Addiction groups target primary care in effort to boost opioid crisis response

A $12 million federal grant will allow a coalition of national groups to help equip primary care practices and organizations to achieve a more effective response to the opioid crisis. While expanding patient access to the approved medication treatments for opioid dependence stands as a primary goal, a spokesperson for the coordinating organization says this will not be a medication initiative alone.

“The comorbidity of behavioral health [disorders] is being addressed in this as well,” Jane Goodger, outreach and communications coordinator at the American Academy of Addiction Psychiatry (AAAP), tells Addiction Professional. “This will address root causes, as opposed to just prescribing. We have to approach this from a holistic view.”

The Substance Abuse and Mental Health Services Administration (SAMHSA) has awarded AAAP and a coalition of nearly two dozen organizations $12 million to advance tailored state-based solutions to expand the availability of treatment for opioid use disorders. Strategic planning is being overseen by a core group of organizations that includes the Addiction Technology Transfer Center (ATTC) Network, Community Anti-Drug Coalitions of America (CADCA), the Center for Social Innovation, the Division on Substance Use Disorders at Columbia University, the Research Triangle Institute, and the Adolescent Substance Use and Addiction Program at Boston Children's Hospital.

Notably absent from the full coalition, which also includes groups such as the National Association of Drug Court Professionals and the National Council for Behavioral Health, is the American Society of Addiction Medicine (ASAM). Goodger says ASAM was a competing bidder for the award that went to AAAP; it had been asked to participate in the grant, but chose to apply for it separately from AAAP, she says. Goodger adds that there have been no discussions to date regarding ASAM's possible participation in the initiative going forward.

Beyond securing waivers

Although the Opioid State Targeted Response technical assistance program will seek to increase the number of providers (including physicians and physician extenders) certified and equipped to prescribe buprenorphine, methadone and injectable naltrexone, the participating organizations do not see increasing the number of prescribers as sufficient by itself.

Regarding “the basic infrastructure of a lot of these [primary care] centers, they don't have the resources and training they need to treat what can be some pretty complex patients,” says Goodger.

The participating individuals and groups, acting as the State Technical Assistance Team Education and Support Consortium, will tap into the infrastructure and knowledge base of other ongoing initiatives, including the Providers Clinical Support System, says Goodger. Specialized plans that take into account varying regulatory circumstances in each state will be devised.

Goodger says the initiatives will encourage prescription opioid misuse prevention (through proper prescribing), better identification of opioid use disorders, and treatment, with primary care practices and community health centers as the targeted organizations. “You have to train NPs, PAs and physicians in the community, or you're missing a big part of the base,” she says.

Much of the training effort has to focus on attacking stigma, she says, demonstrating that the patients who are often the subject of providers' greatest scorn have a disease like any other. “They're treatable, and the outcomes can be wonderful,” she says.

The $12 million grant is for a one-year period, although indications are that this could be extended into a two-year grant program.