Medication for Opioid Use Disorders Program Expansion Impact and Plans for Sustainability in Rural Colorado

CLAUDIA AMURA, PhD, MPH
University of Colorado College of Nursing

Opioid use disorders (OUD) remain a national crisis. Over 750,000 people have died from drug overdose in the US in the last two decades, with rural counties showing the highest rates. Colorado ranks 12th nationally in non-medical use of opioids. A considerable proportion of rural Colorado represent low socio-economic, Hispanic, underserved populations. In July 2019, the Colorado Senate approved the expansion the Medication for Opioid Use Disorders (MOUD) program to increase access to care in rural areas for Coloradoans with OUD. Several rural Colorado counties were identified as health professional Shortage Areas, and prioritized by the legislature due to highest drug overdose deaths.

Under SB 19-001, 8 clinical service organizations received funding to bring MOUD into 21 rural Colorado counties in a Hub and Spoke system that expanded to 51 sites. In collaboration with the Center for Prescription Drug Abuse Prevention, the CU College of Nursing provided clinical expertise, oversight, and evaluation of the program.

The Reach, Effectiveness, Adoption, Implementation, and Maintenance and Practical Robust Implementation and Sustainability Model (RE-AIM/PRISM) frameworks informed the program planning and evaluation using de-identified patient-level data to measure OUD’s impact across various life domains. Organizational data collected by each Hub helped understand needs and plan for MOUD program sustainability.

Since January 2020, the Hub and Spoke system doubled the health provider capacity serving over 1700 new individuals with OUD. Patients identified as White (79%), half as Hispanics (49%), with a mean age of 26 yr. old. The vast majority were under Medicaid or uninsured (>80%), with unstable house and work situations and reported had low to fair health. The COVID-19 pandemic deeply impacted services and patient’s lives. Clinical sites focused on social determinant of health and patient centric care, , building organizational capacity in multidisciplinary teams, and developing a network for treatment and referral through community partners, care coordination systems, and peer-support specialists for resource connection. While these adaptions prove impactful for patient care and opioid use (p=0.01), only a portion of patients were retained in treatment during the pandemic. Stakeholder-informed plans for sustainability include leveraging existing partnerships, solidifying care coordination systems and pipelines for referral, integration with behavioral health, and utilization of case management and peer support specialists for patient retention in treatment.

Lessons learned from this implementation informed quality improvements to program implementation though enhanced capacity to offer services in rural healthcare clinics, stronger care coordination and community partnerships, and bring sustainable solutions for addressing the opioid crisis in rural Colorado.