We aim to develop and implement person-centered treatment approaches for painful conditions frequently treated at the Emergency Department (ED) of University Hospital. Our population of focus will be patients from the University Hospital ED with substance use disorder, particularly Opioid Use Disorder (OUD), who have high rates of intravenous drug use, and are overwhelmingly resource limited. Our population lives in Newark NJ or the surrounding communities hence it is an urban, predominantly African-American population. Moving forward, we will utilize data to develop informed training programs and tailor existing strategies to ensure an understanding of pain management responses and help-seeking behaviors across different cultures and mental health backgrounds to address provider biases related to behavioral health, cultural, and social determinants of health disparities. We will train both ED and other medical/surgical providers on how to incorporate Medication for Opioid Use Disorder (MOUD) during treatment and prescribe buprenorphine in order to identify people who are in need of treatment for pain and OUD. Across the 3-year grant period, approximately 430 trainees (residents, NP and PA students) and 2,400 patients will benefit from specialty-focused strategies on pain management and MOUD. We will develop strategies to provide pharmacological and nonpharmacological alternatives to opioids using innovative and multidisciplinary strategies that can be initiated in the ED setting. Currently, our pain guidelines is a syndrome-based approach tailored to pain etiology, and utilizes over 30 different nonopioid medications for pain relief.
We will continue to develop our pain guidelines by incorporating innovate and less common pharmaceutical approaches for pain (e.g., IV buprenorphine, IV magnesium, and INH nitrous oxide, etc) and will adopt our strategies to also apply to the prehospital setting through our Emergency Medical Services (EMS). Healthcare providers will be trained on alternative nonpharmacological interventions. ED-Alternative (ED-Alt) bedside interventions will include education on breathing exercises/meditation, visual therapy using virtual reality headwear, and music therapy using audiophones with options that reflect a diverse range of cultures and languages. ED-Alt referrals for acupuncture, meditation, physical therapy, and cognitive behavioral therapy will be given by trained peer navigators and physicians. We will ensure fidelity to our evidence based practices by emphasizing a team-based approach utilizing peer navigators, ED Pharmacists, and clinical decision support systems (CDSS). Our peer navigators and trained ED providers will provide ED patients with brief counseling and instruction on breathing exercises and meditation techniques at the bedside. Navigators will assist in arranging outpatient referrals to ensure appropriate linkage to multidisciplinary MOUD services and ED-Alt referrals. A CDSS will be linked within the Electronic Health Record and will incorporate our updated pain guidelines, tailored order sets based on pain etiology, and MOUD dosing guidelines based on patient history and COWS score. We will work with SAMHSA to catalogue best practices and ensure these strategies are shared with the healthcare field at large. We will share our training on Interdisciplinary Strategies for Managing Opioid Use Disorder, with modules on Cultural Approaches to Pain and Potential Provider Biases, Pain Management Strategies using Innovative Pharmaceutical Approaches and Alternative Nonpharmacological Interventions. We will strengthen our partnerships with community organizations, drug rehabilitation programs, shelters, government agencies, educational institutions, EMS, and our country prison, to disseminate our evidence-based practices on alternatives to opioids for pain.
