The California Department of Public Health will incorporate academic detailing into health plans and health payer systems, establish a fentanyl reporting system, and work to improve the functionality of the opioid surveillance dashboard.

The California Department of Public Health (CDPH) will incorporate academic detailing into health plans and health payer systems and will conduct up to four academic detailing training sessions to train new health care professional detailers within health plan and payer systems to systematically implement academic detailing. CDPH will also establish a fentanyl reporting system and improve detection of fentanyl outbreaks, while also working to improve the opioid surveillance dashboard for poly drug use and expand the dashboard to include social determinants of health.

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The Center for Care Innovation’s Addiction Treatment Starts Here program includes three learning collaboratives designed to increase access to MAT through primary care, behavioral health and 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. Visit the Addiction Treatment Starts Here project page to learn more.

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The California Bridge Program is developing hospitals and emergency rooms into primary access points for the treatment of acute symptoms of SUDs – enhancing and increasing access to 24/7 treatment in every community in the state.

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. As of March 2019, 31 health care facilities are participating in this program, spanning 27 counties throughout 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. The program has a robust and comprehensive set of technical assistance materials that are free and open to any clinician available at www.bridgetotreatment.org.

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The California Conservation Corps is performing initial assessments to determine prevention, treatment and/or recovery activities that can address the opioid crisis.

Continuity Consulting will Establish an initiative with the California Conservation Corps and the California Department of Corrections and Rehabilitation Division of Juvenile Justice to perform initial assessments to determine the activities that can address the opioid crisis through prevention, treatment and/or recovery.

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The California Hub and Spoke System consists of narcotic treatment program (Hubs) and office-based treatment settings (Spokes) that provide ongoing care and treatment. The program aims to increase the number of providers prescribing buprenorphine for opioid use disorder.

The California Hub & Spoke System (H&SS) aims to increase access to MAT services throughout the state, particularly in counties with the highest overdose rates. This program was modeled after the Vermont Hub and Spoke system, which successfully increased access to MAT in a rural state with little treatment infrastructure. The H&SS has increased the availability of MAT for patients with OUD by increasing the total number of physicians, physician assistants and nurse practitioners prescribing buprenorphine.

The H&SS consists of narcotic treatment programs which are referred to as “Hubs” and serve as experts in treating OUD as well as office-based treatment settings which are referred to as “Spokes” and provide ongoing care and maintenance treatment. The CA H&SS is composed of 18 Hub and Spoke networks and over 200 Spoke locations. Visit the California Hub & Spoke System project page to learn more.

The University of California, San Francisco is building expertise of opioid overdose, opioid withdrawal, and initiation of buprenorphine for pharmacists and physicians staffing the California Poison Control Center, leveraging the existing scope, ease of access, and current CPCS/emergency department consultation relationships.

The University of California, San Francisco is leading an effort to build in new expertise in the areas of opioid overdose, opioid withdrawal, and initiation of buprenorphine for the pharmacists and physicians staffing the California Poison Control Center (CPCS), leveraging the existing scope, ease of access, and current CPCS/emergency department consultation relationships.

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The University of California, San Francisco is expanding the current 24/7 MAT mentorship network to cover all new emergency departments, primary care, mental health, and hospital access points.

The University of California, San Francisco is expanding the current 24/7 MAT mentorship network to cover all new emergency departments, primary care, mental health, and hospital access points. Funding will be utilized to cover training costs and extra staff required for project ramp-up.

The California Substance Use Line is a free, 24/7 tele-consultation service for clinicians in California. Physicians and pharmacists are available to answer confidential questions about substance use evaluation and management, including medications to treat opioid use disorder.

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This program aims to increase access through expansion of current and new services for MAT and OUD prevention for youth & families.

California Youth Opioid Response (YOR California) aims to expand access to Medication Assisted Treatment (MAT) for youth (ages 12-24) and to prevent opioid overdose-related deaths among youth through a continuum of prevention, intervention, MAT, and other treatment and recovery services for youth and their families. YOR California provides  implementation and planning grants across California, a learning collaborative and youth-specific protocols, guidelines and toolkits, and OUD educational materials. Visit the YOR California project page to learn more.

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Public Health Institute is working with hospitals in rural areas to improve access to OUD treatment services and test the concept of rural hospitals as a primary location for MAT.

The goal of this project is to increase referrals into treatment for patients with OUD and to test the concept of rural hospitals as a primary location for MAT.

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This project aims to increase awareness of treatment resources, how to access MAT services, and overdose prevention and intervention tactics for various criminal justice populations.

The goal of this project is to develop and implement a Targeted Information Campaign aimed at increasing awareness of treatment resources, providing information about accessing MAT services, and educating the target audience on overdose prevention and intervention tactics. The Targeted Information Campaign shall target criminal justice audience including adult, family, and juvenile courts, judges, probation and parole departments, attorneys, local law enforcement, and other criminal justice entities as determined by DHCS. This project includes Learning Collaboratives, the creation and distribution of audience-specific workbooks, facilitated webinars, and county-specific communication plans.

