Program helps primary care practices expand access to opioid use disorder treatment
A multilevel program that provided support and resources to rural primary care practices was associated with an increase in buprenorphine prescriptions, data show.
Prior to the study, very few health care providers in rural Colorado, where the study was conducted, had the Drug Enforcement Administration’s waiver to prescribe buprenorphine for opioid use disorder, study co-author Linda Zittleman, MSPH, a senior instructor in the department of family medicine at the University of Colorado School of Medicine, told Healio.
“Clinicians and staff repeatedly described the clinical and emotional strain from their concern about patients’ opioid use — and the lack of resources to do something about it,” she said.
Zittleman and colleagues engaged 42 primary care practices in the Implementing Technology and Medication-Assisted Treatment Team Training (IT MATTTRS) program. This initiative uses a team-based approach to increase knowledge of opioid use disorder, buprenorphine and treatment-seeking behaviors, offers free DEA waiver training and provides other support for implementing opioid use disorder treatment in practice.
“The on-site team training truly aims to give practices a resource that utilizes the entire team,” Zittleman said. “Everyone — front desk staff, medical assistants, nurses, billing —can play a role, reduce stigma around opioid use disorder and medication-assisted treatment and help clinicians provide this treatment.”
The IT MATTTRs program also works with members of the community to develop locally relevant messages and materials around opioid use disorder and medication-assisted treatment, Zittleman said.
At baseline, the primary care practices that participated in the study offered an average of 4.7 components necessary to deliver medication-assisted treatment, such as a medication-assisted-treatment team, a behavioral health expert on staff or a professional agreement with one, and an opioid use disorder screening process. Very few of the practices employed a prescriber with a waiver.
The researchers reported in Annals of Family Medicine that 1 year after IT MATTTRS was implemented, the participating primary care practices had 13 treatment components in place (P < .001). In addition, the proportion of practices offering or connecting patients to opioid use disorder treatment increased from 18.8% to 74.4%. The researchers also observed an 87% increase in patients with a prescription for buprenorphine in the study region compared with a 65% increase in the rest of Colorado (P < .001).
Zittleman said that IT MATTTRS helps remove the stigma that some health care professionals have about opioid use disorder.
“We heard over and over from community members and practice staff that understanding the cycle of addiction was a game changer,” she said. “When they learned that people with opioid use disorder come to the point where they no longer take their opioids to feel but to feel normal, their view of opioid use disorder changed.”
According to the researchers, limitations to the study include not having all the requested data for each of the participating practices and not evaluating the quality of care that patients within these practices received.
Even so, the results demonstrate that “IT MATTTRs is a resource to make the implementation of treatment with buprenorphine for opioid use disorder in primary care feasible, helping communities increase access to local outpatient care and save lives,” Zittleman said.
Perspective
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This study highlights the importance of meeting people with opioid use disorder where they are, quite literally, and offering care. When we can capture an engaged patient and offer treatment that is appropriate and accessible, the likelihood of treatment engagement and then success increases.
In regard to medication-assisted treatment for opioid use disorder, we know this approach is very safe and effective at treating individuals with opioid use disorder. However, access to this treatment varies widely, as does an individual’s ability to engage with treatment. So, when it can be offered in primary care, as in this study, a critical barrier is removed for many patients struggling with opioid use disorder.
It is important to recognize that (like most health conditions) treatment for opioid use disorder is not one-size-fits-all — there must be a variety of places treatment is offered in order to capture as many patients as possible. There are many other treatment locations for medication-assisted therapy that have strong success, including offering it from the emergency department after someone has experienced an opioid overdose, as well as treatment programs based in pain clinics and other specialty care.
It is also important to include additional services that might help support patients, including counseling, support groups, treatment for comorbid conditions and even interventions to address social determinants of health (such as housing), that will really allow medication-assisted treatment programs to succeed.
University at Buffalo School of Public Health and Health Professions
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