Juliette Perzhinsky has a track record of making waves, big and small, in the way health care is administered in mid-Michigan and beyond.
A board certified internal medicine physician and faculty member at Central Michigan University, Perzhinsky says she's undertaken many patient safety initiatives during her time at CMU. Now, she's tackling a health issue that is hitting rural areas like mid-Michigan hard, and a $433,500 grant from the Substance Abuse and Mental Health Services Administration (SAMHSA) is helping increase the impact of her work.
"An area that we have obvious shortcomings is the lack of access and coordination of care for patients with chronic pain and those who suffer from opioid addiction," says Perzhinsky, "I hope this project will make a difference with expanding services in the treatment of opioid addiction and hopefully, removing the stigma commonly seen with the use of MAT in treating opioid use disorders."
Perzinsky says the approach she's advocating can help patients lead normal lives. "MAT has been traditionally misperceived as ‘replacing one addiction for another’ but in actuality, it is an evidence-based treatment that really can help patients who seek recovery from opioid addiction. After all," she adds, "addiction is a chronic disease and we should approach it in that fashion just like we do when treating lung disease from smoking (ie, COPD) or diabetes from physical inactivity and unhealthy food choices."
We recently sent Perzhinsky a few questions about the grant she's received to continue her work on opioid addiction, and what her approach means for mid-Michigan. Here's what she had to say:
Tell us a little about the grant you just received. As part of the U.S. Department of Health and Human Service's 5-point opioid strategy, can you explain where your work fits in?
The grant is a SAMHSA Provider Clinical Support System – Universities grant that provides up to 3 years of funding to specifically focus on HHS’s strategy regarding access. The goal is to provide better prevention, treatment, and recovery services for patients who suffer with opioid use disorders.
Basically, we hope to integrate a medication-assisted treatment (MAT) curriculum for both medical students and physician assistant students at CMU. They will complete the training to qualify for a MAT waiver to prescribe medications like buprenorphine to treat opioid addiction once they are in independent practice. Also, we will offer this MAT waiver training to faculty practitioners to also expand workforce capacity in treating opioid use disorders.
What went into receiving the grant? What is the application process like?
It required an immense amount of discipline, along with teamwork and collaboration. I have a core team of faculty that I worked with on the application. We had about five weeks to complete the proposal while also competing with immense work responsibilities. In essence, most of the work for the project was done in the evenings and on weekends.
What attracted you to work on opioids and addiction to begin with?
I've had both personal and professional experiences where I have witnessed the current shortcomings of our limited behavioral health infrastructure in Michigan. Many people suffer with addiction and there is a substantial amount of stigma seen in the management of patients who need help for addiction. Many of these patients are without access to the treatment services that have been shown to improve patient outcomes. Much of the time, the complicating factor is that addiction commonly presents in people who are dealing with mental health issues, such as depression, bipolar disorder, post-traumatic stress, or other mental health conditions.
Many people don't think of mid-Michigan as a hub for this kind of innovation. You're on the front lines of a national epidemic right here in small-town America. Why do this work in central Michigan? Why is what you're doing so important locally?
Rural regions in Michigan have been hit hard by the opioid crisis. By offering MAT training to students at an early time in their training, we have a higher likelihood of impacting change in the future by giving the students this exposure early-on. Mid-Michigan has some access to treatment, but there are very few MAT prescribers or clinics in this region. Not only Isabella County, but mid-Michigan in general. CMU has a distributed campus in Mt. Pleasant and Saginaw and our goal is to increase access throughout many areas in this region. We want to hit the bull’s eye on the HHS 5-point strategy by providing quality access to care for opioid addiction where it's needed most.
Historically, as a society, we've looked at addiction as essentially one disease or affliction, but increasingly we understand that addiction treatment requires very individualized care and support. How is what you're doing supporting that? And what does individualized care look like within the framework of the training you're providing?
Absolutely. The MAT waiver training is only one part of this very descriptive approach to caring for patients with opioid use disorders. It must be individualized. By providing a foundation through offering MAT training to students, we hope to have a core element achieved. Currently, there is little covered in the curriculum on treating addiction so we are hoping to change that. The project is strictly a curricular project with a goal of expanding the training to faculty, who we hope will in turn start treating patients with opioid use disorders in their clinical practices. This will then allow students the opportunity to actually get clinical experiences in MAT through faculty who are offering this to their patients. The project does not confer the resources to actually build the behavioral health infrastructure, but this would be a long-term goal.
Talk to me about pain management. What alternatives are there to opioids and what are the success rates like so far with those alternatives?
I’m a general internal medicine physician and though I do treat acute and chronic pain, I would not consider myself to be an expert in this arena. Some of the alternatives to opioids are actually not medications at all. Rehabilitative therapy with physical therapy that focuses on strengthening and endurance are very effective, but they take time and dedication (and can cause discomfort at first). Sometimes we can augment therapy with short-term muscle relaxers especially if patients are getting spasms during treatment. Gabapentinoids are another type of medication/pharmacotherapy that has been used for treating nerve pain, but these have to be used with caution since they can also pose dependency and abuse risks for some patients. An area that is growing more is the use of integrative health strategies, such as yoga, acupuncture and meditation, which are being researched extensively as important pieces of the treatment paradigm and can be very effective.
You're providing this training now, but as we see in so many issues it can take time for the theory to make it into practice. Obviously with this particular subject there is some urgency so that helps. Best case scenario, how quickly do you see your approach making it into local medical facilities? What does it "look" like to take something like this from university to hospital?
I cannot credit myself for the work that many have done before me, especially the researchers and addiction specialists who have been doing incredible work in this area and treating patients with MAT. The project involves taking an accredited MAT waiver training course and integrating this into an interprofessional training curriculum for both medical and PA students at CMU. We will additionally give this training to faculty practitioners who are on the frontlines of clinical care. We may not see the impact of this until a few years, and hope to see growth in access to treatment by giving our healthcare trainees access to the training. Our goal is to partner with our hospitals and clinics where CMU students get their clinical training and give them real-life exposure in MAT being delivered during routine clinical care.
How does your approach here differ from what's happening elsewhere? In your opinion, what's the element that secured the grant?
The innovative spin is that this is an interprofessional training curriculum, that brings other healthcare disciplines together to hopefully impact the opioid crisis in mid-Michigan. Perhaps that is what was appealing to SAMHSA—I also believe that since CMU is in a rural region of Michigan, this also lends to this project having an exponential impact with expanding access to treatment in the surrounding communities that serve rural health populations.