From policy to practice: Pilot program increases access to medication for opioid use disorder in rural Colorado

• Published in: Journal of substance abuse treatment 2020-07, Vol.114, p.108027-108027, Article 108027
• Main Authors: Sorrell, Tanya R., Weber, Mary, Alvarez, Andrea, Beste, Nancy, Hollins, Ursula, Amura, Claudia R., Cook, Paul F.
• Format: Article
• Language: English
• Subjects: Access; Buprenorphine; Cognitive behavioral therapy; Cognitive-behavioral factors; Collaboration; Coordination; Doctors' assistants; Drug overdose; Drugs; Epidemics; Family therapy; Hospitals; Law enforcement; Legislation; Medical referrals; Medication-assisted treatment; Narcotics; Nurse practitioner; Nurse practitioners; Opioid; Opioids; Physician assistant; Policy; Policy making; Rural; Rural areas; Rural communities; Stigma; Substance use disorder
• ISSN: 0740-5472; 1873-6483
• DOI: 10.1016/j.jsat.2020.108027

Medication for opioid use disorder (MOUD) is an important approach to address the opioid crisis, but rural areas have limited access to MOUD. In 2016, Nurse Practitioners (NPs) and Physician Assistants (PAs) became eligible to prescribe buprenorphine. Local and state stakeholders in Colorado, including clinicians, policymakers, law enforcement, and patient advocates, formed a collaborative to develop legislative policy and programs for the opioid epidemic. A pilot MOUD program was developed in 2017 to increase the number of NPs and PAs providing MOUD and to increase access to MOUD in 2 counties with high opioid overdose rates. A central coordinating site selected 3 clinical agencies through an open call for proposals, with review of applications by nursing faculty experts and a community advisory board. We then monitored the number of waivered providers and patients served in targeted counties. Providers at pilot program sites tracked costs, community-level barriers, facilitators of success via monthly reports. Sites were funded for 18 months. Seven MOUD providers were added in County 1, a 350% increase compared to the prior year, and there are now 8 MOUD providers in County 2 where there were previously none. County 1 increased MOUD services from 99 clients in 2017 to 582 in 2018 and 317 during the first half of 2019. County 2 provided MOUD services for 60 new clients in 2018 and 46 in the first half of 2019. Cognitive-behavioral therapy, family therapy, and other approaches were used to increase patient engagement and days without opioid use. Successes included community outreach, referral networks, and provider education to reduce stigma. Barriers to sustainability included 1) reimbursement, 2) stigma, and 3) coordination with hospitals. Policy efforts, legislation, and academic-community collaboration led to an increase in MOUD providers and patients served in rural counties severely affected by the opioid crisis. •Rural areas have limited access to medication for opioid use disorders (MOUD), because of a shortage of trained clinicians.•New regulations in 2016 allowed for MOUD prescribing by nurse practitioners (NPs) and physician assistants (PAs).•The University of Colorado College of Nursing contracted with 3 community agencies in 2 rural counties to deliver MOUD.•Over 18 months, the program trained new 15 MOUD prescribers and served 1,005 patients at 3 rural clinic sites.•Sites reported barriers including startup costs, reimbursement challenges, and