Pilot project increases access to treatment for opioid use disorder in rural Colorado

Researchers at the University of Colorado College of Nursing at the Anschutz Medical Campus found that an 18-month pilot project that trained Nurse Practitioners and Physician Assistants to prescribe Medication for Opioid Use Disorders (MOUD) was successful in increasing availability and access of services to residents of two rural Colorado counties experiencing high overdose rates. As a result of the success of the pilot project, the state legislature passed a second bill to expand MOUD into 17 counties.

The study, out in the July issue of the Journal of Substance Abuse Treatment, reviewed the 18-month pilot project funded by the original Senate Bill 17-074 that focused on supporting NP- or PA MOUD prescribing in Substance use treatment programs up and running rapidly in areas with significant needs. The University of Colorado College of Nursing oversaw the project.

Project goals were two-fold.

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."

Associate Professor Tanya Sorrell, Ph.D., PMHNP-BC, Lead Author

Traditionally, NPs and PAs 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."

The state of Colorado is ranked 12th nationally for self-reported non-medical use of opioids. According to the Colorado Office of Behavioral Health, only one in three Coloradans with OUD reported that they had access to treatment; and one in five Coloradans said that even if they wanted help no services would be available in their home county. The pilot program grew out of a formal statewide collaborative, focused on rural counties with limited MOUD services and high opioid death rates, and capitalized on current trends in treatment of opioid use disorder (OUD). New legislation in the Comprehensive Addiction and Recovery Act of 2016 allowed NPs and PAs to begin prescribing MOUD. "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," said Sorrell.

Due to the success of the pilot, the state passed SB19-001 in 2019 to expand MOUD into 17 counties. However, there were barriers, which included transportation, MOUD reimbursement from Medicaid or other insurances, and continued stigma. "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," said Sorrell.