[Each month, the Addiction Legal Resource Team at Penn State’s Dickinson Law recognizes an exceptional individual for their contributions to the addiction treatment community. The individual recognized as Advocate of the Month for the month of May is Dr. Daniel Ventricelli, an Assistant Professor for Clinical Pharmacy at the Philadelphia College of Pharmacy at the University of the Sciences. Professor Daniel Ventricelli’s research focuses on policy to destigmatize substance use disorders and to better understand the interdisciplinary role of healthcare professionals in treating people with substance use disorders through evidence-based treatment and harm reduction methods. His teaching focuses on training future pharmacists to embrace harm-reduction methods and to be advocates for their patients and their profession. We are thankful for inspiration from our honored advocates and from Dickinson Law’s Inside Entrepreneurship Blog.]
By Travis Murray
When I first contacted Dr. Daniel Ventricelli in early February of 2020, the world was a much different place. There was only a handful of COVID-19 positive Americans domestically and the cases were far away on the West Coast. Dr. Ventricelli is an Assistant Professor of Clinical Pharmacy at my alma mater and I was excited to meet with him in person in Philadelphia in late March at my former campus. We planned on meeting with another one of my professors, Dr. George Downs, and talking over lunch from my favorite food cart when I was a student, Linda’s Cart. However, like many people in America and around the globe, we were forced to change our plans as COVID-19 quickly turned into a pandemic, forcing most colleges to switch to remote learning. I may not have gotten the chance to return to Philadelphia and to taste a bacon, egg, and cheese with fried onions on an everything bagel from Linda’s Cart, but we were able to improvise and conduct our meeting through everybody’s new tool to stay connected – Zoom.
After some initial minor technical difficulties, we were able to get our meeting underway from the comforts of our own homes. Dr. Ventricelli has an extensive history of education and post-graduate training and my first question was to ask him about it and how he first became interested in substance use disorders. He explained that after earning his Doctor of Pharmacy (Pharm.D.) degree from the University of Connecticut School of Pharmacy, he completed a Post-Graduate Year One (PGY1) community pharmacy residency in West Virginia through West Virginia University School of Pharmacy and Kroger Pharmacy. During his residency, he worked at a dual-diagnostics addiction treatment unit at a behavioral health hospital. It was during his rounds with the interdisciplinary team that he was asked questions about improving relationships with community pharmacists and ensuring that when patients leave the facility, they would have access to medications like buprenorphine. This led to his ultimate research question that he continues to study – what is the role of the community pharmacist in substance use disorders and addiction? He wanted to hone in on his research skills to answer this question, and matriculated on to a community practice research fellowship focused on “prescription drug abuse and misuse.” [As we discussed later, these terms have fallen out of favor for their implicit biases and stigmatizing nature.]
He accepted a two-year fellowship at East Tennessee State University and collaborated with a research team that included people with backgrounds in public health, behavioral science, and medicine. He also earned his Masters in Public Health along the way. During his fellowship, he engaged in qualitative research with providers to determine why the relationship between providers and community pharmacists were strained and how this relationship impacted patient care. More recently, he completed a statewide survey of community pharmacists to get their perspective about their behavioral intentions to dispense buprenorphine for the treatment of opioid use disorder (OUD). In his capacity as a clinical professor at the Philadelphia College of Pharmacy, he works with the University’s Substance Use Disorder Institute and works on SBIRT training for pharmacy students. SBIRT is a method of identifying and referring people to treatment by Screening patients, providing a Brief Intervention, and if appropriate, Referring to Treatment. SBIRT is an evidence-based method of delivering early intervention to patients that is embraced by the Substance Abuse and Mental Health Services Administration (SAMHSA), and a tool that Dr. Ventricelli believes that community pharmacists can use in their own practice.
Dr. Ventricelli is also based in community organizations and coalitions, especially in the southeastern Pennsylvania (SEPA) region. In particular, he is involved in the Regional Overdose Prevention Coalition (ROPC). The coalition, composed of community advocates, public health workers, and healthcare professionals, meets throughout the year to address concerns and share helpful information from their respective communities. The mission of the ROPC is to bring together stakeholders to work as regional partners to reduce the harms of substance use. The ROPC allows the region to collaborate and to address various aspects of the epidemic in the SEPA community, including naloxone access, data sharing, safer pain medication prescribing, and legislative responses. He has been with the coalition since its inception and now serves as a member on its executive board.
He is also involved at the state level in the Pennsylvania Pharmacists Association to work on continuing education programs for pharmacists and at the national level through the profession’s largest advocacy group, the American Pharmacists Association, in the Pain, Palliative Care, and Addiction Special Interest Group. Dr. Ventricelli says that in his capacity as a professor, he has become very involved with the American Association of Colleges of Pharmacy and is the Chair-Elect for their Substance Use Disorder special interest group.
