MAT for Opioid Use Disorders

Medication Assisted Treatment (MAT) of Veterans with Opioid Use Disorder (OUD) decreases
mortality and improves treatment follow-up. However, outside of large and/or urban VA medical
centers, there are shortages of providers with experience treating OUD and a license to
prescribe buprenorphine. This has resulted in decreased access to MAT (buprenorphine/naloxone
and injectable naltrexone) at rural CBOCs and increased overdose rates in rural areas. Some
individual prescribers have used clinical video teleconferencing (CVT) to overcome geographic
barriers and prescribe MAT to Veterans in CBOCs. However, while locally effective, these
arrangements are not standardized and are not parts of larger VISN-wide or national VHA
strategies.

This proposal describes an effective program that the investigators propose to replicate and
expand. The program involves increasing prescribing rates of MAT for OUD in CBOCs using
telemedicine. The investigators propose to (A) develop materials and procedures for the
dissemination of telemedicine delivery of MAT to Veterans at CBOCs and (B) implement
telemedicine prescribing of MAT at rural CBOCs in Northern Maine that lack on-site MAT
providers. MAT will be prescribed by the VISN 1 Telemental Health Hub, which already provides
medication management, psychotherapy, and some MAT to sites in Northern Maine.

In later years, the program will be expanded to other VISN 1 CBOCs, and to other TMH Regional
Hubs that provide services to wide catchment areas in other VISNs. By building on an existing
infrastructure connecting these TMH Regional Hubs to CBOCs and collaborating with other
national initiatives (e.g. SCAN ECHO, PDSI, and academic detailing), telemedicine MAT will be
rapidly disseminated to Veterans at CBOCs who are at high risk for illness, overdose, and
premature death from opioids.

The "Replicating Existing Programs with Blended (External and Internal) Facilitation"
approach will be the study's implementation strategy. Existing programs of telemedicine
MAT---including those by VA Maine and VISN 1 TMH Regional Hub prescribers---will be
replicated. External Facilitation, an approach that has been effective in increasing
intervention uptake in controlled trials, will be provided to rural CBOCs in Northern Maine
by expert study investigators. Internal Facilitation will be provided by VA Maine primary
care and pharmacy staff, who are already supporting programs in opioid prescribing safety in
the VA Maine Healthcare System. Supporting this project are consultants and collaborators
with expertise in implementation science, program evaluation, pain treatment, academic
detailing, and telemedicine MAT. Data collected during implementation will inform program
expansion. The primary measure of program outcomes will be the SAIL SUD16 measure of MAT use
for Veterans with OUD.

Inclusion Criteria:

- Veterans with OUD

Exclusion Criteria: