“When we’re actually prescribing treatments where people live, where they’re in their support group, it makes the difference between being able to complete treatment and live, or not complete treatment and die,” Tacoma City Councilmember Catherine Ushka said, looking out at the MEDEX Tacoma students in the midst of completing their 8-hour Medications for Opioid Use Disorder (MOUD) training for opioid use disorder at the end of their didactic year.
The University of Washington’s MEDEX Northwest Physician Assistant (PA) program is on a mission to put the treatment options referred to by Councilmember Ushka into the hands of PAs across the Pacific Northwest. Last year more than 100,000 Americans lost their lives to drug overdose, most involving opioids like Oxycodone, Fentanyl and Heroin. Many more have been hospitalized for life-threatening overdoses or other medical complications of addiction. Clinicians have had safe and effective ways of treating opioid addiction (also called opioid use disorder – OUD) on their prescription pads since 2002. Buprenorphine, a safe, synthetic opioid replacement drug, is available at your local community pharmacy and taken by patients under the tongue. It allows individuals to achieve sobriety where Methadone clinics and hospital-based addiction services don’t exist. However, few clinicians are willing to prescribe Buprenorphine for addiction, due to stigma and lack of education around it. Less than 10% of physicians, physician assistants and nurse practitioners nationwide prescribe Buprenorphine for OUD.
Each of the MEDEX classes that have just finished their didactic year now have the training to prescribe these life-saving medications. Pamela Pentin, MD, an Associate Professor of Family Medicine at the University of Washington, and her colleague Krissa Orlowski, DMSc, PA-C, recently facilitated 8-hours of MOUD–also known as Medication-Assisted Treatment (MAT)–training at all five MEDEX campuses in Kona, HI; Anchorage, AK; and Spokane, Tacoma, and Seattle, WA.
“We are turning around, and in many cases saving the lives of our patients in the most direct and powerful way possible” Dr. Pentin reflected, thinking back on the five trainings conducted over the last few months. Dr. Orlowski added, “the students were really engaged in learning, and so many expressed the desire to use their training in their future clinical practice. This education is crucial to combating this epidemic, and this is the first step in producing a robust workforce to address this deadly issue. I look forward to continuing this crucial training, and seeing my students save lives in the battle against opiate abuse disorder.”
The MEDEX MOUD trainings differed from typical online MOUD education because they pushed the definition of what education addressing addiction treatment should entail and who should be in the room when they happen. At each MEDEX campus location, community leaders were invited to speak and share why treating opioid addiction matters not only to individual patients, but also on a community and state-wide level. Mayors; City, County, and Tribal Council Members; Police Chiefs; State Secretaries of Health all have personal and professional reasons for caring about the opioid epidemic, regardless of political orientation. By bringing these stakeholders into the conversation about addiction treatment, MEDEX PA students were able to see the immense impact of their work, the influence of their scope of practice, and the importance of MOUD-prescribing skills both in and out of the clinic.
In Kona, Hawaiʻi County Council Member Holeka Inaba joined the MOUD training to speak on the impacts of OUD from the perspective of an educator and public health advocate. In Anchorage, Assembly Members Felix Rivera and Christopher Constant spoke to the MEDEX cohort about the challenges and successes of behavioral health and substance use treatment across Alaska. Drs. Pentin and Orlowski were joined in Spokane by Spokane Tribe of Indians Secretary Monica Tonasket, Spokane Mayor Nadine Woodward, and Spokane City Council Member Breean Beggs. As each community representative addressed the students, they spoke from the heart by merging personal stories with professional perspectives.
“It’s all about partnerships. It’s all about relationships. We’re not the experts on the treatment side of opioid addiction. We are not the experts. We are looking for assistance. We are looking to you all.” – Spokane Tribe of Indians Secretary Monica Tonasket
“As future medical professionals, you are part of leading our community and our region in encouraging healthy living, free from addiction… and you will absolutely make a difference in the communities where you live and eventually work.” – Spokane Mayor Nadine Woodward
“My hope for you all is that when you’re seeing patients, however you’re seeing them, you are honoring them as people, recognizing all the traumas they’ve been through, not judging them by their worst day, and really trying to uplift them so that they can heal.” – Spokane City Council Member Breean Beggs
In Tacoma, similar sentiments were expressed by the community leaders and guest speakers. Tacoma City Councilmembers Catherine Ushka and Olgy Diaz, along with State Senator Yasmin Trudeau spoke to the Tacoma MEDEX cohort about the importance of ending stigma associated with substance use disorders and creating accessible opioid addiction treatment options.
During her time with the students, Senator Yasmin Trudeau took a few minutes to describe a recent change in Washington’s public policy known as the Blake Fix. She explained to Tacoma’s MEDEX students how the state of Washington has made a substantial shift in its approach to drug possession. Previously, drug possession was considered a felony offense, leading to incarceration and limited access to treatment. However, the Washington State Supreme Court ruled that the existing statute on drug possession was unconstitutional due to the lack of intent requirements. This decision prompted the legislature to reassess its approach to drug possession and develop a comprehensive solution. The Blake Fix, signed into law this spring, reclassifies drug possession as a gross misdemeanor.
Senator Yasmin Trudeau explained that while the Blake Fix is imperfect, the change allows for off-ramps to treatment programs before individuals face charges, providing them with an opportunity to seek help and recovery. By hearing directly from a state policy-maker, MEDEX Tacoma students were able to better understand the transitioning Washington State treatment landscape and conceptualize how their new MOUD skills are applicable, useful, and necessary no matter what area of practice they eventually pursue.
For their final training, Drs. Pentin and Orlowski were joined by Washington State Health Secretary Dr. Umair Shah, along with King County Council Member Claudia Balducci, and Seattle Chief of Police Adrian Diaz (see banner photo at top of article). Together, they painted a picture of Seattle and King County as a place greatly impacted by the opioid epidemic, but also as a place navigating a multifaceted approach to public health and safety, deeply intertwined with treatment. All of these community representatives expressed immense appreciation for MEDEX’s PA students’ future contributions in the region.
King County (WA) Councilmember Claudia Balducci
Spokane (WA) Mayor Nadine Woodward
Anchorage (AK) Assembly Member Christopher Constant
Tacoma (WA) Councilmember Catherine Ushka
Washington Secretary of Health Umair A. Shah, MD, MPH
Spokane (WA) Council Member Brean Beggs
With the support of community leaders and passionate faculty, MEDEX Northwest’s didactic year students across Washington, Hawaiʻi and Alaska will head into their clinical year with an advanced understanding of MOUD, OUD, trauma-informed approaches to addiction, and how to properly combat stigma in the medical field. This newly piloted 8-hour MOUD training program for PAs involving community leaders signifies a new era of OUD treatment, one that demands comprehensive and collaborative approaches across disciplines to advance knowledge, expertise, and advocacy. By working alongside policymakers, PAs can contribute to reducing stigma, improving prescribing practices, and providing compassionate care to individuals and families affected by opioid use disorder. Through these concerted efforts, MEDEX graduates can aptly work towards a society that supports recovery, reduces harm, and helps individuals reclaim their lives from the grip of addiction.
Toward the end of a long and intense day of MOUD training, Dr. Umair Shah shared a piece of advice that he grew up hearing from his parents with the Seattle cohort. “Do good, and do well.” When it comes to treating addiction, MEDEX students are well on their way.
