The Community-Based Medication-First program for opioid use disorder: a hybrid implementation study protocol of a rapid access to buprenorphine program in Washington State

Abstract

Background Opioid use disorder (OUD) is a serious health condition that is effectively treated with buprenorphine. However, only a minority of people with OUD are able to access buprenorphine. Many access points for buprenorphine have high barriers for initiation and retention. Health care and drug treatment systems have not been able to provide services to all—let alone the majority—who need it, and many with OUD report extreme challenges starting and staying on buprenorphine in those care settings. We describe the design and protocol for a study of a rapid access buprenorphine program model in six Washington State communities at existing sites serving people who are unhoused and/or using syringe services programs. This study aimed to test the effectiveness of a Community-Based Medication-First Program model. Methods We are conducting a hybrid effectiveness-implementation study of a rapid access buprenorphine model of care staffed by prescribers, nurse care managers, and care navigators. The Community-Based Medication-First model of care was designed as a 6-month, induction-stabilization-transition model to be delivered between 2019 and 2022. Effectiveness outcomes will be tested by comparing the intervention group with a comparison group derived from state records of people who had OUD. Construction of the comparison group will align characteristics such as geography, demographics, historical rates of arrests, OUD medication, and health care utilization, using restriction and propensity score techniques. Outcomes will include arrests, emergency and inpatient health care utilization, and mortality rates. Descriptive statistics for buprenorphine utilization patterns during the intervention period will be documented with the prescription drug monitoring program. Discussion Results of this study will help determine the effectiveness of the intervention. Given the serious population-level and individual-level impacts of OUD, it is essential that services be readily available to all people with OUD, including those who cannot readily access care due to their circumstances, capacity, preferences, and related systems barriers.

Community-Based Wound Care Programs for Unhoused Individuals

“…Features such as drop-in service availability [ 18 , 23 , 32 ], HIV or other disease screening [ 18 , 20 , 32 , 33 ], syringe exchange [ 18 , 20 , 21 , 27 , 30 , 32 – 34 ], provision of temporary housing or assistance in securing housing [ 18 , 26 , 30 , 32 , 35 ], case management [ 26 , 30 , 35 ], preventative education [ 18 , 20 ], and the incorporation of an interdisciplinary staff [ 23 , 25 , 26 , 30 , 32 , 35 ] contributed to the effectiveness of community-based programs. For example, the Homelessness Team Program at Cohealth in Melbourne, Australia, offered a fixed site and multiple outreach services.…”

“…Similar services were also offered in IDEA SSP in Miami, Florida [ 33 , 34 ]. Another program focused on drop-in, and easy-access care was the Community-Based Medication-First (CBMF) Program for opioid use disorder (OUD) in Washington State, which provided same-day medication for individuals suffering from OUD [ 32 ].…”

County-level neonatal opioid withdrawal syndrome rates and real-world access to buprenorphine during pregnancy: An audit (“secret shopper”) study in Missouri

“…Furthermore, our data is specific to the state of Missouri, where recent efforts to increase OUD treatment have focused on buprenorphine rather than methadone ( Winograd et al, 2019 ). However, data has shown that “medication-first” initiatives to boost access to OUD have heavily focused on buprenorphine, suggesting that the data from Missouri is likely generalizable to many other regions of the USA ( Banta-Green et al, 2022 ; Brady et al, 2021 ). Finally, while the present study was performed when the DATA 2000 X-waiver was still required, which may limit generalizability, the removal of the X-waiver has not been found to significantly increase buprenorphine prescribing rates,( Luo and Erikson, 2023 ; Stringfellow et al, 2023 ), suggesting that the lessons gained from data preceding X-waiver removal periods will likely still apply to the present.…”

Removal of Medicaid Prior Authorization Requirements and Buprenorphine Treatment for Opioid Use Disorder

“…Critics of buprenorphine PAs point out that many PA requirements are not supported by evidence, including mandatory counseling, dose limits, and predefined tapering schedules . These unnecessarily restrictive requirements run contrary to growing evidence that low-barrier, on-demand addiction care can increase treatment engagement and retention, including in historically marginalized populations …”

“…4,23,24 These unnecessarily restrictive requirements run contrary to growing evidence that low-barrier, on-demand addiction care can increase treatment engagement and retention, including in historically marginalized populations. [25][26][27][28] While fairly limited to date, research on the outcomes associated with buprenorphine PAs has been mixed. In the most comprehensive study to date using Medicare claims data, Mark et al 6 found that removal of buprenorphine-naloxone PAs in Medicare Part D plans was associated with an increase of 17.9 prescriptions filled per plan per year, equivalent to approximately a doubling of the number of prescriptions.…”