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ORN Works with Pain Clinic to Get Buy-in to Treat OUD



Jay Kuchera, MD, a pain specialist working in Florida, knows that many of his patients are at risk for developing opioid use disorder (OUD). He couldn’t stop thinking that if his clinic was treating pain patients, and those pain patients developed OUD, shouldn’t his practice continue to treat them for OUD rather than refer them to another clinic, another physician? He thought it was an idea that would be readily embraced by the other clinicians in his practice.

Dr. Kuchera knew many clinicians across the pain treatment landscape struggle to integrate treatment for substance use disorders into their scope of practice. And that’s when he turned to the Opioid Response Network (ORN) for help in getting buy-in for what turned out to be a fairly radical idea: pain specialists treating substance use disorders. While pain physicians are adept at recognizing when a patient is taking more medication than prescribed, unfortunately their solution had always been to stop treating that patient rather than address their substance use disorder.

“The first step was just to get my colleagues to retain the patient,” Dr. Kuchera said. These patients are often seen as a liability, one the clinicians did not want to take on. That has been the culture in the pain treatment world,  but things are changing, he said.

ORN’s efforts, Kuchera said, were a catalyst for change. “The real value in and the beautiful effect was all the ranting I’ve been doing in this practice for the last eight years—you have to retain, you have to offer treatment, and treat whenever possible—all of that conversation wound up getting validated.” 

“This was one of the first requests from a chronic pain specialist looking to elevate their ability to address OUD,” said Nick Szubiak, MSW, LCSW, who is part of the ORN Advanced Implementation Science team and an integrated health consultant. ORN brought together resources from not only ORN, but also Addiction Technology Transfer Center, the American Academy of Addiction Psychiatry, and Providers Clinical Support System. ORN also brought together leading experts in chronic pain as it relates to OUD for a special presentation. All of these resources helped to address bias and stigma around OUD, Szubiak said.

“It took eight years to change our practice. My message to my fellow pain doctors is, this is a crisis” and getting pain medicine involved in treating OUD is vital, Dr. Kuchera said. He’s heard that “Prescription opioid use disorder is not the problem, heroin is the problem. Pain doctors have no business treating addiction. Those messages shouldn’t be allowed to persist.”

The end result is that the practice has shifted from not treating OUD, to identifying and addressing OUD, and ultimately providing better care. “They’re not pushing away OUD patients but rather embracing and treating them,” Szubiak said, and this is helping to improve whole health outcomes. “There’s a serious shortage of treatment for opioid use disorder, and opioid dependent pain patients do not easily transfer to treatment settings. Treating patients with opioid issues in the clinic that they are found in is particularly important.”


If you are interested in learning more about integrating the treatment of OUD into your pain clinic, contact orn@aaap.org.