A Clinical Approach to Overcoming Opioid Use Disorder in Patients

Overcoming Barriers in Managing Opioid Use Disorder: Strategies for Effective Care

Opioid use disorder (OUD) is a serious health issue that affects many people today. It falls under a larger group called substance use disorders (SUD). Treating OUD can be tough because each person has their own set of problems, like other health conditions or pain. Doctors and other health care workers need to create plans tailored to each patient. They also have to stay current on laws, ethics, and methods for protecting patient information. While general rules like the Health Insurance Portability and Accountability Act (HIPAA) of 1996 cover all patients, there are extra rules for those getting help with alcohol or drug problems.

In this guide, we explore how to overcome challenges in OUD management. We look at patient-centered care, communication tips, stigma, team-based approaches, and legal matters. By using these strategies, health providers can help patients recover better. Keywords like “opioid use disorder management,” “overcoming stigma in OUD,” and “patient-centered care for SUD” highlight key ideas for better understanding and search visibility.

Learning Objectives

• Explain treatment planning methods that use patient-focused choices and proven ways to talk.
• Name the three kinds of stigma and how they affect people with mental health issues, SUD, and especially OUD.
• Talk about legal, ethical, and privacy concerns in caring for people with OUD.

Effective Treatment Planning with Patient-Centered Decisions

People with complex issues, like mental health problems, SUD, and pain, need special care. Each person shows up differently, so health systems are now focusing on care that puts the patient first.

Patient-centered care means building teams with doctors, patients, and families. They work together to plan, give, and check health care. This way ensures the patient’s needs are met, and their wishes, likes, and family situations are respected. It focuses on shared choices about treatments while seeing the patient as a whole person in their daily life (Dwamena et al., 2012; Bokhour et al., 2018).

Studies show key steps for a good patient-centered plan:

• Take a full patient history and a check-up, reviewing old and new treatments.
• Find all available drug and non-drug options.
• Check the patient’s current health, recent changes, and patterns.
• Look at risks for misusing or abusing opioids.

If starting opioids or if the patient is already on them, think about opioid stewardship. This means checking harms, benefits, risks, side effects, pain control, daily function, drug tests, stop plans, and ways to spot OUD. These programs, sometimes called analgesia stewardship, help manage opioids safely (Harle et al., 2019; Coffin et al., 2022). Guides exist to set them up (American Hospital Association, n.d.; Shrestha et al., 2023).

Integrative chiropractic care can play a big role here. It uses spinal adjustments and targeted exercises to get proper spinal alignment. This helps reduce pain without relying only on drugs, making it a good fit for OUD patients with pain. For example, adjustments fix spine issues that cause pain, and exercises strengthen muscles to keep alignment right.

A Nurse Practitioner (NP) adds full management and ergonomic advice. They look at work setups to prevent pain, such as how to sit or lift. NPs coordinate care by reviewing options such as therapy, meds, and lifestyle changes, ensuring everything works together.

Dr. Alexander Jimenez, DC, APRN, FNP-BC, with over 30 years in chiropractic and as a family nurse practitioner, observes that blending these methods cuts opioid use. At his El Paso clinic, he uses functional medicine to address root causes through nutrition and non-invasive treatments. He notes that poor posture from modern life worsens pain, leading to OUD risks. His teams help patients with self-massage and VR for recovery, reducing drug needs (Jimenez, n.d.a; Jimenez, n.d.b).

Evidence-Based Ways to Communicate

Good talking skills are key to building a patient-centered plan (Schaefer & Block, 2009). There are proven methods for starting conversations and getting patients involved.

One method is BATHE:

• Background: Ask, “How have things been since your last visit?”
• Affect: Ask, “How does this make you feel?”
• Trouble: Ask, “What bothers you most?”
• Handling: Ask, “How are you coping?”
• Empathy: Say, “That sounds hard.”

This uses open questions to let patients lead and feel supported (Stuart & Lieberman, 2018; Thomas et al., 2019).

Another is GREAT:

• Greetings/Goals: Start with hello and set aims.
• Rapport: Build trust.
• Evaluation/Expectation/Examination/Explanation: Check and explain.
• Ask/Answer/Acknowledge: Listen and respond.
• Tacit agreement/Thanks: Agree and thank.

This guide talks well (Brindley et al., 2014).

Motivational interviewing is also useful. It’s a team-style talk to boost a patient’s desire to change. Build a bond, focus on the issue, spark a desire for change, and plan steps (Frost et al., 2018).

