Outcomes from the medication assisted treatment pilot program for adults with opioid use disorders in rural Colorado

Abstract

Background As Colorado ranked among the top nationally in non-medical use of opioids, a pilot medication for opioid use disorder (MOUD) program was developed to increase the number of NPs and PAs providing MOUD in order to bring this evidence- based treatment to 2 counties showing disproportionally high opioid overdose deaths. Over the first 18 months, the MOUD Pilot Program led to 15 new health care providers receiving MOUD waiver training and 1005 patients receiving MOUD from the 3 participating organizations. Here we evaluate patient centered clinical and functional outcomes of the pilot MOUD program implemented in 2 rural counties severely affected by the opioid crisis. Methods Under state-funded law (Colorado Senate Bill 17–074), three rural agencies submitted de-identified patient-level data at baseline (N = 1005) and after 6 months of treatment (N = 190, 25%) between December 2017 and January 2020. The Addiction Severity Index, PhQ9 and GAD-7 with McNemar-Bowker, and Wilcoxon Signed Rank tests analysis were used to measure patient outcomes across after participation in the program. . Results Patients in treatment reported using less heroin (52.1% vs 20.4%), opioids (22.3% vs 11.0%), and alcohol (28.6% vs 13.1%, all P < 0.01). Patients reported improved health (53.4% vs. 68.2%, P = 0.04), less frequency of disability (8.69 vs. 6.51, P = 0.02), symptoms (29.8% vs 21.3%), pain (67.5% to 53.6), worry (45.3% vs 62.3%), anxiety (49.7% vs 23.2%), depression (54.1% vs 23.3%, all P < 0.02) after treatment. Conclusions This study shows decreased substance use, improved physical and mental health, and reduced symptoms after 6 months of MOUD. Although more research on retention and long-term effects is needed, data shows improved health outcomes after 6 months of MOUD. Lessons learned from implementing this pilot program informed program expansion into other rural areas in need to address some of Colorado’ major public health crises.

Perceived stigma, barriers, and facilitators experienced by members of the opioid use disorder community when seeking healthcare

“…MOUD‐related stigma is well documented in the literature (Amura et al, 2022; Cioe et al, 2020; Garrett & Young, 2022; Kennedy‐Hendricks et al, 2017). Findings from this study revealed participants continue to experience stigmatizing behaviors from healthcare professionals, family, and community members about MOUD.…”

“…Our findings were consistent with Cioe et al (2020); participants expressed concern with the need to take MOUD because of the perception that it was replacing one drug with another, fear of being seen at a MOUD clinic, and being judged from others in the recovery community. MOUD is considered the most effective treatment for OUD, but stigmatizing attitudes negatively affect retention and adherence to the treatment regimen (Amura et al, 2022; Cioe et al, 2020; Hawk et al, 2021). Amura et al (2022) found withdrawal and detox treatment modalities were favored by some people over MOUD regardless of the known detrimental effects of these inferior treatment approaches.…”

“…MOUD is considered the most effective treatment for OUD, but stigmatizing attitudes negatively affect retention and adherence to the treatment regimen (Amura et al, 2022; Cioe et al, 2020; Hawk et al, 2021). Amura et al (2022) found withdrawal and detox treatment modalities were favored by some people over MOUD regardless of the known detrimental effects of these inferior treatment approaches. In contrast, implementing MOUD has been associated with a reduction in opioid use and other drug use, as well as improvements in healthcare utilization (Amura et al, 2022; Hawk et al, 2021).…”

“…Amura et al (2022) found withdrawal and detox treatment modalities were favored by some people over MOUD regardless of the known detrimental effects of these inferior treatment approaches. In contrast, implementing MOUD has been associated with a reduction in opioid use and other drug use, as well as improvements in healthcare utilization (Amura et al, 2022; Hawk et al, 2021). Researchers also found better access to MOUD in communities helped to reduce stigma associated with MOUD (Lin et al, 2022).…”

Facilitators and barriers to adopting or expanding medications for opioid use disorder provision in rural Colorado jails: a qualitative analysis

“…Two counties did not have operational jails at the time of the study, while the other counties have jails with potential to engage with a network of community health clinics and hospitals participating in the Colorado MOUD expansion program under Colorado’s Behavioral Health Recovery Act of 2021 (Senate Bills 19 − 001 and 21–137) (Amura et al, 2023 ). This scale-up program was implemented after the success of the pilot implementation in two Colorado counties with high opioid overdose death rates (Amura, 2022 ). At the time of the study, the seven jails were not part of the larger MOUD expansion efforts.…”