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  • Health Management Associates

The California Department of Justice will support the optimization and performance of California’s Prescription Drug Monitoring Program database.

The California Department of Justice will support the optimization and performance of California’s Prescription Drug Monitoring Program database.

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The California Product Stewardship Council will support statewide drug take-back programs in approved locations.

The California Product Stewardship Council will support statewide drug take-back programs in approved locations.

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This effort includes California Highway Patrol trainings to increase awareness of drug use and impairment and the creation of linkages between DUI treatment programs and MAT resources and referrals.

This effort is composed to two separate but complementary projects, one led by the California Highway Patrol (CHP) & another led by the California Association of DUI Treatment Programs (CADTP).

Starting in the spring of 2019, the California Highway Patrol (CHP) will deliver Drug Impairment Intervention Trainings (DIIT) throughout the state intended to increase awareness of signs and symptoms associated with drug use and impairment, with an emphasis on opioids. Attendees will gain knowledge and tools to detect the presence and influence of opioids and other drug use, allowing opportunity for early intervention, linkages, and referrals to treatment.

Visit the Drug Impairment Innervation Trainings website to learn more about the DIIT and to sign-up for a training near you. Registration is complimentary and continuing education units (CEUs) will be available!

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CADTP is implementing a pilot program developed to optimize DUI Programs to become new and effective access points for MAT. The data collected will help to determine the population of persons with opioid use disorder (OUD) who can be reached through interaction with the DUI treatment system. Once completed, the program can be updated with best practices and launched to all California DUI programs. This program has the potential to reduce DUI recidivism, increase public safety on the roadways, and help more people suffering from OUD and other polysubstance addictions.

Visit the DUI MAT Integration/Outreach Project website for more information about the program and a list of project participants.

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This program focuses on expanding access to at least two forms of MAT to persons in jails and drug courts.

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 were due March 1.

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The aim of this project is to support MAT start-up activities and/or enhancement efforts in at least 200 MAT Access Points throughout California, with the goal of increasing the number of patients with substance-use disorders treated with medications, counseling and other recovery services.

The aim of this project is to support MAT start-up activities and/or MAT enhancement efforts in at least 200 MAT Access Points throughout California, with the goal of increasing the number of patients with substance-use disorders treated with medications, counseling and other recovery services. MAT Access Points will ensure that the delivery model enables positive treatment outcomes, safe management of care transitions, and long-term recovery. Eligible organizations include primary care facilities, hospitals, emergency departments, narcotic treatment programs/medication units, jails, residential centers, tribal health centers, DUI providers, community or county mental health centers, social services providers, community-based organizations, or other organizations either building new MAT access or expanding current MAT capacity. Funding can be used to purchase equipment, train staff, recruit staff, make capital improvements, and for other start-up and enhancement costs. Visit the MAT Access Points project page to learn more.

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Harbage Consulting is developing a series of educational toolkits about the benefits of MAT, and to promote access to this evidence-based treatment, and to promote access to this evidence-based treatment.

Harbage Consulting is developing a series of educational toolkits about the benefits of MAT, and to promote access to this evidence-based treatment. Each toolkit will be tailored to a specific target audience as determined by DHCS. To date, Harbage Consulting has developed & published MAT toolkits for residential treatment facilities, counselors, and a flyer for consumers. Visit the MAT Toolkits project page to access the toolkits.

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Media Solutions is leading an effort to design a statewide, multi-media campaign targeted at individuals with OUD and their families, with an emphasis on making connections to treatment.

Media Solutions is leading an effort to design a statewide, multi-media campaign targeted at individuals with OUD and their families, with an emphasis on making connections to treatment. Visit the Media Campaign project page to view some of the project’s media efforts.

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This project supports the expansion of the mentored learning project led by the California Society of Addiction Medicine.

This project supports the expansion of the mentored learning project led by the California Society of Addiction Medicine. Funding will support an additional 80 slots over a two-year period.

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This project aims to decrease neonatal abstinence syndrome severity and length of stay in the hospital and increase the number of mothers in long-term recovery through MAT.

The goal of the Mother&Baby Substance Exposure Initiative is to increase access to MAT using the three FDA-approved medications for the treatment of opioid use disorder, reducing unmet treatment need, and reducing opioid overdose related deaths through the provision of prevention, treatment and recovery activities for opioid use disorder (OUD). The aim is to decrease neonatal abstinence syndrome (NAS) severity and length of stay in the hospital, and to increase the number of mothers in long-term recovery.

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The Naloxone Distribution Project aims to reduce opioid overdose deaths through the provision of free naloxone, in its nasal spray formulation.

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

The program started October 1, 2018, 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; county public health and behavioral health departments; and community organizations such as harm reduction organizations or community opioid coalitions.

Apply here to receive free naloxone. Visit the Naloxone Distribution Project page to learn more.

