Office Based Opioid Treatment: Increasing Access Through the Michigan Opioid Collaborative

Opioid overdose deaths are associated with limited access to clinicians prescribing buprenorphine.(1) Despite compelling evidence of the efficacy of medications for the treatment of opioid use disorder (MOUD), there remains a lack of access to evidence-based treatment.(2) Addressing these gaps in treatment is critical to addressing the rise in opioid overdose mortality.(3)This session will discuss the work of the Michigan Opioid Collaborative (MOC), a statewide program comprised of addiction physician specialists and regionally located Behavioral Health Consultants (BHCs). The interdisciplinary team supports providers and communities to increase access to office-based MOUD throughout Michigan. Initially, the program offered same-day case consultation from addiction specialists, BHC outreach to providers to increase interest in MOUD prescribing, and BHC assistance with local referrals to treatment and community resources. The MOC also works collaboratively across Michigan to include community stakeholders to address unique treatment gaps in different communities. Over time, to the program evolved to respond to provider and community needs, including: (a) technical assistance and educational support to clinics and providers starting to prescribe MOUD; (b) frequent DATA 2000 waiver trainings with email follow-up to all attendees to assist them with the process of receiving their X-license; (c) community and provider education on stigma, harm reduction, polysubstance use, chronic pain treatment, and Hepatitis C treatment; (d) outreach to pharmacies that do not dispense buprenorphine;(e) outreach to substance use disorder treatment programs that do not admit patients being treated with buprenorphine; (e) an 8-session tele-counseling patient intervention for patients on MOUD to increase retention in treatment; and(f) a one-year multistage randomized trial to explore the effectiveness of different outreach models targeting X-waivered clinicians who were not prescribing buprenorphine. Since the program's inception in October 2017, the MOC has trained 944 clinicians in 31 DATA 2000 waiver training events. The program expanded from supporting two regions to all areas of Michigan in 2020. The number of providers contacting MOC for addiction medicine consults has increased from 3 in 2017 to 1,364 to date in 2021. The MOC provides timely and remote support to clinicians who often have limited access to addiction specialists and social workers with expertise in working with patients with substance use disorders. The goal is not only to increase access to MOUD but also to promote evidence-based addiction care for patients with substance use disorders across Michigan. The session will describe program successes, lessons learned, and future plans. These processes and programs are transferable to other states and communities seeking to increase access to evidence-based care through education and outreach.