December 2018
Behavioral Health and Opioid Use Disorders Discussed at Blue UniversitySM Event
On Oct. 9, 2018, Blue Cross and Blue Shield of Illinois (BCBSIL) along with national and local providers gathered to discuss the behavioral health and clinical options for patients with opioid use disorder (OUD). The speakers were Roueen Rafeyan, M.D., Omar Manejwala, M.D. and Daniel Yohanna, M.D.
Dr. Rafeyan, chief medical officer of Gateway Foundation, discussed the different ways to identify patients with substance use disorder. He highlighted multiple reasons why substance use disorders are overlooked in the primary care settings, including the negative stigma around substance abuse, shame and guilt from the patient combined with a reluctance to voluntarily share that they have a substance problem. He also discussed how individuals with low D2 receptor density show a genetic predisposition and higher tolerance for methylphenidate.
Dr. Rafeyan suggested providers consult the Illinois Prescription Monitoring Program website before prescribing any prescription drugs. This program records all the controlled substances a person is prescribed, including the amount dispensed, the name of the prescribing physician and the payment method used by the patient. Providers may use this service to monitor their patients for potential misuse of their controlled substances. He also suggested that providers “think of addiction as a chronic illness with effective treatments” and that this disease is not about willpower or that care should stop after a relapse.
Dr. Manejwala, Senior VP and Chief Medical Officer of Catasys, Inc., spoke about behavioral considerations in managing chronic pain. His presentation discussed the following ideas:
- Chronic pain and behavioral health conditions have a bidirectional relationship.
- Functional imaging suggests this is partly because of shared neural mechanisms.
- Heavy overlap exists with depression, anxiety and substance use disorders.
- Smoking, suicide or historical and ongoing sexual violence may be common.
- “Fear-avoidance” model provides framework for understanding and treatment.
- Non-intoxicant based strategies can be highly effective.
Dr. Manejwala described how adults with behavioral health disorders are twice as likely as those without behavioral health disorders to receive prescription opioids. Providers may consider treating behavioral health disorders with therapy, such as acceptance and commitment therapy (ACT). ACT uses techniques to enhance nonjudgmental acceptance of pain that help patients commit to life goals and acceptance of pain in context.
The next speaker, Dr. Yohanna, interim chair and associate professor at the University of Chicago, discussed the integration of physical and behavioral health and the argument for collaborative care in primary care settings. He said, “Collaborative care is consistently more effective than care as usual,” and meets the “triple aim” per the Institute for Health Improvement, which includes:
- Improving the patient experience,
- Improving the health of the population, and
- Reducing the per capita cost of healthcare.1
Collaborative care deploys behavioral health managers in medical practice with the backup of a psychiatric consultant to provide:
- Assessments
- Brief psychosocial interventions
- Medical management support
Additionally, Dr. Yohanna noted that the Association of American Medical Colleges projects a shortage of psychiatrists by 2025, and that 60 percent of psychiatrists in the U.S. are over 55 years old.
More than 100 behavioral health and primary care providers attended the Blue University event and had the opportunity to ask the speakers questions about many subjects including, the relationship between trauma and pain, and the use of mindfulness-based techniques to treat chronic pain. They also had the ability to receive Continuing Medical Education (CME) credits.
Through the Blue University provider education program, BCBSIL is working to improve the affordability of care for our members through offering educational opportunities to support a diverse and quality provider network. Together, we can raise the standard and better help our members, your patients, navigate the health care system. Look for more information about our 2019 Blue University programs in future issues of the Blue Review.
1http://www.ihi.org/Engage/Initiatives/TripleAim/Pages/default.aspx