The project demonstrates success in increasing availability and access of opioid-related services to residents of rural counties experiencing high overdose rates.
Tanya Sorrell, PhD, PHMNP-BC
Results of an 18-month pilot project that trained nurse practitioners and physician assistants to prescribe medication for opioid use disorder demonstrate success in increasing availability and access of services to residents of Colorado counties experiencing high overdose rates.
Lead author Tanya Sorrell, PhD, PMHNP-BC, and a team of Colorado-based investigators reviewed a pilot project funded by the original Senate Bill 17-074 that focused on supporting medication for opioid use disorder prescribing in substance use treatment programs in areas with significant needs. Due to the success of the pilot, the Colorado state legislature passed a second bill to expand medication for opioid use disorder into 17 counties.
The team’s goals were two-fold, to increase the number of nurse practitioners and physician assistants waivered to prescribe medication for opioid use disorder and to increase the availability of services for patient access in rural counties.
“This program provided the training and support for them to lead as (medication for opioid use disorder) providers as well,” Sorrell said in a statement. “By adding nurse practitioners and physician assistants confident in prescribing (medication for opioid use disorder), we were able to increase availability of services for Pueblo and Routt counties. We went from two clinical providers at three sites to 15 (medication for opioid use disorder) waivered providers, and from caring for 99 clients to more than 1000 in less than two years.”
The pilot was designed to use a community advisory group from members of the consortium, other substance use interest groups, educational initiatives, healthcare providers in the targeted counties, and clients receiving care to help select programs for funding and to provide ongoing feedback on administration. The advisory board met during 4 of the first 6 months to develop a call for proposals and to review applicant organizations. Three organizations were funded and started providing services and the board then met every 6 months to review progress and program data.
The organizations chosen to be funded included 1 that wanted to add buprenorphine and naltrexone prescribing to their current stand-alone methadone program, a community mental health center adding buprenorphine/naltrexone and rehabilitation services as part of an integrated care model, and a startup for opioid use disorder that an organization that operated a chronic pain management program in a different county developed. Organizations needed to offer a variety of behavioral health services.
Overall, the count of medication for opioid use disorder providers at participating clinical sites increase from 2 in 2017 (1 nurse practitioner and 1 physician) to 10 in 2019 and 15 in the first half of 2019. Of the waiver-trained prescribers, 6 were nurse practitioners, 5 were physician assistants, and 4 were physicians.
In the first county, there was a net of 1 provider added—a 100% increase from the start of the program. A net of 4 medication for opioid use disorder providers were added to site 2, a 400% increase. There was a total of 15 providers trained with a net gain of 13 across 2 counties.
In county 1, medication for opioid use disorder services increased from 99 clients in 2017 to 582 in 2018 and 317 in the first half of 2019. For county 2, there were services for 60 new clients in 2018 and 46 in the first half of 2019.
To increase patient engagement, cognitive-behavioral therapy and family therapy were used to do so without opioid use. Community outreach, referral networks, and provider education were successful in reducing stigma.
Some challenges presented in service sustainability. Barriers included reimbursement, stigma, and coordination with hospitals. However, policy efforts, legislation, and academic-community collaboration increased the number of providers and patients served in those areas severely affected by the opioid crisis.
The study, “From policy to practice: Pilot program increases access to medication for opioid use disorder in rural Colorado,” was published online in the Journal of Substance Abuse Treatment.