“That pain, that despair, is what we have to grapple with because I think for too long, what we have assumed is that dealing with that pain is up to each individual and it’s their responsibility. We can believe that all we want, but the reality tells us something very different, which is as social creatures, as communal creatures, that we have to help heal one another’s pain, that we have to help support and create the circumstances and institutions that allow people to heal, that helps prevent that pain in the first place. That’s our collective responsibility to one another.
When you have a circumstance where we put that aside and say it’s each person for themself — then this is what happens: you have people struggling in pain, you have situations where people can’t come together around solutions because they can’t agree on our common responsibility to one another.
And I think this, to me, is one of the fundamental issues that we need to talk about, is: What is our responsibility to one another? This is a moral question. It’s a spiritual question that has implications for policies and for programs, but it has to start at the moral and spiritual level. We can build the best programs and policies in the world, but my belief is that none of those will work as well as they need to if we are not clear on the values that should be guiding us in our work.”
The methadone prescribing algorithm is published as part of the Southern New Jersey Medication for Addiction Treatment Center of Excellence (MATCOE) Emergency Department Addiction Pathways (EDAP) and in the Journal of Emergency Medicine (JEM), March 2023. Learn more here.
Recommended citation:
Huo S, Fortunato P, Haroz R. Treating Opioid Use Disorder with Methadone Algorithm. Southern New Jersey Medication for Addiction Treatment Center of Excellence. 2022.
In January of 2022, an emergency medicine (EM) resident collaborated with an addiction medicine medical director to consider the possibility of micro-induction when presented with a unique opportunity to establish a patient on buprenorphine from an urgent care center. The multidisciplinary team previously established a buprenorphine/naloxone sublingual (BUP/NX SL) micro-induction for outpatient protocol* for clinical implementation and successful utilization across campuses and with Southern New Jersey Medication for Addiction Treatment Center of Excellence (MATCOE) networks.
*To support buprenorphine prescribers who may often find themselves sketching the micro-induction process for patients, the addiction medicine content manager designed health communication material outlining the aforementioned protocol for micro-induction in the outpatient setting, in addition to adjunctive medications. The protocol is featured in a manuscript, authored by the content manager and clinical team, and submitted for peer review and publication. Learn more here.
Recommended citation:
Haroz R, Milburn C, Fortunato P, Baston K. E. Buprenorphine Micro-Induction Algorithm for Patients. Southern New Jersey Medication for Addiction Treatment Center of Excellence. 2022.
Yesterday, I received the COVID–19 booster shot. My minor side effects are fatigue, sore arm, headache, and body chills. Overall, it was a very positive experience. Thank you to the dedicated teams at Rowan University and the New Jersey Department of Health (DOH). ♥
In January of 2022, a medical director of government relations partnered with an addiction medicine content manager and medical director, to write a white paper on the importance of expanding access to medication for addiction treatment (MAT). The paper expounded on methadone treatment for opioid use disorder (OUD), racial disparities in access to MAT, the community pharmacist role, and supports H.R.6279: Opioid Treatment Access Act of 2022, introduced by Congressman Donald Norcross in December of 2021.
The Act aims to increase access to and modernize the process of obtaining MAT. This proposed change in federal legislation would decrease barriers to treatment by sustaining relaxed methadone dispensing regulations enacted during the COVID–19 pandemic and making methadone available at pharmacies, enabling ease of patient access to evidence-based treatment and empowering them to spend less time waiting in line for their medication. During the pandemic, federal restrictions have been temporarily lifted and allow patients to take home larger quantities of methadone at a time; preliminary studies have shown that this has increased engagement with treatment. The federal exemption has been extended—however, patients are still required to obtain their medication albeit larger doses from opioid treatment programs (OTP). The bill also calls for research to evaluate the effects that legislative changes have on treatment access and outcomes.
The paper was presented to Senator Joseph F. Vitale and the New Jersey State Legislature, and an iteration abridged summary was published in the New Jersey Medication for Addiction Treatment Centers of Excellence (MATCOE) newsletter. Learn more here.
Recommended citation:
Fortunato P, Haroz R, Baston K. E. Expanding Access to Medication for Addiction Treatment: A White Paper Prepared for the New Jersey State Legislature. Cooper University Health Care Center for Healing, State of New Jersey Medication for Addiction Treatment Center of Excellence. 2022.
