As the opioid epidemic continues to grow in the United States, physicians across a number of specialties are challenged with learning how to diagnose and treat this type of substance use disorder, especially in the context of treating a patient’s other primary health care needs. While awareness of opioid use disorder is widespread, the process of treatment in an integrated health setting is not as streamlined or common.
However, for treatment providers in the 1917 Clinic and Division of Infectious Diseases at the University of Alabama at Birmingham, removing barriers to treatment has helped patients living with HIV and opioid use disorder get in a care system and clearly navigate treatment in the new Outpatient-Based Opioid Treatment (OBOT) Clinic, located within the 1917 Clinic.
With support from 1917 Clinic leadership, Ellen Eaton, M.D., assistant professor in the School of Medicine, led the OBOT opening in fall 2019. The genesis of the OBOT Clinic came from Eaton and her colleagues — namely 1917 Clinic Director James Raper — after noticing a lack of awareness in the medical community at large about what opioids were doing locally in terms of infections, especially in HIV and hepatitis C. This opened a conversation about opportunities to expand and standardize outpatient treatment for opioid use disorder, in conjunction with other harm reduction services.
“Streamlining care and getting everyone on the same page about treating opioid use disorder is a notion that is not commonly discussed,” Eaton said. “If we normalize the fact that opioid use disorder is a chronic disease that should be taught to all physicians and health care providers, we can help change the conversation about treatment and address the overarching problem of addiction treatment deserts.”
OBOT is the first clinic of its kind on the UAB campus. Eligible patients must be living with HIV and will receive the full spectrum of care specific to their underlying medical issues such as HIV and other infections, as well as specialized treatment for their opioid use disorder, all at OBOT within the 1917 Clinic. Patients have access to medications like Suboxone, supplemental education, counseling and referrals to rehabilitation. They can also receive prevention services ranging from the flu shot to birth control — a huge benefit for patients who may not otherwise have access to similar resources.
OBOT’s interdisciplinary provider team is made up of another practicing infectious diseases physician, Orlando Turner, M.D., a social worker, pharmacist and nurse practitioner. This facilitates all aspects of care in a “one-stop shop” setting that provides ease and convenience for patients, all of whom are already seeking care at the 1917 Clinic.
Eaton notes that the attrition rate related to opioid use disorder treatment is high, often taking five or more attempts at recovery over a decade. While she hopes referrals can help patients in need get on a treatment regimen, she also hopes knowledge about the OBOT Clinic will help reduce the stigma associated with treating patients with substance use disorders.
“While our mission is to treat patients who need care, my hope is that OBOT also reinforces the idea that we must as medical providers reduce stigma and harm about substance use,” Eaton explained. “Patients with substance use disorders do not have malicious intent, but often have underlying trauma or mental illness that was never addressed and led them to this place. Regardless of our area of medicine, we as physicians will continue to see patients presenting with substance use disorders and need to capitalize on opportunities to integrate education, treatment and care to slow the progression of the epidemic.”