By Whit Oyler, Strategic Planning Coordinator

What are STR and SOR?

The State Targeted Response to the Opioid Crisis grant (STR) and the State Opioid Response grant (SOR) are major funding sources from the Substance Abuse and Mental Health Services Administration (SAMHSA) to the Colorado Department of Human Services, Office of Behavioral Health (OBH) to address the opioid epidemic in Colorado. These funds were made available through the Comprehensive Addiction and Recovery Act (CARA), which was signed into law in 2016. The STR grant has provided Colorado with $7.8 million dollars per year for two years, ending in April 2019; The SOR will provide $15.2 million annually, ending in September 2020.

Strategies that were implemented with the STR funds will continue with the SOR. Most of the initiatives started in STR are continuing in SOR and many have expanded. The primary objective for both STR and SOR has been to increase availability and access of treatment resources for opioid use disorder (OUD).

Below is a full list of the strategies implemented with STR. The initiatives being funded by SOR are being refined and will be included in the June newsletter.

A.   Distribute naloxone to both at risk individuals interfacing with treatment as well as those at-risk individuals who are not yet seeking treatment

B.   Expand networks to provide support for people who are uninsured or underinsured to receive medication-assisted treatment (MAT)

C.   Expand capacity to provide MAT by incentivizing doctors, nurse practitioners, and physicians’ assistants to be trained to provide buprenorphine and receive a waiver through the IT MATTTRs program

D.  Support a pilot with two hospital emergency departments to begin buprenorphine inductions

E.   Fund residential treatment for homeless individuals and other multisystem high utilizers so they may initiate MAT

F.   Expand Day of Release services for people with OUD leaving county jails to support linkage to effective treatment

G.  Offer family support services using Community Reinforcement and Family Treatment (CRAFT) or Celebrating Families curricula to those close to people with OUD

H.  Enhance existing statewide crisis line to better serve individuals and law enforcement dealing with OUD

I.    Targeted communications campaigns on stigma reduction, naloxone use, crisis services, and trainings for professionals

J.    Utilize peers within each sub-state planning area to support treatment engagement

K.   Enhance existing “OpiRescue” application that supports overdose reversal and tracking to include a treatment referral component

L.   Utilize Colorado Consortium for Prescription Drug Abuse Prevention to support strategic implementation of STR activities to assure coordination with other opiate related prevention, treatment, and recovery related interventions

M. Support two Colorado tribes to identify their unique needs related to opioids/opiates and develop a strategic plan

Moving forward we hope to provide a quarterly update that highlights the successes, challenges, and opportunities related to this grant. For more information on the progress of the grant, please visit this link to view the most recent progress report.

In addition to keeping everyone informed on the SOR, we are hoping to crowdsource strategic thinking. There is a lot of activity in Colorado and limited resources and time. Efficiency is key to our being effective in these efforts.

Successes

Overall the STR grant is performing very well. Most of the initiatives are at or near their goal. The transition to the SOR grant is underway and the team at OBH is busy working through the contracting process to create a smooth transition. A couple of important highlights from the STR grant are:

  •  1,850 people who are uninsured or underinsured have been provided MAT
  • Naloxone purchased with STR funds has been used to save 917 people from an overdose
  • The Colorado Crisis Hotline has received 1,703 calls related to opioids
  • 530 prescribers are now able to prescribe buprenorphine for OUD

Challenges

No project proceeds without challenges and lessons learned. Some of the challenges encountered, and how those challenges have been addressed, are listed below:

  • The number of prescribers able to treat OUD with buprenorphine has dramatically increased but the number of people receiving these services has not increased. This is an issue that has been seen across the nation and the IT MATTTRs team is actively working to identify and address barriers for prescribers. One of the most prominent barriers identified thus far is the availability of behavioral health providers, especially in rural and frontier areas, to provide therapy to people starting MAT. IT MATTTRs is working with the regional health connector program to begin identifying opportunities to address this need. Please visit the following link to learn more about IT MATTTRs http://www.practiceinnovationco.org/itmatttrs2/.
  • The family services initiative was created to provide services to individuals close to a person with OUD. Facilitators use either CRAFT, Celebrating Families, or Incredible Years curriculum. The CRAFT program has been a major focus and this curriculum provides attendees with the skills to support a person with OUD in their journey towards recovery. This initiative struggled to meet service delivery goals in year one. With adjustments in implementation, this initiative is exceeding the goal of serving 200 individuals. Adjustments made so far have included:
    • Changing the location and times of these classes;
    • Expanding access to provide these curricula by training additional facilitators, and;
    • Opening up eligibility criteria.
  • The pilot with the Colorado Hospital Association to induce people with OUD on buprenorphine in three emergency departments in the Denver metro is very innovative, and as expected with a pilot there have been several adjustments. We have learned about the resource, staffing, and facility needs to ensure a smooth implementation. We have also seen the opportunities for law enforcement assisted diversion (LEAD) programs to access patients in the emergency department. These patients can then be diverted to treatment programs rather than to the criminal justice system. With the recently approved no-cost extension, we anticipate that these pilots will meet their service delivery goal of 160 inductions. Please visit the following link for more information about the pilot https://cha.com/quality-patient-safety/opioid-safety-updates/mat-project/.

 

Opportunities

There are always more opportunities for collaboration. As an example, building community capacity to provide evidence-based treatment of OUD is complex, but with the programs and supports we have in Colorado, it is achievable. Keeping with our example, connecting programs that address the following needs can help us build capacity quickly by mutually reinforcing efforts:

We are at a place now where many initiatives funded by STR have been put into place. Aside from implementing these programs, it is essential to work across programs to strategically align resources to achieve an optimal outcome. As an example, we may look at communities with a low capacity to provide MAT and behavioral health treatment and strategize how these funds can be used to increase capacity.

Some steps to increase capacity may include:

  • Assess local need and readiness around OUD and MAT
  • Build community and provider readiness and knowledge around OUD and MAT
  • Identify which programs can provide services immediately
  • Build capacity with existing providers to deliver OUD treatment through the ITMATTTRs program, or via provider education work group support

As additional funding, attention, and effort are directed to the opioid epidemic, these efforts will be key in making the best use of this window of opportunity.

Please email Whit Oyler if you think there may be a way to align efforts.