​Introduction and upcoming to OC and efforts against opioids

Our Opioid Hero of the Month for June is Dr. Cameron Harding! He is the Clerkship Director for the Department of Internal Medicine and is also the Director of the Addiction Consult Service at UCI. Dr. Harding was originally from Kentucky and has been in California for a little over two years. He is now in his third year at UCI. Being from Kentucky, he witnessed firsthand the devastation of the opioid epidemic. Coming out to California, Dr. Harding noticed that there wasn't much support to treat patients with opioid use disorder, specifically at UCI. Dr. Harding wanted to start was a way to help these patients, and so he began the Addiction Consult Service. This service allows for increased awareness of how to treat opioid use disorder. Patients with opioid use disorder often leave against medical advice and do not address their medical problems only to be readmitted to the hospital later. By starting them on buprenorphine as an inpatient and treating their addiction, Dr. Harding works to directly break the cycle. Any patient that is hospitalized with opioid use disorder can now receive buprenorphine and treat their addiction in the hospital, with follow ups at outpatient clinics. 
When Dr. Harding first came to UCI, he was the only X-waivered physician within the hospitalist program. Since that time, the majority of the hospitalists have become X-waivered. Dr. Harding notes that there is significant bias and stigma towards patients that have any sort of substance abuse disorder. A patient that comes into the hospital with a history of IV drug use immediately faces stigma and bias. Dr. Harding emphasizes that it is within all of our powers to reduce this stigma by considering addiction as a disease, which it is. This normalizes the disease, similar to how diabetes is a disease and needs to be treated. The same is true for addiction; it can be identified, named, and treated.

Current work, and how COVID-19 has affected work

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Dr. Harding is currently working on a systematic review to determine exactly what evidence is out there for stigma against patients with opioid use disorder. His publication and potential grant acceptance will allow him to shed some light on what interventions can possibly be done to reduce stigma. Dr. Harding stresses for normalization, so that more harm reduction can be done for these populations. If a patient says that they are using intravenous drugs, they should not be labeled as an IV drug user. Harm reduction should instead be prioritized, which does take a cultural change to accomplish. The first step is being able to show fellow physicians there actually are good medicines for this. This is one step towards the normalization of opioid use disorder and reducing stigma and bias towards patients with substance use disorders.
According to Dr. Harding, the COVID-19 pandemic was actually in some ways beneficial to patients with substance use disorders, because it allowed easier access to the medications to treat them. The revisions and legislation during the pandemic allowed this. Patients often have not just a substance use disorder, but also have other social determinants of health that are affecting them. Maybe they're homeless, and are not able to actually find transportation to an actual clinic. Well, now with a virtual visit with their clinic physician, they are able to prescribe the medicine to whatever pharmacy they're close to. This allowed a bypass of a lot of the natural hurdles that were out there for these patients.

Accomplishments, Future plans, and Shoutouts

One of Dr. Harding’s proudest accomplishments is starting the Addiction Consult Service at UCI. It started as Dr. Harding helping other hospitalists take care of patients with opioid use disorder; amongst the medicine teams, if somebody was hospitalized with opioid use disorder, Dr. Harding would serve as their go-to expert for those cases. Once enough of those hospitalists were trained and got X-waivered, Dr. Harding was able to then open up services with his medicine consult service to the entire hospital. Now, it doesn't matter if the patient is from OB/GYN, Ortho, Trauma, etc, Dr. Harding, and the Addiction Consult Service can still provide care for those patients. The program is at the point now where they have a fully staffed medicine consult service team that's able to provide addiction services to all departments throughout the hospital. 
The most rewarding aspect of this for Dr. Harding is the patient impact. Dr. Harding has had a patient a couple weeks ago that ended up on his team and he noticed she was on buprenorphine. Another physician had actually started her on buprenorphine a couple months before and she told him that the buprenorphine had saved her life. Knowing that Dr. Harding had some part in providing this patient with the care they needed, it really came full circle the work he's been doing and it's just a tremendous feeling that cannot be simply described by words.  UCI does not have any outpatient buprenorphine clinics or providers that are able to provide MAT services, therefore, in the long term, Dr. Harding plans to find ways to have these patients follow up with UCI providers.
Dr. Harding’s message to other physicians is that “If you are a provider, you should obtain your x-waiver. The hurdle has been removed, now is the opportunity to actually provide the care that these patients are long overdue.”
Finally, Dr. Harding would like to issue a special thank you to Dr. Chakravarthy, Tiffany Hwang, and Mahan Naeim.

Opioid Hero of the Month: June 2021

Dr. Cameron Harding

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.