UHealth's Primary Care Clinic Now Treating Opioid Use Disorders 

Written by Amanda Torres

Published on November 5, 2019

UHealth—the University of Miami Health System—is one of six health systems in the United States to house an office-based addiction treatment (OBAT) program in its primary care clinics. At the clinics, opiate use disorder is managed in the same way other chronic health conditions are–with confidentiality, medication-assisted treatment, and counseling. Patients also receive help with linkage to other providers, health, and social service resources.

The clinic, located at the UHealth Professional Arts Center and housed under the Department of Family Medicine and Community Health, is made up of a team of dedicated medical professionals who specialize in the treatment of opiate use disorders. The team includes two advanced practice registered nurses, Caroline Piacentini Rinehart, DNP, APRN, FNP-C, and Lainey Kieffer, DNP, APRN, FNP-BC, as well as Robert Schwartz, M.D., who is professor and chair of the Department of Family Medicine and Community Health. Melissa Chee, BSN, RN-BC, serves as the nurse care manager of the OBAT program.

Since opening its doors in February 2018, the lives of various patients have been transformed with the help of the program. Chee reminisced on the very first patient she oversaw, who has now been in treatment in the clinic for a year and a half.

“When I first met this patient, she came to the clinic a little disheveled. She was using a walker, was not as social, and would isolate herself at home because she was in a lot of pain. She was also worried about feeling the effects of withdrawal in public,” Chee said. 

Chee recalled first conducting a screening–the protocol for each new patient who seeks treatment at the clinic. The screening process consists of analyzing the patient’s medical and substance use history. Based on those factors, Chee determines whether they misuse opiates. If they do, one of the doctors on the team diagnoses the patient and begins to oversee their care or writes prescriptions.

After being in treatment for less than a year, Chee said "The patient started doing simple things like dying her hair again. She doesn’t have a walker anymore, she cooks, goes out, and socializes. She has her life back."

Each patient is evaluated based on their opiate use disorders. Nurses like Chee and physicians provide them with patient-centered care, as well as with education and training on overdose and Naloxone, which reverses overdoses in an emergency situation.

The physicians and nurses also administer medication-assisted treatment for addiction, such as Buprenorphine, which is for individuals who have had the disorder with opiates, heroin, fentanyl, or carfentanyl. 

When Viviana Horigian, M.D., M.H.A., a professor in the Department of Public Health Sciences, heard of the Primary Care Opioid Use Disorder Treatment (PROUD) Trial, she applied for and received the National Institute on Drug Abuse grant that enabled UHealth to participate in the trial.

PROUD began in February 2018 and has enabled participating sites to implement office-based addiction treatment programs within their health systems, including the UHealth system. The goals of this trial are to increase the number of patients who seek medication-assisted treatment, as well as to help guide health system leaders with information when deciding on treating opioid-use disorder in primary care.

“In most instances, patients prefer to obtain treatment in the same setting where they receive care for other medical conditions, such as asthma, diabetes, or hypertension. Patients prefer the convenience of receiving treatment in primary care,” said Dr. Horigian. “We have a long way to go in battling stigma for this chronic mental disorder, but providing treatment in primary care for cases that qualify is a huge step forward in this battle.”