The next generation of physician assistants spent the day Friday learning how to treat opioid addiction at the University of Washington MEDEX Northwest PA School in Kealakekua.
In addition to the coursework, the two dozen students heard from Gov. Josh Green and U.S. Rep. Jill Tokuda via Zoom, along with other professionals in the field.
“What we are teaching today is an eight-hour course on the use of medication in the treatment specifically for opioid use disorder,” said Clinical Coordinator Margot Karr, PA-C. “We are looking at what kind of medications are within the wheelhouse and purview of these students to prescribe once they go on to graduate to assist with opioid use disorder.”
The MEDEX program received a grant from SAMSA, the Substance Abuse and Mental Health Services Administration, providing funding for the eight-hour continuous medical education curriculum into the classroom for first year students.
“In order for the students to receive a DEA license required to prescribe buprenorphine, they have to complete this training, which is required at the school for graduation.”
Buprenorphine is a synthetic opioid developed in the late 1960s and is used to treat pain and opioid use disorders.
Karr said most medical programs, specifically PA programs, do just a handful of hours on substance abuse disorder as part of the curriculum within behavioral medicine.
“Our students get a whole day of it. I tell them this might not be your cup of tea, caring for people struggling with this disorder because it’s not for everyone,” she explained. “However it’s going to show up no matter what area of practice you go into. If you are in orthopedic surgery, what are you going to do if you have someone who has an extremely high tolerance and dependency to an opioid and they get into a vehicular accident. How are you going to manage them?”
She said it is about raising overall awareness.
“It’s taking what is typically a really short piece of curriculum that doesn’t go into great detail about what you can do to intervene and try to help. We are talking a lot about harm reduction like where are the points of contact throughout someone’s life and interaction with the medical system where you can be part of the active solution rather than a continuous part of the problem. Sometimes it’s as simple as asking the right questions,” Karr added.
MEDEX graduates an average of 24 students per class, with many coming from the mainland for the program.
“The goal is absolutely to attract, train and mostly retain people,” she said.
Karr said about 70% of this graduating class will stay in Hawaii, and 100% of the next incoming class for the two year program claim Hawaii as their place of residence.
Green spoke about policy decisions that have been made to retain medical professionals in the state including the loan forgiveness program.
“The shortage is still really profound. This loan forgiveness program is going to cut into it fast. We did 485 scholarships this year and we’re going to do another 1,000 in the fall, so it is going to accelerate,” he told the students. “The goal ultimately is to take the pressure off of you healthcare providers so you can focus on your job and focus on the discipline that suits you most.”
The governor, who is also an emergency room physician, talked about the opioid crisis in Hawaii.
He said about six or eight years ago, the state reached a threshold where there were more overdose fatalities than car accident fatalities.
“That was the moment we kicked in a powerful task force and we began to explore ways to diminish the amount of prescriptions in a safe way without taking away people’s access to pain medication. We made sure we characterized the proper amount of opioids for people and their concerns, we also have been doing what we can to ramp up the access to buprenorphine and other drugs to make sure that people have access points to get off of their substances,” he said. “COVID created an incredible amount of isolation for people and they couldn’t get to their doctors or PA or nurse practitioner’s offices, and often couldn’t get their prescriptions and then they got strung out on heroin or meth for self medication.”
He said when dealing with illicit usage, people are often lacing drugs with all sorts of things like fentanyl.
“At one point it got so bad that we would often need to give people two or three doses of Narcan to bring them back because the amount of opioid in their system was so bad,” he said.
“We cracked down on overprescription. One of the challenges was we didn’t even have enough pain pills coming into the state. Plenty of totally legit patients could suddenly not get their necessary pain medications which created a whole new problem for them. There is a lot of nuance to this problem,” he stated.
Tokuda told the students opioid addiction and substance abuse does not discriminate. It doesn’t care if you are young or old, Asian American or Pacific Islander, white or Black – it hits all families.
“Something that is there to stop pain creates more pain and reeks havoc on families and individuals in every day life,” she said.
She said as a community, we have to support families dealing with addiction, but also have to reduce the stigma associated with addiction and actually get them the help they need.
“Shame is the word that keeps coming up. They don’t want to talk about it and don’t want to admit it. No one talks about it, no one acknowledges it and no one accepts it that it is something people need help with, it not only affects that individual, it ripples out onto the family unit, the community and has multiple impacts,”
She told the students they could make a difference.
“You are on the front lines. You’re the warm hand that someone is going to hold when they are scared, confused and nervous and hurting. Your ability to connect with them will make the difference as to whether or not they will get help and continue with that help or if we loose them. Learning this area and being knowledgeable in this area, you are going to save lives,” she said.
Kona resident and first year PA student Yizheng Logan was a psychiatric aid at Kona Community Hospital before enrolling in the program. She has a special affinity for mental health and substance abuse and was grateful for Friday’s class.
“I believe in kindness I believe in humanity. The biggest act of kindness is to give people help with healthcare. Helping people makes me happy,” she said.
She said Friday’s class was a wake up from the busy medical studies to realize they are supposed to be helping the community.
“That’s why we are doing this. Look at the community and how many people are suffering. We are a big ohana, she said. “I want to serve people as a human.”