immediate relief or provide longerlasting results that can be performed in a primary care setting. Osteopathic medicine treatments, trigger point injections, knee and shoulder injections, occipital nerve blocks, and sphenopalatine ganglion blocks are just a few procedures providers could develop in their practice to ease their patients’ pain. This skill-based workshop will provide physicians with hands-on training to confidently perform these procedures in their practice by skilled specialists. Utilizing these procedures can: This program is only available in a live format option and is under review for how it can be offered on a distance learning platform in the future.

• Provide immediate and long-lasting pain relief to patients • Reduce the amount of opioid prescriptions that may increase side effects, addiction, overdose, and death • Increase physician skills and patient satisfaction • Increase patient volume and billable revenue from office procedures • Youth Vaping Response for the Provider—Taking Action Now: In response to the growing youth vaping epidemic, MAHEC will provide this course to educate providers on age-appropriate evidence-based screening, prevention, intervention, and treatment of nicotine dependency in youth as a result of vaping. This course will provide an overview of the growing youth vaping/e-cigarette crisis, and discuss the increased incidence of e-cigarette or vaping product use associated lung injury (EVALI), deaths, and other adverse effects of vaping in youth. Participants will examine effective and evidence-based substance use screening tools and techniques, and discuss evidence-based youth nicotine cessation treatment options. Click here to learn more and register.

Opioid Use Disorder Education Programs • MAT 101: In the collective effort to reduce the opioid overdose crisis in North Carolina, MAHEC will provide Introduction to Medication-Assisted Treatment (MAT-101) training to share best practices in the treatment of opioid use disorders.

The program begins with an overview of the current state of the opioid overdose crisis on both a national and local level.

Participants will gain knowledge on the CDC guidelines for the treatment of acute and chronic pain and the efficacy of non-opioid treatment modalities. The presentation will outline the origins of substance use disorders (SUDs) and the use of various medication-assisted therapies for the specific treatment of OUD. Lastly, the presentation will end with a discussion of how healthcare providers can address the bias and stigma associated with SUDs and the importance of using harm reduction strategies, such as naloxone distribution, in the treatment of patients with SUDs. • MAT Waiver Training: This training is required for all prescribers to become waivered and can count towards the 24hour training requirement for Advanced Practice Providers. The presentation is designed to train qualified physicians in dispensing or prescribing specifically-approved Schedule III, IV, and V narcotic medications for the treatment of opioid use disorder in an office-based setting. The goal of this training is to acquire the knowledge and skills needed to provide optimal care to opioid use disorder patients by providing: 1) an overview of opioid use disorder, 2) the efficacy and safety of buprenorphine, 3) process of patient selection, 4) clinical use of buprenorphine, 5) non-pharmacological interventions, 6) medical psychiatric conditions in opioid use disorder patients, 7) office procedures, and 8) special treatment population.

• SUDs 101 for the Clinic Team: This course will outline the basics of substance use disorders/addiction, specifically opioid use disorder, and will discuss various models of treating substance use disorders (biomedical, psychological, and biopsychosocial) and address stigma and biases related to substance use, as well as an overview of some harm reduction strategies. In addition, the course will provide information on some aspects of the nuts and bolts of what it takes to provide opioid use disorder treatment through an integrated care team approach. The program includes how to use SBIRT in primary care.

• Introduction to Perinatal Substance Use Disorders: This program, which provides an overview of perinatal substance use disorder, offers a review of evidence-based treatment recommendations for pregnant women with substance use disorder, Neonatal Abstinence Syndrome (NAS), and the ongoing needs for the family after delivery.

• Opioid Education for Community Health Workers Online Series: This online series contains four learning modules that address the unique role that Community Health Workers play when helping clients who have substance use disorder. Faculty for these courses are from various disciplines and are currently engaged in the care of individuals dealing with opioid addiction. These include behavioral health specialists, peer support specialists, community navigators, primary care physicians, and emergency medical services. The courses are offered free of charge. www.aheconnect.com/opioided Community and Overview Education Programs • State of the Opioid Crisis: The program provides as overview of the history, progression, and impact of the opioid crisis.

