Training general psychiatry residents to prescribe buprenorphine in treatment of patients with opioid dependence

The most commonly abused substances in southwest Virginia are prescription medications. One of the most significant trends in Virginia is the percent of the population aged 12 and older using pain relievers for nonmedical purposes. Although the rate for the state as a whole (4.42%) is less than the national rate (4.89%), the southwest Virginia regional rate of 5.51% exceeds the national rate.1 The American Academy of Addiction Psychiatry, the American Osteopathic Academy of Addiction Medicine, and the American Psychiatric Association have been awarded a 3-year grant by the Substance Abuse and Mental Health Services Administration's Center for Substance Abuse Treatment to operate the Physicians' Clinical Support System for Buprenorphine (PCSS-B), effective July 1, 2011.2 This initiative provides training and clinical mentorship to practicing physicians and physicians-in-training who wish to include office-based treatment of opioid use disorders in their practices.2 The state of Virginia has 5 general psychiatry residency programs, of which Carilion Clinic–Virginia Tech Carilion Psychiatry Residency Program (CC-VTCSOM) may be the first to teach their general psychiatry residents about office-based treatment of opioid dependence by using this initiative. The program coordinates PCSS-B training for 17 of CC-VTCSOM's 32 psychiatry residents. The size of the training group was capped at 20, and 3 members of the faculty took the training as well. Residents and faculty completed a 3.75-hour training course, according to guidelines from PCSS-B, followed by a 4.25-hour face-to-face session by board- certified addiction psychiatrists, which included the program director for the addictions fellowship at CC-VTCSOM. This session included an interactive component with clinical case vignettes. Topics included an overview of office-based treatment of substance use disorders, review of opioids, introduction to buprenorphine/naloxone, special aspects of treatment of substance abuse disorders, and use of buprenorphine in special patient populations. This workshop was intended to prepare psychiatry residents to understand the complex demands of southwest Virginia's patient population, given the region's higher risk for opioid dependence.