Academic Detailing to Address Substance Use in New Jersey: An “All-Hands-on-Deck” Approach

An interview with Clement Chen, PharmD, BCPS, Clinical Pharmacist Specialist, Rutgers New Jersey Medical School.
 
by Anna Morgan, MPH, RN, PMP, Senior Manager, Training & Education, NaRCAD
 
Tags: Substance Use, Detailing Visits, Evidence Based Medicine

Anna: Hi Clement! We can’t wait to hear about all the impactful work you’ve been doing in New Jersey. Tell us a little about your academic detailing program.
 
Clement: The Northern New Jersey Medication-Assisted Treatment Center of Excellence was established in 2019 and is funded by the New Jersey Department of Human Services. Our goal is to not only increase access to medications for opioid use disorder (MOUD) in office-based addiction treatment practices, but also to ensure that providers treat this chronic disease with evidence-based practices. Our vision is to end the stigma of addiction and ensure that all people with substance use disorders have access to high quality care so they may live full and satisfied lives. I was hired as the academic detailer to provide education and identify the needs of providers in these practices.

Anna: Tell me more about the types of providers you visit.

Clement: I’ve been working with providers from all areas of care. In addition to office-based providers, they also include those from hospital settings, psychiatric hospitals, community health centers, substance use licensed facilities, and prison settings.

Addressing the substance use crisis requires an “all-hands-on-deck” approach. Any setting where patients seek care are environments where detailing can improve patient access to support.

Anna: It’s so important to approach academic detailing with a wider lens and consider where it can fit in with other community initiatives. Can you walk us through some of the work you’ve done so far, or are planning to do, in each of these settings?

Clement: I’d be happy to!

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Hospital Setting: One of the inner-city hospitals that we are working with is looking to establish an addiction medicine service within their hospital system. The goal is to provide trainings and consultations on best practices for addiction medicine, in addition to technical assistance in setting up a program. I’ll be working with their attending physicians and residents to provide evidence-based practice trainings. 

Another one of our partners, an addiction medicine provider, has been pushing for greater initiation of MOUD in her own hospital system. The main issue is to ensure that providers use MOUD in an evidence-based manner and adhere to the latest findings. For example, the provider has been receiving pushback from other providers due to the lack of referral sources. These providers have shared that they believe MOUD should not be initiated without a “warm handoff.”

Furthermore, buprenorphine has been discontinued during the pre and peri-operative settings and only resumed post-operatively despite growing evidence for continuing buprenorphine in these settings. I plan to detail these providers in-person to provide literature supporting the use of MOUD, even when warm handoffs are unavailable. I’ve provided supporting literature and a summary to the addiction medicine provider to assist with her case to expand this initiative, which helped her to develop an information sheet to justify the expansion of MOUD in her hospital.

Psychiatric Hospital Setting: We’ve also partnered with physician champions at some of the psychiatric hospitals in New Jersey. Stigma and the inaccurate idea that patients do not experience acute withdrawal for opioid use has made many providers hesitant to start therapy with buprenorphine. Psychiatric hospitals have been fervently looking to provide treatment for opioid use disorders.

The goal is to implement a clinic designed for initiating and maintaining those on buprenorphine and naltrexone extended release. We’ll be assisting with the implementation of the clinic and provide individual in-person detailing visits for the providers at the hospital. To prepare for this, we’ve developed several informational sheets on MOUD and other related information to give to the providers.  

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Community Health Center Setting: One of the community health centers that we’ve partnered with wants to begin providing MOUD for those already on the therapy. There are several advanced nurse practitioners and physicians at the health centers looking for more guidance and support on the appropriate prescribing of buprenorphine. I’ll be working with their team to provide them with evidence-based practices and help them with buprenorphine induction strategies. 

Substance Use Licensed Facility Setting: One of the substance use licensed facilities I’ve consulted with mentioned that fentanyl has made initiation of buprenorphine very difficult due to the increase in the number of cases with precipitated withdrawal. As a detailer, I’ve worked closely with their lead providers, providing them with available literature on alternative buprenorphine induction strategies. They're in the process of updating their protocols for the induction of buprenorphine. Another facility is working with us to start prescribing MOUD within their residential settings.
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Prison Setting: I regularly consult with the Department of Corrections providers since access to MOUD have traditionally been low in the prison system. Their patients also have unique needs compared to those in the community setting. I meet with them on a monthly basis via a case conference and discuss clinical solutions in order to help them provide the best care to their patients. ​

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Anna: Your work is incredibly comprehensive and thoughtful. It’s truly amazing to see how your team has incorporated academic detailing into so many initiatives and clinical settings within your community.

Clement: We believe that to overcome this crisis, all patients with opioid use disorder need equitable and timely access to care. With the record number of overdose deaths reaching over 100,000 in one year, this is our greatest focus. We’re confident that our academic detailing work will help us achieve this goal.

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Biography.  Dr. Clement Chen graduated from the Ernest Mario School of Pharmacy at Rutgers University in 2013 with his Pharm.D. He then completed a one-year residency at the Hudson Valley Veterans Affairs Ambulatory Care Clinic. Thereafter, he has worked as a staff pharmacist at St. Michael’s Medical Center in Newark and as a cardiology heart failure clinical pharmacist specialist at University Hospital in Newark. In addition to working as a clinical pharmacist specialist, he was a Transitions of Care pharmacist at Hunterdon Medical Center from 2016-2020. This has helped him to balance his inpatient and outpatient roles as a pharmacist. To further demonstrate proficiency in clinical pharmacy care, he received his Board Certification in Pharmacotherapy in July of 2016.  His current role is as the academic detailer in the Northern NJ Center of Excellence, with the goal of providing education and support to increase statewide capacity to provide medications for addictions treatment (MAT) for patients with substance use disorders with a focus on opioid use disorder.

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