Excerpted from “The Treatment of Patients,” an essay on Dr. Marie Nyswander, in the New Yorker, July 3, 1965.
Dr. Nyswander was a psychiatrist and psychoanalyst who, along with Dr. Vincent Dole, began providing methadone treatment to patients with opioid use disorder (OUD) in 1964.
My sister, pictured with me above, accompanied me this past weekend and helped support my new work’s open house celebrating our outpatient addiction medicine clinical practice site and artwork exhibition. I really do have the best sisters.
I’m so grateful to my family, friends, and colleagues as I embark on new experiences.
Learn more about our collective teamwork caring for our communities and enhancing and innovating the field here and here.
Since early 2019, I’ve had the pleasure to serve as instructional designer, content manager, and program manager at my home state’s integrated pain management and addiction medicine institute, part of the osteopathic medical school at my alma mater. In these roles, I’ve primarily focused on continuing medical education (CME) clinical research funding/programming. Having the opportunity to transition from my grounding—in journalism and global media; and fundraising focused on global health and equity, and more recently, disabilities programming, closer to home—is an honor.
I’m ever-grateful to have learned so much and still. Through this work, I’ve cultivated even greater empathy for all people living in chronic pain and/or with addictions, and have zeroed in on the urgent need to eliminate disparities in social determinants of health (SDOH) and advance health equity for all marginalized groups. Also through this work, my abilities are respected and stretched further by my physician leadership, and I’m proud to share that I’ve overseen a full portfolio of exhaustive, innovative, heavily successful programming, primarily focused on the confluence of acute or chronic pain and preventing, treating, and/or reducing harm in substance dependence or substance use disorder (SUD) among special populations. It cannot be understated how these multitude of distinctive and humanistic experiences have helped shape the professional, leader, and person I am today. I came into this work driven by healing and I continue with a clear understanding of my why—and for that, I’m forever grateful.
Across late 2020, as part of my existing role, I had the opportunity to collaborate with partnering physicians, part of my alma mater’s allopathic medical school, to lead oversight of the Medication for Addiction Treatment Center of Excellence (MATCOE) Training and Education Program. This experience resulted in a milestone outcome of medical licensees who completed our CME didactics, and the opportunity to become skilled in facilitating large-scale educational workshops and technical assistance (TA) sessions with prescribers. With the confluence of the overdose crisis and pandemic increasingly impacting the state and on a global scale, I recognized that continuing my path was where I could be helpful.
This collaboration led to connecting on shared values and new colleagues creating and proposing a uniquely-designed role for me. I’m very happy to share that I’ve since continued in my initial position, albeit in a less consuming capacity, and have joined my new colleagues as content manager as of early 2021. In this role, I’m partnered with physician leadership and defining direction, establishing tone, and stewarding content strategy across departmental and institutional addiction medicine efforts. It’s been a rush of new work and similarly, having the opportunity to continually collaborate and innovate.
My new work supports a full portfolio of pre-award to post-award clinical innovations, with initial focus on clinical design programming. Most recently, I had the opportunity to work with the addiction medicine medical director on the Emergency Department Addiction Pathways (EDAP) “bridge” innovation in a rural area. This program has since launched (photograph above of addiction medicine prescriber resources hub in the ED) and ensures patients can receive buprenorphine and naloxone sublingual film (BUP/NX SL) induction based on the Clinical Opiate Withdrawal Scale (COWS). All patients are discharged with a prescription; follow-up appointment for continued care in an outpatient addiction medicine setting; and health communication, focused on home induction guidance, education on all forms of opioids and harm reduction strategies, and SDOH resources. Bridge to methadone treatment is also available.
Together we strategized and envisioned the compendium of clinical and educational resources. These resources consist of prescriber education materials, and destigmatizing health communication materials, written by the addiction medicine physician leadership team and I, from clinical and peer perspectives, and that I developed and designed. After preparing and implementing the EDAP hub and promoting its launch, our prototype continues to be iterated and disseminated across statewide and national clinical networks. The project team is also pursuing funding to support alternatives to opioids for acute pain management education and research in the ED.
I’m so grateful to be helping drive this work—towards a future of dignity and respect for all people living in pain and those with substance dependence or SUD, and/or other addictions/disorders. No shame, no stigma. A paradigm shift is needed and my hope is that our collective work influences tangible improvements across addiction and harm reduction policy—and that, in the very near future, the “X-waiver” is eliminated, and the full range of harm reduction services are widespread funded, sustained, and destigmatized.
