Colorado program to increase access to medication for opioid use disorder

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A new program that allows nurse practitioners and physician assistants to prescribe medication for opioid use disorder (MOUD) increases the availability and access to services in the rural communities it served.

A study, from the University of Colorado College of Nursing at the Anschutz Medical Campus, found that the 18-month pilot project increased access to MOUD 10-fold in the two rural Colorado counties the program ran in.

Because of the success of the program, the Colorado legislature passed a bill to expand MOUD into 17 counties in that state.

The project’s goals were to “increase the number of NP/PA providers waivered to prescribe MOUD, and to increase the availability of services for patient access in these rural counties, with some of the highest opioid overdose rates in the state,” said lead author Associate Professor Tanya Sorrell. Traditionally, nurse practitioners and physician assistants are successful front-line primary care providers in rural areas. “This program provided the training and support for them to lead as MOUD providers as well. By adding nurse practitioners and physician assistants confident in prescribing MOUDs, we were able to increase availability of services for Pueblo and Routt counties. We went from two clinical providers at three sites to 15 MOUD waivered providers, and from caring for 99 clients to more than 1000 in less than two years.”

Colorado is ranked 12th nationally for self-reported non-medical use of opioids. According to the Colorado Office of Behavioral Health, of the Coloradans diagnosed with OUD, only one in four reports they have access to treatment, and one in five said that even if they wanted help, no services were available in their home county.

The new treatment program was developed via a formal statewide collaborative to capitalize on current trends in treating OUD. Changes in legislation allowed nurse practitioners and physician assistants to prescribe medication for OUD in 2016.

“This opened up a unique opportunity for Colorado to expand MOUD services across the state and potentially reduce the impact of the opioid epidemic in our state,” Sorrell said.

Still, barriers to access abound, Sorrell said. Transportation, reimbursement through Medicaid or insurance, and the stigma of OUD continue to prevent people from having adequate access to treatment.

“One agency, initially framed their services as pain management versus substance abuse treatment to help overcome some of the stigma associated with substance abuse. Thankfully, with the notable care and treatment provided to clients in that area, now that agency is a leader in the community, and known for its substance use treatment services,” Sorrell said.

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