Exploration Resources

1. Module 1: Understanding Substance Use Disorders
2. Module 2: Alcohol and Drug Use Disorders
3. Module 3: The Opioid Epidemic
4. Module 4: Medication and Behavioral Treatment of Substance Use Disorders
   • Pharmacotherapy for Alcohol Use Disorder
   • Pharmacotherapy for Opioid Use Disorder

1. DeFlavio et al., 2015, Analysis of barriers to adoption of buprenorphine maintenance therapy by family physicians: Anonymous survey of family physicians: Anonymous survey of family physicians (N=108, VT, NH). Approx 10% were bup prescribers, 80% felt they regularly saw patients addicted to opioids, 70% felt they bore responsibility for treating opiate addiction. Logistical barriers to bup adoption included: inadequately trained staff (88%), insufficient time (80%), inadequate office space (49%), and cumbersome regulations (37%). Common themes addressed in open-ended questions included lack of knowledge, time, or interest; mistrust of people with addiction or buprenorphine; and difficult patient population. Results suggest family physicians are excellent candidates to provide bup, but significant barriers remain and addressing these may lower resistance to bup adoption & increase access.
2. Jacobson et al., Organizational Facilitators and Barriers to Medication for Opioid Use Disorder
   Capacity Expansion and Use
3. Lister et al., A systematic review of rural-specific barriers to medication treatment for opioid use disorder in the United States

1. Boston Medical Center OBAT Policy and Procedure Manual
2. 2021 Version: Boston Medical Center OBAT Policy and Procedure Manual
3. Case Example of Integrated SUD/Behavioral Health Services in Primary Care, Including Financial/Reimbursement Considerations (Webinar Recording)
4. CIHS MAT Implementation Checklist
5. Courtenay Gilmore Wilson, PharmD and E. Blake Fagan, MD, Providing Office-Based Treatment of Opioid Use Disorder Office-Based Opioid Treatment (OBOT) with buprenorphine has been available since 2000; however, many barriers to OBOT within primary care exist, and only 3.6% of family medicine physicians are waivered to prescribe buprenorphine.
6. Centers of Excellence – Rhode Island
   1. Certification Standards for Centers of Excellence
   2. Policy and Procedures for Centers of Excellence
      1. Table of Contents
      2. Intake Assessment 1
      3. Intake Assessment 2
      4. Intake Assessment 3
      5. Intake Assessment 4
      6. Induction
      7. Follow Up
      8. Record Keeping and Accountability
      9. Buprenorphine Information
      10. Injectable Naltrexone Information
      11. Ongoing Treatment 1
      12. Ongoing Treatment 2
      13. Evaluation
   3. Guidance Document on Best Practices: Key Components for Community-Based Medication Assisted Treatment Services for Opioid Use Disorders in New Hampshire
   4. Integrated Treatment Continuum for Substance Use Dependence - “Hub/Spoke” Initiative—Phase 1: Opiate Dependence
   5. Korthuis et al., 2016, Primary Care–Based Models for the Treatment of Opioid Use Disorder: A Scoping Review: Models for integrating SUD medications into primary care vary in structure. This article summarizes 12 models of care for OUD based on a literature review and interviews with key informants. Common components of existing care models include: pharmacotherapy with buprenorphine or naltrexone, provider and community education, coordination and integration of OUD treatment with other medical and psychological needs, and psychosocial services and interventions. Models vary in how each component is implemented and should be selected/tailored based on individual settings.
7. Levels of Integrated Care

1. Business Plan for Medication Assisted Treatment (MAT)
2. Clark et al., 2011, The Evidence Doesn’t Justify Steps By State Medicaid Programs To Restrict Opioid Addiction Treatment With Bup: compared spending, services and mortality of 33,923 MA Medicaid beneficiaries receiving bup, methadone, drug-free tx, or no tx (2003-2007). Bup was associated with more services but $1330 lower mean annual spending than methadone. Mortality rates were similar for bup and methadone, but mortality was 75% higher among those receiving drug-free tx and more than twice as high as those receiving no treatment.
3. Documentation & Charge Capture Process: Medications for Addiction Treatment
4. Haddad et al., 2014, Bup Maintenance Treatment Retention Improves Preventive Primary Care Screenings when Integrated into Urban FQHCs: examined quality health indicators (screenings for HCV, HIV, STIs, breast cancer, etc.) from 9 FQHC of 266 OUD patients initiating buprenorphine (2007-2008). Achieving greater than 80% (recommended) of QHIs was positively and independently associated with 3 month or greater bup retention and bup prescription by PCP rather than addiction psychiatrist.
5. National Council for Behavioral Health Training: Financing Factors for Implementing Medication Assisted Treatment

PCSS videos on stigma and how to go about discussing MAT with families and patients:

1. Jack: A father discusses the importance of language in treating addiction:
   Jack discusses his daughter’s recovery and how vital having positive support of the medical community was in his daughter’s treatment, and how kindness and caring can save a life.
2. Stigma and OUD:
   Nurse Practitioner Vanessa Loukas, a Providers Clinical Support System Clinical expert, discusses the issue of stigma in treating patients with opioid use disorder—from the patients to the providers who treat them.
3. Decreasing stigma involving addiction begins with the medical profession:
   Dr. Ayana Jordan, a Providers Clinical Support System Clinical expert, discusses the need for the medical profession to reduce stigma associated with treating patients with opioid use disorder.
4. Paul: A positive experience with addiction treatment:
   In recovery for ten years, Paul has noticed a marked change in the way the medical community treats patients with substance use disorder. The stigma he faced earlier made recovery more difficult.

PCSS Modules

1. Changing Language to Change Care: Stigma and Substance Use Disorder:
   Description: Language can be used intentionally or unintentionally to perpetuate stigma. The language used towards people who use drugs or alcohol and people with addiction includes many stigmatizing terms which have been shown to increase negative attitudes among the public and clinicians. Examples include words like “abuse,” “abuser,” “addict,” and “dirty.” There are also more subtle ways that language can be used to frame issues related to addiction or substance use which can enhance stigma. Nationally there has been growing awareness around the importance of language and the need to use medically appropriate, person first terminology. Changing our language is a crucial component of reducing stigma to improve the lives and health of people who use drugs or alcohol and people with addiction. This module will discuss the importance of language when discussing substance use and review ways to improve language to improve care.
2. Addiction, Stigma, and Discrimination: Implications for Treatment and Recovery:
   Description: International studies indicate that addiction to alcohol and other drugs are among the most stigmatized conditions in society and stigma is a major barrier to seeking treatment in the United States. Studies highlight several factors that influence the degree of stigma related to different health conditions and how these may lead to discrimination and poorer health outcomes. Recent research also underscores the importance of language and terminology in inducing implicit cognitive biases which may unconsciously affect clinicians’ and policymakers’ attitudes, judgments, and behaviors toward those suffering from addiction.