Program Development and Implementation Outcomes of a Statewide Addiction Consultation Service: Maryland Addiction Consultation Service (MACS)

Abstract

Background As the opioid epidemic continues, there is a mounting sense of urgency to improve access to high-quality early identification and treatment services. However, the need is outpacing capacity in many states and effective solutions to support primary care and specialty prescribers to identify and treat more patients with opioid use disorders are still emerging. This paper describes one state's approach to increase access to medication for opioid use disorders (MOUD) through development and implementation of a statewide addiction consultation service: Maryland Addiction Consultation Service (MACS). Methods Program components include a warmline, outreach and training, and resource and referral linkages for prescribers based on related consultation service models and documented barriers to prescribing MOUDs. Results Initial implementation outcomes indicate service components are being adopted as intended and by the target audience; many prescribers who engaged with the service have their buprenorphine waiver (44%) but do not have any additional formal addiction training (57%). Also, statewide penetration is promising with prescriber engagement in 100% of counites, however only 33% of counties in engaged in all four types of MACS services. Most calls (61%) originated from urban counties. Conclusions The MACS program increases access to specialty addiction medicine consultation and training through use of technology. MACS can serve as a model for other states looking to bridge the gap in access to addiction treatment.

Availability and Opportunities for Expansion of Buprenorphine for the Treatment of Opioid Use Disorder

“…67 This finding is consistent with a prior survey wherein OUD treatment providers endorsed little concern over receipt of the X-waiver and instead emphasized their lack of expertise in OUD care and/or clinic infrastructure to accommodate a large number of new patients as major barriers to expansion. 35 To address these concerns, health systems have initiated education efforts, including a consult service 68 or ECHO programs. Both strategies are designed to increase provider confidence for delivering other forms of complex medical care.…”