Just as you are starting to think that there could not possibly be more time in the day to do anything else, he is a regular member of the Addiction Medication Quarterly Partnership Summit of Philadelphia Medical Schools. This Summit strives to develop the curriculum for medical students regarding substance use and addiction training and he has been a presenter for treatment pathways and health policies. His expertise and involvement within the SEPA community has also led him to present to Pennsylvania legislators about medications for opioid use disorder.
I then asked him about medication-assisted treatment in Pennsylvania and why medications with FDA-approved indications for treating opioid use disorder are not dispensed to patients who need them at the frequency that they should. There are many regulatory restrictions at the federal and state levels, especially surrounding buprenorphine, that do not exist for many other medications and other disease states. The question is, “why?” The answer, at least partially, is “stigma within the community” and “misunderstanding of the goals of treatment,” said Dr. Ventricelli.
Medications used for opioid use disorder, though they may need to be individualized for each patient, have such profound success on patients that even the term, “medication-assisted treatment” is falling out of favor. This is a term that I use frequently as a licensed pharmacist myself, and it made perfect sense when he explained why it is not the best term to use for medications like buprenorphine. The term inherently implies that the medication is secondary to other treatment, but data tends to indicate that access to consistent medication to treat OUD in a “medication first” approach has resounding success in preventing opioid overdose deaths. I learned to use the phrase “medication for opioid use disorder” instead from Dr. Ventricelli. Using appropriate terminology and less stigmatizing terms, such as, “a person with substance use disorder” versus “a drug abuser” or “an addict,” results in less punitive recommendations from providers. “The words we use have an impact on the care that our patients receive,” said Dr. Ventricelli.
Reflecting on what we just discussed, I then wanted to get his preliminary observations regarding the challenges that people who have substance use disorder are experiencing during the COVID-19 pandemic and closures of many facilities and resources by the states. He once again pointed out something that I never even thought about, which is the severe respiratory effects of the virus and how dangerous that it could be when coupled with the use of opioids, which cause respiratory depression. He reasonably speculates and worries that “it further complicates the likelihood that [someone who overdosed] will likely be revived with naloxone.” Besides opioid use disorder, at the time of our interview, Pennsylvania closed its state liquor store, which could have a profound impact on people who are dependent on alcohol or have an alcohol use disorder. Alcohol withdrawal can result in seizures, delirium tremens, and in the most severe cases – death. However, despite these emerging issues, there have been some positive changes. For example, SAMSHA has removed many restrictions to receiving buprenorphine and now allow patients to have appointments with providers over the telephone to obtain a prescription. Transportation to formerly-required in-person consultations was a major hardship for some patients. Prescriptions can also now be dispensed in larger quantities for longer durations of therapy. Lack of access to consistent treatment has been a major concern for patients with OUD.
While we were forced to conduct our interview over Zoom, it made me wonder, what do people who rely on group meetings, such as Alcoholics Anonymous and Narcotics Anonymous, do to continue their meetings and routines when large gatherings and shelter-in-place restrictions have been put in place? The answer, to no surprise, is a rise in virtual meetings using Zoom!
I then wanted to open it up and ask Dr. Ventricelli to describe interests and observations that he has found in his research and information that would be helpful to pharmacists and others. He said that pharmacists play an evolving role in harm reduction. Pharmacists can participate in harm reduction at the community level by providing sterile syringes. “There is a lot of really strong evidence, from years, and years, and years already about the public health benefits from providing access to sterile syringes and sterile supplies.” He went on to say, “first and foremost, one of the easiest things that [community pharmacists] could do is provide access to medications. Make sure we have naloxone in stock and ready to go – for anybody who needs it and anybody can get it. It’s not just for somebody who’s using an opioid. It’s great for somebody who might be around somebody else so they can protect their community and loved ones.” He also said to make sure that buprenorphine is available in the pharmacy. This way when a patient has made the decision to use this evidence-based medication and presents to the pharmacy, they don’t have to wait days for the medication to come in or have to go pharmacy to pharmacy looking for one that carries it. Getting trained in SBIRT is another method that community pharmacists should embrace and to engage in preventative services such as vaccines like those for hepatitis B.
These harm reduction strategies seem easy enough to do on paper, but a theme throughout our discussion is the need to break down stigmas and to educate the profession and others to embrace them fully. Dr. Ventricelli is determined to do just that. When I was a pharmacy student, Substance Use Disorders was an elective. Now, it is fully integrated throughout the pharmacy curriculum with Dr. Ventricelli at the helm with some of my other past professors, including Dr. Downs, Dr. Peterson and Dr. Koffer. Knowing this leads me to believe that the future graduates of the Philadelphia College of Pharmacy are in great hands and determined to be fierce advocates for the profession and harm reduction.
We ended our conversation talking about all the changes happening at the college since I graduated and I became even more excited to return to campus once all the travel restrictions are lifted. I work as a per diem hospital pharmacist and I left this conversation more determined to be conscientious of the phrases and terminology that I use to avoid stigmatization of patients in my own practice of pharmacy and to support harm reduction methods in our communities. Dr. Ventricelli exemplifies the type of advocates that we have for health policies that achieve better outcomes for people with substance use disorders and is a deserving Advocate of the Month.