New Toolkit Helps Primary Care Providers Offer Treatment for Opioid Use Disorder

By Devin McBrayer, Senior Policy Consultant

Amid the COVID-19 pandemic, opioid use disorder and opioid-related overdose remain a critical issue impacting communities in California and across the country. In 2018, the year for which the latest data is available, 2,428 Californians died from opioid-related overdoses and opioids accounted for 45% of drug overdose deaths. To combat those numbers, California continues to address the opioid epidemic by increasing access to Medication-Assisted Treatment (MAT) through the state’s MAT Expansion Project.

California’s MAT Expansion Project

MAT is an evidence-based treatment for opioid use disorder that uses U.S. Food and Drug Administration (FDA)-approved medications and counseling to treat the whole patient in the effort to achieve recovery from addiction. The project is administered by the state Department of Health Care Services (DHCS) and funded through federal grants from the Substance Abuse and Mental Health Services Administration (SAMHSA).

California’s MAT Expansion Project takes a three-pronged approach to addressing the crisis:

1) Reducing over-prescribing of opioids;

2) Increasing access to MAT; and

3) Increasing the availability of naloxone, the overdose reversal drug.

On behalf of DHCS, Harbage Consulting created the MAT Toolkit for Primary Care Providers to educate them about MAT, outline how they can become eligible to prescribe FDA-approved medications for MAT, and encourage providers to offer MAT programs in their offices or clinics.

Ongoing Challenges

Increasing the number of providers eligible to prescribe FDA-approved medications for MAT is key to success. The MAT Toolkit for Primary Care Providers aims to address some of the common barriers that might prevent providers from offering MAT. For example, some providers are reluctant to undergo the federally mandated training for the DATA 2000 waiver that allows them to prescribe buprenorphine, an FDA-approved medication for MAT. A survey conducted by UCLA found that some providers that have the waiver are not prescribing buprenorphine due to lack of training, time and staffing limitations, insurance and regulatory barriers, and misconceptions about addiction. While the number of waivered providers statewide remains low (3.2% of prescribers in 2019, according to the Urban Institute), the state has made positive progress in recent years to increase the number of providers receiving training and treating patients.

The growing number of providers eligible to prescribe medications for MAT is encouraging but barriers, such as limits on the number of patients that prescribers can treat, have hindered progress. COVID-19 has further complicated matters, making face-to-face prescribing and therapy difficult during the stay-at-home order. New flexibilities under the federal public health emergency allow waivered providers to assess patients and prescribe some medications for MAT via telemedicine during the stay at home order. However, of the more than 680,000 patients struggling with opioid use disorder in California, more than 500,000 patients still do not have access to MAT.

Harbage Consulting Role

The COVID-19 crisis has highlighted the importance of increasing the number of waivered providers. Primary care providers play a critical role in increasing access to MAT, yet they are often the sole medical provider for individuals in rural and under-resourced areas of the state. Additionally, many individuals see their primary care provider on a regular basis and, in some cases, have established strong relationships over time. The MAT Toolkit for Primary Care Providers encourages participation in MAT by offering:

  • A “quick guide” to helping patients find a MAT prescriber
  • A guide to providing MAT in a primary care practice
  • A flow chart outlining state and federal laws surrounding sharing behavioral health information
  • A guide to obtaining a DATA 2000 waiver, which enables providers to prescribe buprenorphine
  • A list of additional toolkits about providing MAT in primary care settings
  • Two “quick guides” summarizing the FDA-approved medications for treating opioid and alcohol use disorder

Harbage Consulting is distributing the MAT Toolkit for Primary Care Providers online through state associations for primary care providers and family physicians. This toolkit is part of a series of MAT-focused toolkits. Other toolkits address a range of audiences including residential treatment facilities, justice system professionals, and counselors.

Harbage Consulting will continue its work with DHCS on substance use disorder treatment issues and will be creating additional toolkits targeted at different populations that may benefit from understanding more about MAT. We look forward to sharing those resources as they are developed.