Spokane is among four sites in Washington that will expand medication-assisted treatment for opioid addiction under a new two-year, $8 million project.
The launch of the Meds-First initiative was announced this week jointly by the Paul G. Allen Family Foundation, which is giving $4.25 million for staffing and associated research, and the University of Washington’s Alcohol & Drug Abuse Institute, which is providing training and studying the results.
In the Spokane site, services will be offered to people using the syringe service program at the Spokane Regional Health District. Other treatment sites are in north Seattle, Tacoma and Walla Walla. Washington State Health Care Authority, Premera Blue Cross and the Ikigai Fund at Seattle Foundation gave additional funding.
“In Spokane, the intention is we’re going to start taking 50 to 75 individuals,” said Dr. Bob Lutz, a regional health district officer. At least three people had entered the initiative as of this week, staff reported.
Lutz said 75 will be a rolling figure during two years, because people will stay up to six months under the initiative’s model of surrounding them with a care team. That team is focused on getting patients stabilized and then into ongoing treatment at a MAT clinic or in primary care.
At all sites, the two-year initiative is expected to serve more than 1,200 patients.
Research shows treatment with medications such as buprenorphine, a prescribed drug that can block opioid cravings, has proven effective in decreasing deaths from overdoses by at least 50%, said Caleb Banta-Green, a UW institute principal researcher.
However, only 15% to 25% of individuals with opioid use disorder have access to such medications for a number of reasons, he added.
Meds-First is designed to create a new “front door” to opioid treatment networks for underserved populations, including homeless individuals, offering treatment where they’re accessing other services, Banta-Green said.
“We’re really trying to meet people there and not force them through our systems,” he said.
“We know there is often a marginalized group of folks who really aren’t able to navigate the health care system on their own, which is difficult for many people, but particularly for people who are struggling with a lot of things including opioid addiction.”
Meds-First’s design also is based on success in a pilot study that began in 2017 in Seattle’s Belltown Neighborhood and treated 147 patients in one year, 82% of whom were experiencing homelessness. Banta-Green was a lead researcher, and the project unexpectedly reached capacity within three months.
“Seattle showed us there is a lot of demand, and it looks like this is working well,” Banta-Green said. The pilot study was published in the August 2019 Substance Abuse journal.
It also showed retention rates for MAT similar to those seen in primary-care settings. Meds-First won’t require participants to enter the research to receive treatment services, but based on the pilot study, people typically volunteer, Banta-Green said.
The Meds-First model tries to get people started the same day on medications if they want them, he said.
Each Meds-First site will employ a team of care navigators, nurse care managers and prescribers. Nurses will do patient assessments, while they and the prescribers provide medical care. The care navigators will serve people from initial contact through to longer-term health management.
Lutz said the health district is partnering with Frontier Behavioral Health Services to provide the care navigators, who will work at the health district, as well as Abilia Healthcare, a group of nurse practitioners.
A majority of people struggling with opioid addiction want help to reduce or stop use of opioids, Lutz said. In a 2017 survey of people in Spokane using the syringe program, 75% of individuals said they were “very” or “somewhat” interested in that.
“When asked specifically what type of medication or help, 46% said either methadone, buprenorphine or naltrexone,” Lutz said. Another 25% said detox and 29% indicated inpatient or residential programs.
“But if you look at a single method, almost half of the individuals said they wanted medication first.”
In this region, use of injected opioids is primarily heroin, Lutz said. “We’re seeing fentanyl (synthetic opioid) now in our state, but certainly on the street, heroin is still more common.”
He said the majority of people who are addicted use different opioid substances, so it also might be use of prescription medications such as hydrocodone, oxycodone and OxyContin.
Historically, people seeking buprenorphine for addiction treatment in primary-care settings often go to three to four appointments over several weeks before getting medications, Banta-Green said.
“We really are saying everybody deserves access to care, and the majority aren’t getting it,” he added. “The reason isn’t because they don’t want it. I think there has been a narrative that people with addiction don’t want to stop using, don’t want to access services, and they are somehow failing treatment.
“My argument in all of this is, actually, I think treatment is failing people.”
Banta-Green said the research will look at how a Meds-First model works in diverse communities that don’t all have the same resources. “Hopefully it works well in all these places; likely differently.”
The UW institute also will study retention on medications, and other initiative effects such as impacts on the number of hospital visits, use of emergency care, arrests and overdoses.
If data can help health care systems and insurance payers see positive outcomes, it could scale nationwide. “That’s the broader vision of all this work.” Nationally, he estimates it has the potential to save 16,000 lives each year.
Rafael Broze, with the Paul G. Allen Family Foundation, agrees about that potential.
“Last summer, we were looking at the opioid epidemic and saw this project as a particularly compelling vision for how to create change,” Broze said.
“Two Washingtonians a day are dying from opioid overdoses,” he said. “We saw Caleb’s work as a combination of proven medication that wasn’t widely available and that can be applied to new populations, save lives and bend the curve of opioid mortality long-term.”
The initiative’s funding supports staffing at clinics and the UW study costs, he said. The medications are expected to be covered by health insurance such as Apple Health.
Banta-Green said a majority of people in Meds-First likely will be prescribed buprenorphine.
“Every day you’re on medications, your chance of dying from an opioid overdose plummets,” he said.
“The idea of the same-day piece is public health, that I have a person who has a life-threatening condition. I’m not going to wait two weeks, four weeks or eight weeks.”
Lashanette Beavers is a new Meds-First care navigator from Frontier with office hours at SRHD.
“People run into a lot of barriers within our health care system, so my goal and job is to help them navigate through those barriers,” Beavers said. “It might be helping them understand or meeting them at appointments so they feel supported.”
Sam Carroll, a SRHD syringe exchange navigator, is often the person asking people if want medication-assisted treatment. She’s seen the delays of the past as a person they’re trying to help falls away.
Carroll said she thinks Meds-First will make a difference.
“This is the first time in this area that I have seen immediate medication with all-around care included,” she said.
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