“Life is a state of endless becoming. It is vital not to forget where we’ve been, to take inventory of all that we currently have, and to envision bigger lives for ourselves.
I WAS — In a society that is forward facing and fast moving, there is value in pausing and looking back. The first phase asks us to rest and reflect. To acknowledge the stages we have survived, the people we have loved, and the losses we have accumulated.
We must make a home for all of our experiences and allow them to take shape. How will we let our past inform us? How will we carry it forward? How will we become bigger than what has hurt us?
I AM — The character sits centered, anchored in the present.
We must take the time to absorb what is happening now without letting life mindlessly pass us by. Pay attention, even to the hard parts.
I WILL BE — Evolution is inevitable. Should we ever feel stuck or trapped, we can seek comfort knowing we exist in a state of flux.
The character exits the frame, envisioning a life beyond what the viewer can see.
This piece serves as an homage to process, rather than outcome. Healing happens when we are able to incorporate the full spectrum of our experiences and integrate our collective selves. Instead of keeping parts of us in the dark, we deserve to live wholly and authentically. I hope you will honor every leg of your journey, knowing life is infinitely unfolding.”
Chanel Miller. “I was, I am, I will be” is on view at the Asian Art Museum in San Francisco through February 2022.
I’m elated to share our new and ongoing pain management and addiction medicine research project, now live (preview snapshot above from the first module). The predoctoral dental medicine education version of the Opioid Dental Education and Training Program (ODEP), sponsored by the Health Resources and Services Administration (HRSA) and initially created for continuing dental education (CDE) curricula, is available for students in New Jersey.
I had the pleasure of serving as the lead researcher/author for all predoctoral and CDE series, courses, and resources, effectively overseeing, strategizing, envisioning, and developing accurate scientific content, fully entrusted by my physician leadership and expansive stakeholder leadership team. I’m forever grateful for my dedicated and intuitive intern team who supported coordination, formatting, and citations—these contributions cannot be understated. All content was final reviewed by the multidisciplinary project team of prescriber and policy experts, and approved for presentation and publication. Curricula focuses on some of the most critical issues in dental medicine throughout the state and nation: evidence-based education and research on best practices for prescribing opioids; opioid-sparing strategies among common pain medication options; and screening and appropriate referral to medication for addiction treatment (MAT).
Dental medicine education materials, and health communication materials for patients and loved ones/families, are available as part of the curricula. Prototypes and adaptation resources created for students and dentists include printable and digital formats of the following items: concise policy reference charts; evidence-based patient evaluation tools and scoring rubrics, adapted for dentistry practice settings; opioid prescribing protocols and guidelines, developed as charts; concise reviews of the most notable studies on dental pain research and dental pain management; and clinical workflow communication tools for integrated care teams.
For patients and loved ones/families, prototypes and adaptation resources created include both printable and digital shareable formats of the following items: journaling and goal-setting templates, tailored for dental patients at-risk of opioid dependence or opioid use disorder (OUD); safe opioid disposal education; and tailored peer education on naloxone.
The predoctoral dental medicine education version is available only to students as part of their curricula; however, course outlines are available to all here, here, and here. The asynchronous CDE version features open, cost-free registration here, with licensee participants eligible for cost-free CDE credits and certificates for submission to the State Board of Dentistry (BOD). Currently, I’m monitoring and analyzing both series for evaluation purposes and partnered with prescriber leadership as we disseminate, integrate, and adapt the curricula and resources on state and federal levels.
Ava DuVernay: “You understood the dangers of American policing, the criminalization of Black, native, and brown people, 50 years ago. Your activism and your scholarship has always been inclusive of class and race and gender and sexuality. It seems we’re at a critical mass where a majority of people are finally able to hear and to understand the concepts that you’ve been talking about for decades. Is that satisfying or exhausting after all this time?”
Angela Davis: “I don’t think about it as an experience that I’m having as an individual. I think about it as a collective experience, because I would not have made those arguments or engaged in those kinds of activisms if there were not other people doing it. One of the things that some of us said over and over again is that we’re doing this work. Don’t expect to receive public credit for it. It’s not to be acknowledged that we do this work. We do this work because we want to change the world.
If we don’t do the work continuously and passionately, even as it appears as if no one is listening, if we don’t help to create the conditions of possibility for change, then a moment like this will arrive and we can do nothing about it. As Bobby Seale said, we will not be able to ‘seize the time.’ This is a perfect example of our being able to seize this moment and turn it into something that’s radical and transformative.”
