Is there an Opioid Epidemic Hero in your community in Orange County? If so, let us know at saferxoc@gmail.com!  We would love to include them in our series.

Current Work and Effects of COVID-19
Dr. Nelson’s clinical work focuses on pain management and chronic pain at UCI’s pain management clinic. She is also the faculty lead of the 4-year integrated opioid curriculum for the medical students at UC Irvine. This curriculum focuses on primary, secondary, and tertiary prevention of opioids. Furthermore, her curriculum helps students understand the many available resources in Orange County which help properly guide patients towards their necessary service. 
During the COVID-19 pandemic, the pain management center Dr. Nelson worked at had full telehealth services for 2 months, and has gradually evolved to having patients come in for procedures. Patients have successfully become accustomed to telehealth; however, in California it is required for patients to have an in person evaluation prior to initiation of opioid therapy. This causes issues for patients in nursing homes who are typically less mobile and have a difficult time meeting at the health center. We discussed how this is a prime example of how the current laws on opioid prescribing require adaptation to our evolving healthcare environment during and after this pandemic. 
One would think that a person with a history of opioid use disorder (OUD) would be excluded from opioid therapy. However, when providing pain management for patients with this history it is not out of the question for them to receive opioids, just with closer monitoring and a shorter time period of prescription. Occasionally, it becomes more difficult to treat a patient with a past history of OUD because they feel as if they’re being personally attacked. Dr. Nelson finds that shared decision making helps come to a solution with the patient but regardless, it is a difficult conversation prior to these high stakes decisions. According to Dr. Nelson, in most cases opioids are an amazing tool for acute pain, but not so much for chronic pain. There are patients that come in knowing that they want opioids for their pain, and often request it. However, the injury they may have may not require opioids. This is when prescribing buprenorphine may be useful. Generally patients don't prefer it as it anecdotally produces less euphoria than other opioids, but it's much safer to use and is a good compromise for a patient with pain that merits opioid prescription but have risk factors for OUD. For Dr. Nelson, some patients would want to use opioids over cannabis, and there are a handful who would like to use cannabis instead of opioids. Patients may ask for cannabis as a substitute for opioids, but Dr. Nelson helps these patients understand that cannabis will not provide the same relief as an opioid. On the other hand, cannabis can help patients sleep better when pain is a factor hindering their rest because opioids can disrupt sleep causing additional pain, and due to the drug tolerance patients will eventually need additional doses. During this COVID pandemic and the ongoing opioid epidemic Dr. Nelson has been a powerful pillar for patients struggling with pain because her and her team have been adaptable for these patients, and they continue to provide high quality care through each barrier they face.  

Future Plans
Dr. Nelson’s future plans look to improve the capstone period of her opioid curriculum, where they currently have a plethora of workshops to learn about opioid use disorder resources in the county, and look to add a broader and more honed perspective for students going to communities outside of the county for their residency. This opioid curriculum was also one of the largest accomplishments of her work along with all the patients she’s helped overcome opioid dependence. She finds this curriculum to be a powerful set of tools for students to use when caring for their future patients. She sees how teaching these students, in a way, helps her provide care for more patients that her students will take care of one day. Dr. Nelson would like to thank the UC Irvine School of Medicine for supporting her work, specifically Associate Dean Dr. Jeff Suchard and Vice-Dean Dr. Khanh-Van Le-Bucklin. She also wishes to shout-out all the volunteering medical students at the Harm Reduction Institute and her colleague, Dr. Alisa Wray, for her help in implementing the 4-year integrated opioid curriculum. Dr. Nelson, being a phenomenal example of what it takes to be an Opioid Hero, has established herself as a true mentor during this opioid epidemic for many medical students who will one day save lives.

Introduction
Our next Opioid Hero of the Month is Dr. Ariana Nelson! Dr. Nelson is currently an Associate Professor of Anesthesiology at the UC Irvine School of Medicine. Coming from the Midwest, Dr. Nelson arrived in Orange County for the congenial work environment provided by UCI Health, which helped her to thrive in her career. She was attracted by how easy it was to collaborate with different specialists to help improve the care of her patients, something that can be challenging at other institutions. She was motivated to become a physician working in pain management because of the research she did in her early years related to anesthesiology and the adverse effects of opioids. Through both a residency and fellowship in anesthesiology and pain management, she learned that most patient encounters begin with a conversation with a patient about pain. All clinicians therefore need to understand how to converse about opioids and the risks associated with them. Dr. Nelson witnessed the effects of the opioid epidemic on anesthesiologists and described the dangerous nature of their work, being a high risk healthcare worker group for opioid use disorder. The ease with which anesthesiologists access opioids creates a direct route for these physicians to be pressured to divert these medications, and demonstrates how the opioid epidemic can affect all socio demographic groups, even those with advanced degrees and strong understanding of the risks. 

Opioid Hero of the Month: August 2021

Dr. Ariana Nelson