Indiana Health

Opioids Abuse Crisis

The opioid epidemic is devastating communities throughout the United States, especially in Indiana, where hundreds of opioid-related deaths are reported each year. This, along with nearly 1,500 opioid-related hospitalizations across the state, warrants a reassessment of treatment for opioid-use disorders. IU School of Medicine is committed to advancing training and research related to opioid abuse to improve population health and patient care.

6
million opioid prescriptions written in 2015 in Indiana
794
opioid-related deaths in Indiana in 2016
1430
opioid-related hospitalizations in Indiana in 2015
63
Percent of adults who misused opioids to relieve pain*

Data source: National Institute on Drug Abuse (reported Feb 2018)
*Annals of Internal Medicine 2017

Education

Indiana University School of Medicine recognizes the epidemic levels of opioid-abuse, specifically in Indiana, and has enhanced offerings in medical student education and graduate medical education. The school has also increased learning opportunities through both continuing medical education and grant-funded projects.

IU School of Medicine is one of about 40 ACGME-accredited programs to become certified by the American Board of Medical Specialties (ABMS) in addiction psychiatry as part of the Addiction Psychiatry Fellowship program. This comprehensive specialty training program, offered by the Department of Psychiatry, includes education-training opportunities for fellows as well as research. The program centers on clinical care at the Richard L. Roudebush VA Medical Center and at Eskenazi Health Midtown Community Mental Health sites and trains qualified physicians in the diagnosis and treatment of substance use disorders and addictions.

Graduate medical education training in Internal Medicine, Pediatrics and Psychiatry include intoxication and withdrawal; pharmacology for substance use disorders; psychopathology in substance-use disorders; clinical use of motivational interviewing; addictions in adolescence; addictions sub-specialty didactics; addictions clinics; substance induced mood disorders; advanced substance use disorders; pain management outpatient experience; Neonatal Abstinence Syndrome awareness; and identification of drug seeking behavior.

All residents who prescribe medications complete two training modules, which cover the DEA perspective on opioids as well as the medical perspective on opioids, including how to treat patients at risk for (or who suffer from) opioid or illegal drug-use disorders. The modules teach best practices for prescribing opioids in alignment with national guidelines and state laws.

The statewide MD curriculum includes training on prescribing opioids and managing opioid abuse. Each year of the MD curriculum contains content on pain pathways; pain management and opioid addiction; pharmacologic strategies for treating pain, including nonopioid agents; non-pharmacologic strategies for treating pain; motivational interviewing; substance abuse and screening; CDC guidelines; and prescription expectations for Indiana providers. Clerkship rotations in Anesthesia, Emergency Medicine, Medicine, Pediatrics, Psychiatry and Radiology cover topics on acute/chronic pain management; chemical dependency, opioid safety; and fetytoxicology/intoxication and law enforcement.

As part of the MD curriculum for the Rural Medicine Education Program at at IU School of Medicine—Terre Haute, students in this unique four-year medical school program receive emphasized training in primary care and other specialties of need in rural communities, including longitudinal exposure and experiences with health care delivery in a rural setting.

A collection of CME programs offered by IU School of Medicine address opioid-use disorder to help practicing physicians respond to the crisis.

Grants are funding training programs that focus on how emerging and practicing physicians can help ease the crisis in Indiana of opioid-use disorders.

Research

Faculty across many medical specialty areas at IU School of Medicine are conducting focused research on various aspects of the opioid-abuse crisis and drivers of addiction disorders that are devastating the lives and communities of so many Indiana residents.

Bryan K. Yamamoto, PhD (Chair, Department of Pharmacology and Toxicology) and Brady K. Atwood, PhD (Assistant Professor of Psychiatry) at IU School of Medicine are co-PIs on a research study exploring the Long-Term Consequences of Opioid Neonatal Abstinence Syndrome.

While Indiana remains above the national average in prescribing opioids, between 2012-2015 Indiana was second only to Rhode Island in reducing the number of opioid prescriptions. Palmer J. MacKie, MD, MSClinical Assistant Professor of Medicine at IU School of Medicine, has been championing a safer and more appropriate use of opioids for a decade. Dr. MacKie is the director of the Integrative Pain Program, where he and the team use an integrative approach to reduce pain and improve functionality. He has been involved with helping to create, promulgate and educate on most opioid-related legislation in Indiana from 2013 until 2018. This includes testifying for and against proposed legislation. Most recently, he has been part of a team drafting legislation related to office based treatment of opioid-use disorder.

Research led by Zackary Rodd, PhD, Associate Professor of Psychiatry at IU School of Medicine, and Ka He, Professor and Chair Department of Epidemiology and Biostatistics at IU Bloomington, is focused on identifying opioid hotspots through community level assessment of drug intake by analyzing unique compounds in wastewater. Steven E. Lacey, Chair, Department  of  Environmental  Health  Science,  Indiana University Fairbanks School  of Public Health, Indianapolis, has also been a key member of the research team.

Flora Hammond, MD, Chair, Department of Physical Medicine and Rehabilitation at IU School of Medicine, is leading a CDC grant to reduce opioid use among TBI survivors.

Zachary Adams, PhD, Assistant Professor of Clinical Psychology at IU School of Medicine, is leading the Telehealth Recovery and Resilience Program: Opioid Extension (TRPP-O) in Adolescent and Young Adult Trauma Survivors. The program is supported by IU’s Responding to the Addictions Crisis Grand Challenge.

Collaborative Projects

Indiana University School of Medicine is working closely with community health providers and colleagues throughout IU and the state to deliver enhanced support and medical care to help alleviate the tragic impact of opioid abuse in Indiana.

The CARE Plus research project, part of the We Care Indy program, uses a unique, community-focused approach to helping new mothers and babies addicted to opioids get the care they need.

Through technology-enabled collaborative learning, the Opioid Extension for Community Healthcare Outcomes (ECHO) project is improving the treatment of opioid-use disorders in rural and under-served areas.

Faculty Experts in Opioid-Use Disorders

Zachary W. Adams, PhD

Zachary W. Adams, PhD

Assistant Professor of Clinical Psychology
R A. Chambers, MD

R A. Chambers, MD

Associate Professor of Psychiatry
Leslie A. Hulvershorn, MD

Leslie A. Hulvershorn, MD

Associate Professor of Psychiatry
Debra K. Litzelman, MA,  MD,  MACP

Debra K. Litzelman, MA, MD, MACP

D. Craig Brater Professor of Global Health Education
Palmer J. MacKie, MD

Palmer J. MacKie, MD

Assistant Professor of Clinical Medicine
Brandon Oberlin, PhD

Brandon Oberlin, PhD

Assistant Professor of Psychiatry
Zachary A. Rodd, PhD

Zachary A. Rodd, PhD

Associate Professor of Psychiatry
Bryan K. Yamamoto, PhD

Bryan K. Yamamoto, PhD

Chair, Department of Pharmacology & Toxicology