Assessing a Year of Successes and Challenges: PAEA’s MAT Initiative

In 2018, PAEA joined a mission to build a nationwide Opioid Response Network (ORN), funded by the American Academy of Addiction Psychiatry’s Substance Abuse and Mental Health Services Administration (SAMHSA). The Association recognized the unmet demand for medication assisted training (MAT) providers and patient access at a time when opioid overdoses continued to claim the lives of more than 130 Americans every day. PAEA, the only ORN partner organization representing PA education, is pledged to harness the talent of PA faculty and students to increase patient access to effective opioid use disorder (OUD) treatment through the MAT Waiver Training Initiative. The goal of the initiative is to ensure all graduating PA students are eligible to prescribe buprenorphine.

A baseline survey conducted in 2018 revealed that only 2.7% of programs required MAT waiver training prior to the initiative. As the first year of the MAT project came to a close in April 2019, PAEA sought to measure the MAT Initiative’s impact and found that 29.7% of surveyed programs now require students to complete MAT waiver training prior to graduation. Programs not currently requiring MAT training, but planning to implement it by May 2020, will raise the total to 59.3%. This means that, at the conclusion of the two-year project, nearly two-thirds of programs will be graduating MAT waiver–eligible PAs into the workforce.

The survey also asked programs about barriers to adopting student MAT training as a curricular component. The 2019 impact survey, which was sent to PA program directors in the spring, achieved a 73% response rate (172/238), and respondents’ comments revealed key insights regarding the project’s overall progress as well as common barriers that program directors face when implementing student MAT training. 

While this increase alone would be an excellent outcome, the goal of the MAT Initiative has always been to achieve 100% MAT waiver eligibility among PA program graduates and faculty. That is why PAEA queried survey respondents about factors that limit a program director’s ability to integrate MAT training. Based on this feedback, PAEA will offer additional guidance and support to help programs overcome troublesome barriers preventing them from taking part in the initiative.

MAT Project Director John Lopes offers the following solutions to the five most common barriers to implementing the student MAT training requirement, as cited by program directors:

1. I am unsure how to require that my students complete MAT waiver training prior to graduation.
The easiest way to have your students participate in the waiver training is to make it an assignment during the clinical year. Submission of the completion certificate at the end of the year will demonstrate compliance.

2. Our program’s course schedule is already full, which leaves students and faculty with limited time to complete/administer 24 hours of MAT waiver training.
The training is available entirely online. Once students enter their clinical training, their schedules are more flexible, and they can then devote the hour or two per week needed to participate in the training (e.g., one hour per week over a six-month period). Assigning completion of the training during the clinical year enables students to participate in the training on a self-paced basis with input from faculty limited to reminders of the deadline and collecting the certificates of completion. Questions students have regarding the material may be referred to the MAT Initiative project director at MATInitiative@PAEAonline.org or the Providers Clinical Support System.

3. My PA program lacks enough qualified faculty to effectively administer student MAT waiver training.
The waiver training is available online through two primary venues. The American Society of Addiction Medicine and the Providers Clinical Support System both offer the 24 hours of training for PAs. The modules are developed in conjunction with leading providers and researchers in addiction medicine and updated regularly. The online format means that your faculty do not have to be content experts regarding addiction and/or opioid use disorder. PAEA, via funding from the Opioid Response Network offers technical support to programs to answer questions faculty and students may have regarding the training. Expert assistance is also available from the Providers Clinical Support System and their Mentoring service.

4. I am concerned that PA students do not have enough clinical experience to accompany MAT waiver training and successfully treat OUD patients.
No student is completely prepared for every eventuality as clinical experiences vary considerably between sites. However, over time your clinical-year students will encounter patients with a wide spectrum of substance use disorders. If you include tobacco and alcohol use disorders into the mix that students encounter in clinic and inpatient settings, the need for broad understanding of prevention, screening, treatment, referral, and ongoing care should become clear. Shouldn’t they have the medical knowledge to be as prepared to take care of these patients as they are to care for patients with diabetes mellitus or hypertension?

5. MAT waiver training is not appropriate for every PA graduate, and the decision to complete MAT waiver training should be made at the practice level.
MAT waiver training provides participants with broad exposure to the diagnosis and treatment of OUD and further instruction on the rules and regulations applicable to medication assisted treatment of OUD. According to the 2016 National Survey on Drug Use and Health, some 48.5 million individuals in the United States reported the use of illicit drugs or misuse of prescription drugs in the previous year; 11.8 million reported opioid misuse specifically.¹ Compare this with the one million people living with Parkinson’s disease² or 726,000 patients with end-stage renal disease.³ Your graduates are far more likely to meet a patient with a substance use disorder than a patient with either Parkinson’s disease or end-stage renal disease. The number of patients admitted with a diagnosis of OUD and a related infectious complication of injection drug use increased almost 1.5 times between 2002 and 2012.⁴ Graduates should be prepared to address the treatment needs of these patients, either directly or by referral to an appropriate source of care.

If your program has not yet considered training students in MAT or has encountered difficulties in implementing MAT training as a part of the curriculum, please join John Lopes on July 10 at 2:00 p.m. (ET) for a webinar entitled, “Breaking Down Barriers to Student MAT Training.” During the webinar, attendees will learn more about how to successfully resolve typical program challenges to offering student MAT training. Participants will also be given the opportunity to share their personal student MAT training barriers and receive instant advice on how to overcome them.

PAEA would like to thank all the program directors who completed the 2019 MAT Waiver Training Follow-up Survey. With your help, the MAT Initiative is now able to provide improved technical assistance to member programs, which will empower them to train the future generation of MAT providers. We hope that by initiating these improvements, the MAT Initiative will reach its goal by the end of year 2 and put PA education programs on the map as leaders in the fight against the opioid epidemic.

To learn more about PAEA’s MAT Initiative, visit our website or contact us at MATInitiative@PAEAonline.org. For more information on the ORN, you can visit their website, email them at orn@aaap.org, or call 401-270-5900.
_____________________________

1. https://www.cdc.gov/drugoverdose/pdf/pubs/2018-cdc-drug-surveillance-report.pdf
2. https://www.parkinson.org/Understanding-Parkinsons/Statistics?_ga=2.77640087.2039518659.1559323660-71361296.1559323660
3. https://nccd.cdc.gov/CKD/detail.aspx?Qnum=Q67
4. Health Affairs 2016; 35(5):832-837

Funding for this initiative was made possible by grant no. 1H79TI080816-01 from SAMHSA. The views expressed in written conference materials or publications and by speakers and moderators do not necessarily reflect the official policies of the Department of Health and Human Services; nor does mention of trade names, commercial practices, or organizations imply endorsement by the U.S. Government.