These methods emphasize listening, clear communication, and a structured approach to planning. For OUD patients with pain or mental issues, mix techniques for the best results.

Dr. Jimenez shares that in his practice, these talks help patients see non-drug options, such as chiropractic adjustments. He finds that empathy reduces stigma and fear, encouraging openness about OUD (Jimenez, n.d.a).

Understanding Stigma in Mental Health and Substance Use Disorders

Stigma blocks good talk for many with mental health or SUD. It’s attitudes, beliefs, actions, and systems that lead to unfair views and bad treatment (Cheetham et al., 2022).

Studies show stigmas like linking mental illness to violence (Perry, 2011). Media on shootings with mentally ill people strengthens this (McGinty et al., 2014; McGinty et al., 2016; Schomerus et al., 2022). For SUD, people think they’re more dangerous than those with schizophrenia or depression (Schomerus et al., 2011). Society blames people with SUDs more and avoids them (McGinty et al., 2015; Corrigan et al., 2012).

Views come from knowledge, contact with affected people, and the media. Public ideas are tied to norms on causes, blame, and danger. Race, ethnicity, and culture shape attitudes too (Giacco et al., 2014).

Health workers have biases. A survey of VA mental health providers showed awareness of race issues but avoidance of talks, using codes like “urban,” and thinking training stops racism (McMaster et al., 2021).

There are three stigma types:

• Structural Stigma: The ways Society and institutions keep prejudice. In health, it’s worse care, less access to behavioral health. Less funding for mental vs. physical issues (National Academies of Sciences, Engineering, and Medicine, 2016).
• Public Stigma: General or group attitudes, like police or church norms. Laws reinforce it, like broad mental illness rules implying all are unfit (Corrigan & Shapiro, 2010).
• Self-Stigma: When people internalize stigmas, it leads to low self-worth and shame. “Why try” affects independent living (Corrigan et al., 2009; Clement et al., 2015).

Dr. Jimenez observes that stigma makes OUD patients hide symptoms, delaying care. In his integrative work, he addresses this through education on holistic options, showing that recovery is possible without judgment (Jimenez, n.d.b).

Overcoming Stigma and Addressing Social Factors

To fight stigma, use education, behavior changes, and better care. Laws like the ADA and MHPAEA help ensure equal coverage and prevent discrimination (U.S. Congress, 2009; U.S. Congress, 2008; U.S. Department of Health and Human Services, n.d.; Busch & Barry, 2008; Haffajee et al., 2019).

These address social determinants of health (SDOH), such as coverage, access, quality, education, and stability (Centers for Disease Control and Prevention, n.d.).

Community programs help too:

• West Virginia’s Jobs and Hope: Training, jobs, education, transport, skills, record clearing for SUD people (Jobs and Hope, n.d.).
• Belden’s Pathway: Rehab for failed drug tests, leading to jobs (Belden, n.d.).

Education boosts provider confidence in OUD meds, reducing barriers (Adzrago et al., 2022; Hooker et al., 2023; Campbell et al., 2021).

Overcoming stigma is key to success in mental health and SUD.

Interprofessional Team Work

Teams improve outcomes for patients with chronic pain and mental health or SUD (Joypaul et al., 2019; Gauthier et al., 2019).

Teams include doctors, nurses, NPs, pharmacists, PAs, social workers, PTs, therapists, SUD experts, and case managers.

Each helps uniquely:

• Pharmacists watch meds, spot interactions.
• Case managers link specialists, find resources, and support families (Sortedahl et al., 2018).
• Teams set goals, max non-opioid treatments (Liossi et al., 2019).

Integrative chiropractic care includes adjustments and exercises for alignment, easing pain naturally.

NPs give full care, ergonomic tips to avoid pain triggers, and coordinate options.

Dr. Jimenez’s clinic shows this. As a DC and FNP-BC, he leads teams with therapists, nutritionists, and coaches. He observes interprofessional work cuts opioid use by addressing the roots with functional medicine, VR, and nutrition. For OUD, he blends chiropractic care for pain, NP coordination for plans, and stigma-fighting through team support (Jimenez, n.d.a; Jimenez, n.d.b).

Legal and Ethical Issues in SUD Care

Providers must know laws and ethics for mental/SUD patients, like discrimination, aid, and privacy (Center for Substance Abuse Treatment, 2000).

