Impacting the Opioid Epidemic: Care Delivery Innovations from the Behavioral Health Community Nick Szubiak, MSW, LCSW Director, Clinical Excellence in Addictions National Council for Behavioral Health

Care Delivery Innovations Engagement Collaborative Care Evidenced Based Care Recovery Supports

Collaborative Care Primary Care is a golden opportunity to identify, engage, and treat MAT SBIRT ED initiates to engage overdose survivors to treatment CCBHCs = Certified Community Behavioral Health Clinics CBHOs = Community Behavioral Health Organizations can provide ongoing care management and evidenced based psychosocial interventions Reimbursement = improved outcomes, proactive care, workforce support Collaborative Care for Opioid and Alcohol Use Disorders in Primary Care At 6 months, the proportion of participants who received any OAUD treatment was higher in the CC group compared with usual care 39.0% vs 16.8% A higher proportion of CC participants reported abstinence from opioids or alcohol at 6 months 32.8% vs 22.3% (https://jamanetwork.com/journals/jamainternalmedicine/article-abstract/2652574?resultClick=1) Katherine E. Watkins, MD, MSHS1; Allison J. Ober, PhD1; Karen Lamp, MD2; et al

Medication Assisted Treatment MAT is the gold standard for opioid use disorder (OUD) treatment: Reduces drug use Reduces risk of overdose Prevents injection behaviors Reduces criminal behavior 20.2 Million People Have SUD Only a fraction of those that get treatment get MAT 300,000-400,000 people on methadone in a given year 40,000 on buprenorphine 5-10,000 on Naltrexone Only 10% of the prospective MAT patients for (OUD) are receiving it

Why? Perceptions: The perceptions of MAT and its value among patients, practitioners, and institutions – Bias and Discrimination Providers: The availability of qualified practitioners and their capacity to meet patient demand for MAT Payment: The availability and limits of insurance coverage for MAT Coverage for ALL of the MAT medications approved by the Food and Drug Administration. Prior authorization requirements “fail first” policies

Recovery Supports – Part of the Healthcare Continuum Recovery Housing Recovery Education Programs Recovery Employment Peer Coaching Essential Ingredients for Sustained Recovery: Safe and affordable place to live Steady employment and job readiness Education and vocational skills Life and recovery skills Health and wellness Recovery support networks Sense of belonging and purpose Community and civic engagement

Peer Recovery Support Services Services to help individuals and families initiate, stabilize, and sustain recovery Provided by individuals with “lived experience” of addiction and recovery  Non-professional and non-clinical Distinct from case management and treatment Distinct from mutual aid support, such as 12-step groups Provide links to professional treatment, health and social services, and support resources in communities

The Cascade Linkage to care among those diagnosed Medication initiation among those entering care Retention for at least six months among those initiating medication Continuous abstinence among those retained Diagnosis among those affected http://healthaffairs.org/blog/2017/03/13/to-battle-the-opioid-overdose-epidemic-deploy-the-cascade-of-care-model

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Opioid Use Disorder is… -not a moral or spiritual failing -not lack of will or responsibility -not a character defect -not an addictive personality type -does not have personality components such as denial, rationalization, evasion, defensiveness, manipulation, and resistance or any abnormally robust defense mechanisms Is Primary Disease - meaning that it’s not the result of other causes such as emotional or psychiatric problems Is Chronic Disease - like cardiovascular disease or diabetes it must be treated, managed and monitored over a life‐time.   The neurobiology of opioid dependence: implications for treatment. Sci Pract Perspect. 2002;1(1):13–20. Available at:www.pubmedcentral.nih.gov/articlerender.fcgi?artid=2851054&tool=pmcentrez&rendertype=abstract