I want to... Expand access to medications for opioid use disorder

Medications for opioid use disorder save lives.

Resources developed during the HCS in Kentucky (HCS-KY) to help support efforts to expand access to medications for opioid use disorder (OUD) may be a useful tool for community members, agencies, and many others looking to improve treatment access.

In addition to the content provided below developed by the HCS-KY team, the Opioid Response Network (ORN), accessible at opioidresponsenetwork.org, plays a crucial role in addressing the opioid crisis and stimulant use nationwide. ORN's key features include:

Local consultants: ORN has a network of local consultants in every state. These experts respond to community-specific needs by offering free educational resources.
On-demand and live training: ORN provides both on-demand and live training sessions. These cover a wide range of topics related to OUD and substance use prevention, treatment, and recovery.
Open access: Anyone can submit a request for free education and training through ORN. Whether you’re a community member, a healthcare provider, or an advocate, ORN has resources for you.

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Transforming OUD Treatment in Correctional Facilities

Welcome to our resource hub dedicated to expanding access to medications for OUD within the criminal legal system. Medications are a critical tool for treating individuals with OUD during their justice-involved journey. In this section, you’ll find valuable tools, including workflow templates, designed to facilitate integration of medication for OUD within correctional facilities, detention centers, and reentry programs.

Our mission: To break down barriers, promote evidence-based practices, and empower justice-involved individuals on their path to sustained recovery. Explore the resources below, and join us in transforming lives.

Contracted Medical Provider Workflow

This document outlines a structured workflow for providing medications for OUD within correctional facilities. Specifically, it focuses on the role of jail contracted medical providers in administering buprenorphine treatment to justice-involved individuals.

From intake assessments to ongoing monitoring, this sample workflow ensures seamless integration of medications for OUD within the jail system.

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Community-Based Medications for OUD Provider Workflow

This document details how a jail could work with a community-based medications for OUD provider to provide treatment to its inmates. Specifically, it highlights the potential for collaboration between jails and their community health centers, outpatient clinics, and other community agencies that often provide buprenorphine treatment services.

The workflow emphasizes continuity of care, patient engagement, and community support to jails to enhance OUD treatment within the carceral setting and retention in treatment upon release.

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Example Request for Proposal (RFP) Language for Medications for OUD Treatment Integration

This document provides sample language about standards of medical treatment for SUD, including OUD that are in line with practice guidelines published by the American Society of Addiction Medicine. This is language that may be placed in correctional facility requests for proposals for contracted medical providers to ensure that the medical provider hired integrates medications for OUD treatment into their standard medical services provided.

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View the resources above and much more in our Expansion of Medications for OUD in the Criminal Legal System Toolkit.

This resource is comprised of four parts:

an introduction to medications for OUD that provides helpful trainings, educational resources, and the importance of offering medications for OUD treatment
an introduction to medications for OUD that focuses on benefits and challenges of implementing medications for OUD treatment in criminal legal settings, MOAs between the government and criminal legal facilities requiring provision of medications for OUD as required by the Americans with Disabilities Act, and personal stories from patients about their treatment and the impact of medications for OUD
implementation resources for legal system organizations
sample workflows and patient resources developed by the HCS-KY to implement medications for OUD treatment programs in detention centers

Access the toolkit at: https://healingstudy.uky.edu/sites/default/files/2024-03/cls-toolkit-final.pdf

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Medications for OUD Treatment Linkage and Retention Programs

Recovery Coach Training Manual

Recovery coaches are a type of peer support specialist who provide support services like facilitating goal setting with participants, advocating for individuals with SUD, making referrals to resources, and inspiring hope that remission and recovery are possible. HCS-KY worked with Voices of Hope (VOH), a community recovery organization, to employ recovery coaches to help persons link to and stay in medications for OUD treatment.

The VOH recovery coaches completed a standardized training program created by members of the HCS-KY team and VOH to ensure adequate health literacy about OUD and medications for OUD treatment and to equip them with tools to assist clients in meeting their goals.

Care Navigator Training Manual

HCS-KY worked with Bluegrass Care Navigators (BCN) to develop novel linkage and retention programs whereby nurses and social workers worked as patient care navigators to help persons with OUD connect to and stay in medications for OUD treatment. Care navigation activities include. assisting with barriers to treatment engagement and retention (e.g. transportation), patient health education, provision of overdose education and assistance in obtaining naloxone, and connection with community resources

The BCN care navigators completed a standardized training program.

