Planning for Sustainability of Medication for Opioid Use Disorders Services in Rural Colorado

CLAUDIA R. AMURA, PhD, MPH
University of Colorado Anschutz Medical Campus

Opioid use disorders (OUD) have become a national crisis and a huge burden for people with problematic opioid use, their families, and their communities. Colorado rural counties show the highest rates of opioid overdose deaths, and present unique risks such as isolation, low access to treatment or opportunities for overdose reversal. In July 2019, the Colorado Senate approved expansion of the Medication for (MOUD) pilot program to increase access to care in rural areas. Here we focus on lessons learned and plans for sustainability.

Under SB19-001, 8 clinical service organizations received funding to bring MOUD into 20 rural Colorado counties in a Hub and Spoke system that expanded to 47 sites in 20 rural counties. In collaboration with the Center for Prescription Drug Abuse Prevention, the CU College of Nursing provided clinical expertise, oversight, and evaluation of the program.

Informed by the Reach, Effectiveness, Adoption, Implementation, Maintenance and Practical Robust Implementation and Sustainability Model (RE-AIM/PRISM) frameworks, and using a stakeholder-involved approach, we conducted team-based Strengths, Weaknesses, Opportunities and Threats (SWOT) analyses with each “Hub” to understand needs and plan for MOUD clinical service sustainability.

Since January 2020, the Hub and Spoke system doubled the health provider capacity to serve 979 new MOUD patients across the rural areas covered. The COVID-19 pandemic deeply impacted patient retention, requiring sharp adaptations to service provision and outreach activities in order to adhere to social distancing requirements. Despite these challenges, sites developed a network of treatment expertise and referral for patients in under-served, geographically isolated rural areas. Adaptive capabilities included the development of case management and care coordination systems, new partnerships between clinical sites, judicial systems, and community organizations, and utilization of peer-support specialists for patient tracking and connection to resources. Analyses of barriers and successes also helped academic and community partners define opportunities and plans for sustainability. These include leveraging existing community and local relationships, solidifying care coordination systems built during this time, and seeking additional funding for ongoing clinical services, case management and peer support specialists.

Working in multidisciplinary teams and focusing on local needs helped overcame numerous barriers encountered while implementing OUD treatment and behavioral health interventions in primary care rural settings. Lessons learned from this effort should result in program implementation improvement and stronger care coordination systems. This state-sponsored MOUD program has the potential to enhance outcomes and generate sustainable solutions for addressing the opioid crisis in Colorado.