West Virginia's model of buprenorphine expansion: Preliminary results

Abstract

West Virginia (WV) is situated at the epicenter of the opioid epidemic with the highest rates of overdose deaths and some of the lowest rates of access to life saving evidence-based medication assisted treatment (MAT) for patients with opioid use disorder (OUD). WV used a modified hub-and-spoke model to build organizational capacity for facilities to use buprenorphine to treat patients with OUD and to provide ongoing case consultation. The purpose of this study is to 1) describe the groupbase model of buprenorphine treatment and the model used to build organizational capacity, 2) to describe the preliminary results of buprenorphine expansion in WV and 3) to report preliminary data describing and comparing the characteristics of the patients served across five hubs. A single Coordinating Center uses video conferencing to train hubs and provide ongoing case consultation, as well as clinical support. Hubs were trained to deliver a buprenorphine treatment model that is multidisciplinary and includes group-based medication management and psychosocial therapy. Five regional hubs independently treat patients and are leading MAT expansion in their local areas by training and mentoring spokes (n = 13). As a result of the WV STR funding, 14 health care facilities have started to use buprenorphine, 56 health professionals were trained and 196 patients with OUD have been treated. There were few sociodemographic characteristic differences across patients treated at the five hubs, while there were differences in self-reported alcohol and drug use in the 30 days prior to intake. Additional research is needed to determine whether the WV modified hub-and-spoke model resulted in statistically significant improvements in buprenorphine treatment capacity; there is a need to address MAT stigma and regulatory barriers in order to ensure the long-term sustainability of the buprenorphine expansion.

Sublingual Buprenorphine/Naloxone and Multi-Modal Management for High-Risk Chronic Pain Patients

“…Interestingly, we noticed this retention rate was higher than that of the COAT clinic, the buprenorphine MOUD program that this clinic is adapted from. In COAT, a sample analysis showed that 37.8% of patients were retained less than one year and 14.7% were retained 10 or more years [ 9 , 10 ]. The increased retention in the High-Risk Pain Clinic may be explained at least in part by a selection effect, as patients with active SUD required at least 90 days of sobriety prior to entering the program.…”

“…As one of the hardest-hit states in the nation, West Virginia began developing a comprehensive approach to the treatment of OUD in the early 2000s, focusing on the use of combination buprenorphine/naloxone (bup/nal) as the medication for OUD. This program has since developed into the Comprehensive Opioid Addiction Treatment (COAT) program that treats over 400 patients with eight prescribers spread over three locations [ 9 , 10 ]. The COAT clinic employs a graded approach to group-based therapy and medical appointments, requiring initial weekly contact with a multidisciplinary treatment team that reduces in frequency with increasing duration of sobriety.…”

Mental Health and Psychosocial Needs of Patients Being Treated for Opioid Use Disorder in a Primary Care Residency Clinic

“…12 Estimates of the prevalence of comorbid psychiatric disorders in the literature range from 23% 13 to 90%, 14 with most reported to be 45% to 80%. 9,[15][16][17][18][19] In addition to anxiety and affective disorders, 14,[20][21][22] patients with OUD experience high rates of posttraumatic stress disorder 23 and sexual or physical abuse. 18 Given the large overlap between mental illness and substance use disorders, one may posit that having comorbid diagnoses may be a risk factor for early treatment discontinuation.…”

“…These psychosocial needs are integral to patient health and functioning, particularly among patients with OUD. For example, 60% to 70% of patients with OUD are unemployed, 13,17,18,[22][23][24][25] and 60% earn less than $10 000 annually. 25 Approximately 25% to 30% of patients receiving MOUD report homelessness and/ or housing instability, factors that reduce the likelihood of seeking treatment.…”

Introduction to the special issue on innovative interventions and approaches to expand medication assisted treatment: Seizing research opportunities made available by the opioid STR program

“…Originally developed and demonstrated to be effective in Vermont (Brooklyn & Sigmon, 2017), the Hub-and-Spoke model is a system-level intervention that entails the use of opioid treatment programs serving as hubs that then transfer clients to spokes in the community, including primary care providers and office-based practitioners. Miele et al (2019) and Darfler, Sandoval, Pearce Antonini, and Urada (2019) provide two companion articles focused on the implementation and preliminary evaluation results for California's STR Hub-and-Spoke model, while Reif et al (2019) and Winstanley et al (2019) provide descriptive data related to Hub-and-Spoke programs in Washington state and West Virginia respectively. While the Hub-and-Spoke model has an existing evidence-base, these four articles provide important details regarding its adaptation and implementation in new contexts.…”