Medications for OUD Essentials for Healthcare Providers

Your Guide to Medications for OUD

In this session, we’ll delve into the world of medications for OUD treatment. Our focus will be on three key players: naltrexone, buprenorphine, and methadone. First, James Hawthorne III, MD explores their mechanisms of action, efficacy, potential side effects, dosing, and how they’re metabolized. Cases are shared to illustrate how to effectively utilize these medications in real-world patient care.

Long-acting injectable buprenorphine

In this session, Michelle Lofwall, MD explores the fundamental pharmacology of long-acting injectable buprenorphine (LAI-B) formulations. Participants will identify three potential advantages of LAI-B and learn how to use weekly and monthly formulations for patients who may be new to buprenorphine treatment or currently maintained on sublingual (SL) buprenorphine. Additionally, we'll discuss practical issues with obtaining and storing medication, common side effects, and more!

Initiation of buprenorphine in the emergency department

Dr. Andrew Herring’s California Bridge Model rests on three pivotal pillars. First, it prioritizes low-barrier access to addiction treatment, aiming to eliminate obstacles that hinder individuals seeking help. Second, it establishes clear pathways for active support and follow-up, ensuring continuity of care beyond initial treatment. Lastly, the model emphasizes creating a non-stigmatizing hospital culture for people who use drugs, fostering empathy and dignity. Dr. Herring’s vision inspires us to build bridges toward healthier futures for all.

Know your patient's rights

The Americans with Disabilities Act (ADA) is a critical legislation that safeguards the rights of individuals with disabilities. Substance use disorder including OUD is a disability under the ADA. Healthcare professionals and others including patients, their families, and communities are encouraged to learn about the protections offered by the ADA to persons with SUD. Landmark settlements between the Department of Justice with public entities help to appreciate how the ADA supports access to medications for OUD. The ADA and Its Implications for Patients with OUD: A Workshop, presented by Anna-Maria South, MD serves as a primer to explain how to advocate for increased access to medications for OUD and decrease in health inequities by understanding the ADA.

Learn how to submit feedback on state policy and regulations

Feedback from the community has an impact. Collecting public comments is a critical part of rulemaking within state agencies. Public comments impact policy, guiding implementation and shaping priorities. Learn how to submit feedback on Kentucky Administrative Regulations to ensure state policies reflect community expertise.

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National resources for OUD and other substance use disorders

Providers Clinical Support System (PCSS), available at https://pcssnow.org/, has a clear mission: to enhance healthcare providers’ expertise in preventing, identifying, and treating substance use disorders, with a particular emphasis on OUD. PCSS offers both on-demand and live webinars, and providers can also request personalized one-on-one mentorship tailored to their specific needs—whether they serve in specialty areas, rural or urban settings, or local communities—all aimed at improving OUD treatment practices.

SAMHSA's Practice Guide to expand access to medications for OUD

The Opioid-Overdose Reduction Continuum of Care Approach (ORCCA) Practice Guide 2023, published by the Substance Abuse and Mental Health Services Administration (SAMHSA), serves as a valuable resource for individuals working to combat the opioid crisis. It offers:

A menu of evidence-based practices to reduce opioid overdose deaths.
Real-world tips for implementing these evidence-based practices.

The guide targets a diverse audience, including community coalition members, treatment providers, recovery specialists, policymakers, and others involved in preventing, treating, and supporting recovery from OUD.

It provides guidance, resources, and insights from HCS sites and subject matter experts. Additionally, the guide features “Stories from the Field,” offering practical examples and lessons learned from coalitions implementing the ORCCA strategies.

Click here to access the guide.

Looking for something else? Check out some of our other content.

New to medications for OUD?

Learn more about medications for OUD, including how the three medications that are FDA-approved to treat OUD work and how they are administered, the science behind their effectiveness, and the facts on how long someone should take medications for OUD.

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Emergency Department and Emergency Medical Service Buprenorphine Induction Toolkit

This toolkit provides an overview of the evidence for initiating buprenorphine in emergency departments and through emergency medical services, clinical tools and protocols, and additional implementation resources to help you and your organization offer buprenorphine in these critical settings.

Click here for toolkit.

Educational Videos

HCS-KY produced teleconference and learning collaborative videos are available on a range of topics like:

foundations in OUD and OUD treatment,
medications for OUD in specific settings like criminal legal settings and emergency departments,
novel harm reduction efforts like naloxone vending machines,
and many more!

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Image of an LPN standing outside with a quote that reads "As a nurse on the frontlines of the opioid epidemic, I am a believer in MOUD."