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Integrated, multidisciplinary approach key to opioid fight: panel

Jul. 26, 2018, 9:10 AM

U.S. Assistant Secretary for Health Adm. Brett Giroir, MD, took part in Tuesday’s panel discussion on opioid use disorder in pregnancy and neonatal abstinence syndrome. (photo by Susan Urmy)

No single approach will end the epidemic of fatal overdoses caused by addiction to opioid painkillers and heroin that is ravaging this country, the U.S. Assistant Secretary for Health, Adm. Brett Giroir, MD, warned Tuesday during a panel discussion in a packed lecture hall at Vanderbilt University Medical Center.

“There is no silver bullet but there’s a lot of silver buckshot,” Giroir said. “Really integrated, multidisciplinary, holistic kinds of approaches are critically important. We thought we could cure pain by giving a pill. You can’t cure addiction by giving a pill either.”

Giroir, a pediatric critical care physician who oversees the Office of the Surgeon General and the U.S. Public Health Service Commissioned Corps, said he came to VUMC to learn more about the treatment of neonatal abstinence syndrome (NAS), drug withdrawal symptoms experienced by newborns exposed to opioids in the womb.

He said that when he asked officials of the American Academy of Pediatrics to point him to leaders in the field, they told him, “Go to Vanderbilt.”

“There are a lot of other great places and we’ll be going to them, but you are clearly a leader,” Giroir continued.

The hourlong discussion featured Stephen Patrick, MD, MPH, assistant professor of Pediatrics and Health Policy and a national expert on NAS; Bonnie Miller, MD, MHHC, Senior Associate Dean for Health Sciences Education; and A.J. Reid Finlayson, MD, associate professor of Psychiatry.

The discussion, moderated by Tennessee Deputy Commissioner for Public Health Michael Warren, MD, was sponsored by VUMC, the Vanderbilt University School of Medicine and by the Vanderbilt Center for Child Health Policy, which Patrick directs.

“We’ve seen a massive increase in pregnant women with opioid use disorder, and that’s disproportionately occurring in rural areas,” Patrick said. Yet few can obtain the treatment they need because of lack of insurance and other financial barriers.

In addition, “many of these women have complicated histories of psychiatric disorders, severe trauma, which I think predisposes people to use these drugs,” said Finlayson, an expert on treating opioid addiction.

“I’m a real proponent of long-term treatment.”

Miller acknowledged that the opioid epidemic began with the well-intentioned desire by physicians to relieve pain.

“As a surgeon, I can tell you how difficult it is to round on your patients and they’re in pain,” she said. “And we were told you don’t get addicted.”

That is changing. Miller described efforts at Vanderbilt and throughout Tennessee to change the way doctors are trained, and to encourage physicians to change their prescribing practices.

Giroir outlined a five-point strategy for confronting the epidemic: strengthening public health data reporting and collection; advancing pain management to decrease the inappropriate use of opioids; improving access to prevention and recovery services; enhancing the availability of overdose-reversing medicines; and supporting cutting-edge research.

“We have to have reimbursement at the core of this,” he added. “If we don’t reimburse for the right things … we lose.”

The U.S. Department of Health and Human Services is working on the problem. In the coming months, Giroir said, “you’re going to see dramatic changes in … how we’re tailoring reimbursement systems to support holistic-centered care.

“We shouldn’t be paying for doing more procedures,” he said. “We should be paying for … the integration of services, and releasing the creative energies of places like this.”

Giroir concluded his remarks by congratulating all those “who are working on the front lines to advance the knowledge, but also (Vanderbilt) University, for prioritizing and allowing the academicians and clinicians to have the freedom to work on this. Thank you really sincerely for what you do.”

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