The Use of Buprenorphine to Treat Opioid Use Disorder Quadruples Among Medi-Cal Enrollees

Between 2014 and 2018, the use of buprenorphine to treat opioid use disorder increased nearly four times among Medi-Cal enrollees, according to a recent article from California Healthline. The article also describes California MAT Expansion project efforts including a recent media campaign, Choose Change California and its treatment locator, as well as efforts to inform providers about obtaining a waiver to prescribe buprenorphine and expand MAT for tribal populations.

Tribal MAT

DHCS collaborated with American Indian and Alaska Native community stakeholders to design the California Tribal Medication-Assisted Treatment (MAT) Project. Described by its lead entities as “a unified response to the opioid crisis in California Indian Country,” the Tribal MAT Project is designed to meet the specific opioid use disorder (OUD) prevention, treatment, and recovery needs of California’s Tribal and Urban Indian communities. It was a core component of the original California MAT Expansion Project and is continued through the California MAT Expansion Project 2.0. In close partnership with representatives of the communities being served, DHCS developed the Tribal MAT Project to promote opioid safety, improve the availability and provision of MAT, and facilitate wider access to naloxone with special consideration for Tribal and Urban Indian values, culture, and treatments. For a snapshot of the Tribal MAT Project, take a look at the flyer.

The Tribal MAT Project is well underway. Click here to read more about the organizations implementing complementary initiatives to achieve the goals of the Tribal MAT Project.

Funding Available – California Youth Opioid Response

California Youth Opioid Response (YOR California) has released a Request for Applications (RFA) for projects that strengthen capacity and access to prevention, treatment, and recovery services, as well as access points to Medication-Assisted Treatment (MAT) as indicated, for youth (ages 12-24) and their families. These sub-grants are also designed to foster the coordination and strengthening of existing multi-system organizations and encourage the development of new partnerships between agencies that touch youth. The YOR California team (California Institute for Behavioral Health Services in partnership with Advocates for Human Potential, Inc.) seeks to identify up to 20 sub-grantees to expand and enhance services for youth, with, or at risk of, an opioid disorder and their families. Click here to apply.

California MAT Expansion Project in the News

During an ABC 10 Sacramento and Company segment, Department of Health Care Services (DHCS) Division Chief of the Substance Use Disorder Compliance Division, Marlies Perez, discussed opioid use disorder, medication assisted treatment (MAT), and DHCS efforts to address the opioid crisis through the California MAT Expansion Project, highlighting the recently launched Choose Change California campaign, which includes an MAT treatment locator.

Waivered Prescriber Support Program

DHCS funded the Integrated Substance Abuse Programs at the University of California, Los Angeles (UCLA) to provide training services and technical assistance (TA) across the State of California, assisting DHCS’ efforts to improve, expand and increase access to MAT services. Activities are broken out into four objectives:

  • Develop and conduct a statewide survey among DATA 2000 waivered prescribers to determine training / technical assistance needs;
  • Interpret results and identify targeted areas of prescriber support and mentorship;
  • Build the appropriate training / TA team and develop curriculum; and
  • Provide distance and / or face-to-face training and technical assistance to increase prescriber / provider skills in delivering MAT services.

In the first phase of the project, the UCLA team collaborated with clinical experts and MAT champions to develop an online survey targeting California DATA 2000 waivered prescribers to identify why prescribers are NOT prescribing and identify the most effective supports / strategies to mitigate these barriers. Survey dissemination and data collection will occur in April 2019, and qualitative interviews will follow to further delve into the findings and understand prescribing barriers. In addition, UCLA secured a consultant agreement with Dr. Candy Stockton-Joreteg, family practitioner and MAT champion, who will provide ongoing expertise on the project team to assist in translating the survey findings into practical technical assistance and curriculum development. UCLA plans to build a team of clinical experts / physician champions to provide distance and / or face-to-face training and TA.

If you are interested in becoming a physician champion (e.g., being available by phone or email for questions, allowing a physician to shadow you for a day, etc.) please contact Valerie Antonini from UCLA. Training and TA is scheduled to initiate in early Summer 2019.

Addiction Treatment Starts Here: Primary Care, Behavioral Health, & Community Partnerships

The Center for Care Innovation’s (CCI’s) Addiction Treatment Starts Here (ATSH) program includes three learning collaboratives designed to increase access to medications for addiction treatment (MAT) through hands on work in primary care, behavioral health and community partnerships. Each provides targeted hands-on technical assistance, education, and other methods to help clinics and communities advance their efforts. In designing these programs, CCI carried forward lessons from past addiction treatment work in primary care. To learn more about that work and the experience of a health center integrating MAT into primary care, view a short video of Marin City Health and Wellness Center’s transformation and read a description of the project’s goals and participant’s achievements.