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The goal of this project is to expand MAT capacity in California’s Narcotic Treatment Programs, with an emphasis on increasing access to buprenorphine.

By participating in this project, NTPs will be trained on the efficacy and usage of FDA-approved MAT, receive information about the Drug Addiction Treatment Act (DATA) 2000 waiver, and learn more about requirements for NTPs when prescribing MAT.

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  • TBD – Identified through RFA process.

This project will educate and train health care professionals about addiction medicine by incorporating addiction medicine & MAT curriculum into California residency programs.

To educate and train health care professionals about addiction medicine, the California Academy of Family Physicians is leading a project to develop and implement curriculum about addiction medicine & MAT into California residency programs.

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This workforce training summit will provide education and resources pertaining to MAT, tools to address and reduce stigma, and ways the workforce can join California’s current efforts to address SUD emerging epidemics.

The Substance Use Disorder (SUD) Workforce: Recovery & Medication Assisted Treatment (MAT) Summit brings together registered and certified SUD counselors and other disciplines of the behavioral health workforce to provide education and resources pertaining to MAT, tools to address and reduce stigma, and ways the workforce can join California’s current efforts to address SUD emerging epidemics. Two Summits were held on the following dates & locations:

  • June 4, 2019 at the Doubletree Hotel in Sacramento
  • June 11, 2019 at the DoubleTree Hotel in Anaheim-Orange County

The goals of the Summit are as follows:

  • Provide an understanding of the disease of addiction and address the stigma often associated with MAT.
  • Share MAT facts, outcomes, and the benefits that MAT has on individuals to achieve a sustainable recovery.
  • Provide tools designed to initiate MAT conversations and available resources aimed at connecting individuals to MAT.

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Health Right 360 is providing access to recovery residence transitional housing and peer support for homeless individuals with OUD in San Francisco to facilitate continued engagement in SUD treatment and related recovery support services.

Health Right 360 is providing access to recovery residence transitional housing and peer support for homeless individuals with OUD in San Francisco to facilitate continued engagement in SUD treatment and related recovery support services.

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This project aims to strengthen the addiction treatment eco-systems in California counties and decrease gaps in coordination of patient transitions moving between higher and lower levels of care.

The Transitions of Care project is surveying treatment systems stakeholders, conducting onsite process improvement events, and launching an ongoing program of technical assistance to increase the overall number of MAT access points and the overall addiction treatment capacity. This project will operate in up to ten counties under the current SOR funding and has rolled out onsite county efforts in Humboldt, Mendocino, Fresno, Kern, Ventura, and Imperial counties.

A summary of the project as well as a report from the first county-level process improvement event which happened in Imperial County can be found on the Transitions of Care website. New reports will be uploaded as they are completed with county stakeholders throughout the summer and into the fall.

AddictionFreeCA.org
HMA has developed a powerful data dashboard to interactively explore data on the county level to understand the epidemic and treatment system landscape in each county. In addition to rich epidemiological data, the dashboard pulls together data on treatment resources, infrastructure, and State Treatment Response (STR) and State Opioid Response (SOR)-funded projects operating throughout California. The ability to overlay various data points in an interactive way is a powerful tool for understanding the state of the epidemic. HMA is happy to make this dashboard publicly available on its new website which will also:

  • Host publicly available educational resources for use by provider entities that need support expanding their addiction treatment capacity;
  • Link site visitors to treatment locators for finding addiction treatment care;
  • Feature detail about HMA’s four opioid addiction treatment programs running in the state and host the programs’ technical assistance resources for program participants; and
  • Communicate the work done by programs built under the STR and SOR grants and link to more detailed information on them.

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The Tribal MAT Program aims to improve MAT access for urban and tribal communities by increasing the total number of waivered prescribers certified and providing expanded MAT services that incorporate the values and culture of the communities being served.

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. The following organizations are implementing complementary initiatives to achieve the goals of the Tribal MAT Project: the California Consortium for Urban Indian Health, California Rural Indian Health Board, TeleWell Behavioral Medicine, Two Feathers – Native American Family Services, UCLA Integrated Substance Abuse Programs, and the USC Keck School of Medicine. Visit the Tribal MAT Project page to learn more.

The University of California, Los Angeles will survey waivered prescribers, which will guide the work of “physician champions” deployed to provide on-site support.

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.

Services offered may include direct mentorship by phone or video, on-site or off-site TA (e.g., program/provider visits, prescriber shadowing), and in-person or virtual training activities related to treating patients with OUD. Free CMEs will be made available where possible.

To access more information, curriculum, and/or to request direct technical assistance, visit http://uclaisap.org/MATPrescriberSupport/

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Young People in Recovery will launch chapters and life-skills curriculum programs to youth in recovery from opioid use and substance use disorders.

Young People in Recovery (YPR) is a grassroots organization focused on creating recovery-ready communities throughout the nation for young people in, or seeking, recovery. YPR is partnering with the DHCS to launch YPR chapters and life-skills curriculum programs to individuals in recovery from opioid use and substance use disorders.

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