TECHNICAL ASSISTANCE To break down barriers to practice change by treating pain safely and/or setting up Office Based Opioid Treatment (OBOT).

• Academic Detailing: MAHEC’s nationally trained academic detailer will provide 1:1 supportive and educational academic detailing sessions with providers in North Carolina who would benefit from (or who request) mentoring on the management of patients with acute and chronic pain. The detailer will present evidence-based clinical education tools while building a peer-to-peer relationship that will encourage buy-in for sustainable practice change and improve the prescribing practices of the provider, thus improving patient outcomes in the short and long terms. CME credit can be provided.

• Project ECHO® Programs: Project ECHO® (Extension for Community Healthcare Outcomes) is a lifelong learning and guided practice model that revolutionizes medical education to provide best-practice specialty care and reduce health disparities. ECHO is led by an expert team that uses multi-point videoconferencing to conduct virtual learning sessions comprised of a short didactic followed by case presentations provided by participants.

• Project ECHO® Behavioral Health for Chronic Pain: Chronic Pain is at epidemic levels and has become the highest-cost condition in healthcare. Subsequently, there is now an opioid epidemic, and drug overdose is the leading cause of death from injury in the United States. This live video teleconferencing series explores evidence-based behavioral health interventions to increase a person’s ability to meet treatment goals, increase acceptance, handle adverse situations, reduce risks related to opioid use, and enhance functional ability despite their ongoing pain. This Behavioral Health for Chronic Pain ECHO is designed to provide behavioral health professionals with specialized training in cognitive behavioral therapies and mindfulness approaches. Participants will also explore strategies for increasing integration and communication with healthcare providers. Additionally, participants will increase their knowledge of individuals experiencing pain with or without co-occurring issues with chronic pain.

This ECHO video teleconferencing series, guided by experts, takes place over five weekly modules (one-hour each) and will cover topics such as: • Understanding Chronic Pain and Opioids • CBT for Chronic Pain • Integration Issues: Creating Collaboration and Communication Routes • Mindfulness Approaches for Chronic Pain • Common Co-occurring Issues with Chronic Pain • Project ECHO® for Chronic Pain: The increase in mortality due to the misuse of prescription medications has caused the medical field to re-examine the use of opioids for pain management. This live online course explores the benefits and risks of opioids as well as various medications currently available for the treatment of chronic pain. This Chronic Pain ECHO is designed to provide medical professionals with specialized training in opioid prescribing and interventional pain management. Evidence-based practices will be shared by an interdisciplinary team of experts in chronic pain management, integrated family practice, and medication-assisted therapy.

This video teleconferencing series, guided by experts, takes place over five bi-weekly modules (1hour each) and covers topics such as:

• Opioid Basics: Regulatory Update (CDC, NCMB & Stop Act) • The Urine Drug Screen • Psychology of Pain and Behavioral Health Treatment Modalities • Opioid De-prescribing • Central Sensitization and Addiction: Identifying and Treating Substance Use Disorder.

• MAHEC’s Project ECHO® for Medication-Assisted Treatment: The increase in mortality due to the misuse of prescription medications has caused the medical field to re-examine the use of opioids for pain management.

MAHEC’s Medication-Assisted Treatment (MAT) ECHO is designed to provide medical professionals with specialized training in office-based opiate treatment (OBOT). Evidence-based practices will be shared by an interdisciplinary team of experts in OBOT, integrated family practice, and medication-assisted therapy.

This video teleconferencing series, guided by experts, takes place over six bi-weekly modules (1-hour each) and covers topics such as: • Opiate Use Disorder Overview • Nuts & Bolts of Office-Based Opiate Treatment: Part I • Nuts & Bolts of Office-Based Opiate Treatment: Part II • Buprenorphine Induction • Medication-Assisted Treatment Options • Behavioral Health Treatment Modalities • MAT Policies, Procedures, & Resources Manual: download the manual • Coaching calls with our integrated team (includes health behavior specialists, peer supports, MDs, NPs, & pharmacists)

CONTACT US For more information about scheduling programs, please contact Amanda Espinel at amanda.espinel@mahec.net or fill out the program request form.