Key Federal laws:

• Americans with Disabilities Act (ADA) of 1990.
• Rehabilitation Act of 1973.
• Workforce Investment Act of 1998.
• Drug-Free Workplace Act of 1988.

ADA and Rehabilitation ban discrimination in government and in business services like hotels, shops, and hospitals. Protect those with impairments limiting life activities (U.S. Department of Health and Human Services, n.d.).

Provisions:

• Protect “qualified” people who meet the requirements.
• Reasonable accommodations for jobs.
• No hire/retain if there is a direct threat.
• No denial of benefits, access, or jobs in funded places.

For SUD: Alcohol users are protected if qualified, no threat. Ex-drug users in rehab are the same. Current illegal drug users are protected for health/rehab, not others. Programs can deny if used during.

Workforce Act centralizes job programs; no refusal to SUD people (U.S. Congress, 1998).

Drug-Free Act requires drug-free policies for federal funds/contracts: statements, awareness, actions on violations (U.S. Code, n.d.).

States have their own laws; check the local laws.

Public Aid laws:

• Contract with America Act (1996): No SSI/DI if SUD key factor (U.S. Congress, 1996).
• Adoption Act (1997): 15-month foster reunification limit (U.S. Congress, 1997).
• Personal Responsibility Act (1996): Work after 2 years of aid, drug screens (U.S. Department of Health and Human Services, 1996).

These push work, sobriety.

Dr. Jimenez notes that legal awareness helps his practice by ensuring holistic plans comply and by reducing OUD risks through a non-drug focus (Jimenez, n.d.a).

Keeping Patient Info Private

Privacy is vital. Laws include:

• HIPAA (1996): Protects PHI, sets use/disclosure rules (U.S. Department of Health and Human Services, n.d.).
• 42 CFR Part 2: Extra for SUD records. No disclosure of name or status without consent. Fines for breaks. Applies to federal-aided programs (Substance Abuse and Mental Health Services Administration, n.d.).

Consent needs: program name, receiver, patient name, purpose, info type, revoke note, expire date, signature, and date.

This fights discrimination fears, encouraging treatment (Center for Substance Abuse Treatment, 2000).

Wrapping Up

Successful care of opioid use disorder (OUD) necessitates a multimodal strategy that puts patient well-being ahead of band-aid solutions. Healthcare professionals have a critical role in changing lives, from adopting patient-centered decision-making and evidence-based communication to eliminating the three forms of stigma—structural, public, and self—that impede recovery. Interprofessional teams promote complete treatment, while legal and ethical frameworks such as HIPAA and 42 CFR Part 2 privacy regulations guarantee that people with disabilities may seek assistance without fear of discrimination.

With its emphasis on spinal adjustments and specific exercises for correct alignment, integrating chiropractic therapy provides a non-invasive method of reducing pain and opioid dependence. Nurse Practitioners (NPs) improve this by offering comprehensive care, ergonomic advice to avoid injuries, and coordination of many treatment choices, including lifestyle modifications and therapy. In his clinical practice, Dr. Alexander Jimenez, DC, APRN, FNP-BC, highlights that these integrative approaches not only treat physical symptoms but also empower patients via education and individualized strategies, resulting in long-lasting recovery and reduced opioid usage (Jimenez, n.d.a; Jimenez, n.d.b).

As we look to the future, new developments in OUD therapy as of 2025 highlight a move toward accessibility and personalization. As an example:

• FDA-approved medications such as methadone, buprenorphine, and naltrexone remain the mainstays for treating OUD; they help lessen cravings and withdrawal symptoms while promoting long-term stability.
• Precision medicine promises better outcomes by tailoring treatments to social, psychological, and genetic factors, going beyond one-size-fits-all approaches.
• Updated Guideline: In addition to pharmaceutical therapies, the World Health Organization’s 2025 revisions prioritise psychosocial assistance, with an emphasis on community-based overdose prevention and increased access to care.
• Declining Trends: The first yearly decline in opioid-related mortality since 2018 occurred in 2023, which is encouraging since it shows that continued efforts in treatment, education, and legislation are having an effect.

By integrating these advancements with collaborative care and stigma reduction, we may create a future in which OUD is a treatable illness rather than a life sentence. Policymakers, communities, and healthcare professionals must keep pushing for fair access so that everyone receives the kind of evidence-based treatment they need. In the end, overcoming obstacles in OUD management is about more than simply treatment—it’s about regaining dignity, optimism, and a high standard of living.

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