Planning for all three ATSH collaboratives is well underway. The following is a short summary of each:

  • Addiction Treatment Starts Here: Primary Care (ATSH:PC) is working with 39 health centers across California to implement new or expand existing MAT programs. The collaborative launched in February 2019 and will conclude in September 2020. All sites have been selected and materials and resources are available on ATSH:PC website. The primary care collaborative is also supported by Cedars-Sinai.
  • Addiction Treatment Starts Here: Behavioral Health (ATSH:BH) will work with 10 mental health and substance use disorder sites to design and launch MAT programs. ATSH:BH will launch in May 2019 and conclude in September 2020. The program is in the process of selecting participants. The request for application is available on the ATSH:BH website and responses are due by April 5, 2019.
  • Addiction Treatment Starts Here: Community Partnerships (ATSH:CP) is a 16-month learning collaborative that supports multi-sector collaborations between community stakeholders (e.g., health care providers, local community residents, public agencies, first responders, and other local organizations) to address opioid use disorder (OUD). The project will equip California community opioid coalitions with on-the-ground technical assistance to identify their best opportunities through systems mapping and solutions for fighting the opioid crisis. A summary of the program and the letter of intent is available on the ATSH:CP website.

California Bridge Program

The California Bridge Program is establishing a culture of evidence-based medicine in California. Over the course of 17 months (February 2018 – July 2020), accelerated training and technical assistance for health care providers will provide the foundation necessary to enhance and increase access to 24/7 treatment in every community in the state.

The California Bridge Program will develop hospitals and emergency rooms into primary access points for the treatment of acute symptoms of substance use disorders by way of motivation, resources, and encouragement for patients to enter and remain in treatment. Participating sites will address substance use disorders as a treatable chronic illness and utilize harm reduction techniques, such as naloxone distribution, to minimize the risks associated with substance use disorders. Funding, training, and technical assistance will increase and improve access to facility-wide treatment and referral of those with acute symptoms of substance use disorders.

The current cohort includes Star sites, Rural Bridge sites, and Bridge Clinics. Star sites will become centers of excellence for initiating treatment of substance use disorders from anywhere in the hospital. Rural Bridge sites will generally be in less-urban centers and begin developing treatment primarily in the emergency department. Bridge Clinics will be ‘low-threshold’ follow-up clinics that patients can visit after starting treatment in the hospital setting while a longer-term outpatient referral is identified.

Profiles of this work have been widely reported in the New York Times and Vox.

Expanding Access to MAT in County Criminal Justice Settings

The Expanding Access to MAT in County Criminal Justice Settings Learning Collaborative is funded by the SOR grant and administered by Health Management Associates (HMA). HMA recruited teams from counties that committed to expanding access to at least two forms of MAT to persons in jails and drug courts. Each team includes 5-8 leaders from jail health care services, jail custody operation, county manager’s office, probation, drug courts, county AOD program, and others. Teams receive $25,000 each to cover costs of participation and other training/learning activities.

Over the course of 18 months (August 2018 – January 2020), teams will participate in four in-person learning collaboratives to gain deep understanding of opioid and other addictions and treatments, share best practices, learn about the many facets of continuing MAT and inducting persons with OUD on MAT in jail or through courts and probation, and develop or expand county-specific MAT programs in jails and drug courts. Teams receive monthly coaching calls and technical assistance from HMA and HMA is developing a series of webinars and podcasts on topics specific to MAT in criminal justice that are available to the teams and to the public. DHCS has also offered the teams grants of $100,000 to $300,000 to kick off new programs and capacities while sustainable local sources of funding are secured.

HMA will conduct a second cohort of up to 20 additional counties to participate in a second round from April 2019 through September 2020. Applications are due March 1. To learn more about the project and the second cohort application process, click here to visit the project website.

Naloxone Distribution Project

The Naloxone Distribution Project (NDP) aims to reduce opioid overdose deaths through the provision of free naloxone, in its nasal spray formulation. Entities apply to DHCS to have naloxone shipped directly to their address.

The program started October 1, and hundreds of applications have been received. Eligible entities include law enforcement such as police departments, county jails and probation; fire, EMS and first responders; schools and universities; homeless programs; veteran organizations; and community organizations such as harm reduction organizations or community opioid coalitions.

The NDP has distributed 83,962 naloxone units since the beginning of October! If you would like to learn more about the organizations and counties that have received naloxone and to see updated data about the number of naloxone units that have been distributed since October, click here.

If you would like to submit an application for free naloxone, or if you know of other entities that would like to submit an application, you can learn more about the NDP and access the application here.