I’m thrilled to share the initial installment of our new and ongoing pain management and addiction medicine research project (preview snapshot above from the first and sixth modules). To write that this project is a labor of love and persistence, and overall, a professionally centering and spiritual experience, cannot be understated. The Opioid Medical Education and Training Program (OMEP), sponsored by the New Jersey Attorney General (AG), is created for continuing medical education (CME) curricula and available for all medical licensees as well as all other health care professional licensees in the state. We’ve completed six successful CME didactics and all asynchronous cuts/versions are now online.
I’m humbled to share that I served as the lead researcher/author for all series, courses, and resources, fully entrusted by my visionary physician leadership, as well as our expansive and diversified stakeholder leadership team, to effectively oversee, strategize, envision, and develop accurate scientific content. I cannot express enough gratitude for my exceptional and dedicated intern team, medical student contributors, and clinical and peer contributors who supported coordination, data collection, formatting, citations, and configuration, and with support for our exhaustive naloxone pharmacy distribution guide. All content for all series, modules, and materials were final reviewed by our multidisciplinary project team of prescriber experts, clinical consultants, state attorneys and leadership, and other expert stakeholders, all approved for presentation and publication.
Curricula focuses on the most critical issues in medicine and health care in the state: evidence-based education and research for prescribers on best practices in opioid treatment and management; the role of pharmacists in addressing the overdose crisis; mental health professionals’ obligation in screening, brief intervention, and referral to treatment (SBIRT); athletic trainers’ role in acute and chronic pain support, among adolescents and young adults (AYA); how nurses can support patients prescribed medication for addiction treatment (MAT) and effectively counsel on safe prescription management, storage, and disposal; screening methodologies for special populations, focused on pregnant people and AYA; an exhaustive review of the history of and most notable literature supporting evidence-based harm reduction strategies, educational guidance, and implementation support, relevant to prescribers and all health care professionals; and the urgent criticality of expanding access to MAT, telemedicine, take-home flexibilities, and harm reduction services in the era of—and beyond—COVID–19.
Further, prescriber education materials, and health communication materials for patients and loved ones/families, are available as part of the curricula. Prototypes and adaptation resources created for prescribers and other health care professionals include printable and digital formats, and those for electronic medical record (EMR) implementation. These resources include and are not limited to the following items: neurobiology of addiction diagrams for instructional and medical education integration; sample pain management prescriber–patient agreements; adaptations of evidence-based patient evaluation tools and scoring rubrics; substance use disorder (SUD), with focus on opioid use disorder (OUD), clinical presentation tools; concise reviews of the most notable studies on pain research, pain management, and addiction medicine; safer pain management recommendations; scientific education on the evidence base of MAT and naloxone; patient counseling communication points; non-opioid pharmacotherapy guidance; motivational interviewing (MI) reference sheets; trauma-informed care (TIC) technique guides; pain management team clinical workflow communication tools and those for integrated care teams; and clinical reference cards for patient counseling on MAT.
Also created is an exhaustive COVID–19 resource guide for prescribers and all health care professionals, containing changes to policies and practices with focus on opioid prescribing and telemedicine; considerations for special populations, with focus on patients experiencing homelessness; supporting and protecting marginalized communities, with focus on linguistically and culturally appropriate patient care; and guidance from specialty organizations.
For patients and loved ones/families, prototypes and adaptation resources created include both printable and digital shareable formats, including and not limited to the following items: motivational health promotion cards; journaling and goal-setting templates; safe opioid disposal education; and extensive peer education on naloxone and other harm reduction strategies.
The CME series features open, low-cost registration here, with licensee participants eligible for cost-free American Osteopathic Association (AOA) and Accreditation Council for Continuing Medical Education (ACCME) CME credits, and certificates for all other health care professionals to submit to their relevant licensing boards for continuing education (CE) credits. Currently, I’m monitoring and analyzing the series for evaluation purposes, and partnered with my physician leadership and key state stakeholders as we disseminate and integrate the curricula and resources in diverse formats.
Excerpted from Audre Lorde’s paper “The Transformation of Silence into Language and Action,” originally delivered at the Lesbian and Literature panel of the Modern Language Association’s (MLA) December 28, 1977 meeting. First published in Sinister Wisdom 6 and The Cancer Journals.
