Evaluating the Implementation of the Medication for Opioid Use Disorders Pilot Program in Rural Colorado

Join us as this presenter discusses this poster live on Tuesday, August 11, 2020 | Track B at 5:35 PM Mountain

PRESENTER
CLAUDIA R. AMURA
Research Assistant Professor, CU College of Nursing
BACKGROUND
Opioid use disorders (OUD) are a huge burden for both those suffering of addiction and the community. Colorado ranks 12th nationally in non-medical use of opioids, with rural counties having the highest use and overdose-deaths. The Colorado Senate funded an evidence-based Medication for Opioid Used Disorders (MOUD) Program to increase access to care for Coloradoans with OUD in rural areas. We review implementation outcomes from this pilot program. Setting/population: SB17-74 focused on two counties with disproportionally high overdoses deaths, Pueblo and Routt. Three agencies were funded to either start or expand MOUD services. Patients served use either heroin, opioid drugs or prescription painkillers other than in as prescribed.
METHODS
The grantees advertised services through local partnerships. From12/17 to 06/19, the agencies reported on services provided, outreach, barriers and successes, and submitted de-identified patient-level data via REDCap, both at baseline and after 6 months. The Addiction Severity Index was used to measure OUD’s impact across various life domains. Pre-post changes in patient outcomes were tested using 2 and t-tests.
RESULTS
Over the first 18 months, this pilot project added 15 Nurse Practitioners and Physician Assistants and served 1,005 individuals. Patients were mostly 25-44 y.o. (66%), high rate Hispanic (42%), not married (77%), uninsured (47%) or Medicaid (91%), unemployed (65%) or part-time worker (26%). The majority reported less than good health, and use of opioids (42%), heroin (48%), and other substances (32-38%). After 6 mo of MOUD, 28.7 % patients remained in treatment, with 30% missing data. In the previous month, patients used less heroin (13.0 vs. 3.68 d, p<.001, prescription opioids (3.66 vs. 1.86 d), p=0.029, and sedatives (2.59 vs. 1.10 d), p=0.001, and alcohol (3.12 vs 1.67 d), p=0.000. There was no difference in meth, barbiturates or cannabis use. After treatment, patients also had improved health (53.4% vs 68.2 %), p=0.036, with less days unable to carry out normal activities (8.69 vs. 6.51 d), p=0.016. The number of clients with symptoms significantly dropped (64.1% vs. 55.2%), p=0.000. They overall reported lower pain (p=0.000), worry about their health (p=0.000) or medical treatment (p=0.001). There were no changes in emergency room visits or incarcerations. Patient-centered approach, availability and referrals were successful strategies, while education was needed to reduce stigma.
DISCUSSION
While results are limited to patients in treatment with high lost to follow-up, this pilot study shows implementation success, decreased substance use, and improved health after treatment. Research is needed on retention and long-term effects. Lessons learned for barriers and facilitators encountered during implementation could inform new programs to address one of the state’s major public health crises.
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Posted in Measures & Evaluation, Poster Session.

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