Thursday, November 21, 2024
11/21/2024
We will expand and improve our successful program of Emergency Department (ED)-initiated medications for opioid use disorder (MOUD) to include an innovative methadone treatment pathway, improve screening to better identify OUD, remove barriers to ED MOUD enrollment and follow-up in community addiction recovery programs, improve critical supports for participant success in follow-up recovery, and widen the distribution of harm reduction kits in the prehospital and ED settings. Our population of focus includes patients in a large rural and urban catchment area who present to EMS or the EDs of the University of Vermont Medical Center (UVMMC) or Champlain Valley Physicians Hospital (CVPH) in upstate New York with an acute opioid overdose or other signs of opioid use disorder (OUD) who are candidates for starting Medication for Opioid Use Disorder (MOUD). With the continued rise in opioid-related overdose fatalities in these areas, our goal is to address the need to increase the number of individuals with OUD that are screened for risk, offered MOUD and harm-reduction kits, and are successfully enrolled and maintained in certified MOUD community addiction recovery programs, thereby decreasing illicit opioid use, prescription opioid misuse, and risk of opioid overdose. The presentation of patients with OUD both to EMS after a 911 call and at the ED are critical opportunities to identify individuals in need and engage them in MOUD. ED-initiation of MOUD has been found to consistently lead to increased enrollment and maintenance of outpatient treatment programs. The objectives of our fully revised program are built on important lessons learned during the first 4 years of STAR. In our most innovative revised objective, we will include a new ED-initiated methadone treatment arm in addition to revising buprenorphine/naloxone dosing. These are evidence-based responses to improve MOUD success with increased incidents of buprenorphine precipitated opioid withdrawal in the community due to the increased use of fentanyl. There are multiple other areas of improvement addressed in our revised objectives. Our expanded STAR program will identify and offer treatment initiation and harm reduction kits to more prehospital and ED patients with OUD by initiating better screening procedures. We will improve both ED-initiated MOUD program enrollments and community addiction recovery program retention with our expanded ability to link participants to one-on-one peer recovery coaches in the ED, as well as increased options for follow up in additional linked community addiction recovery programs. We will further decrease identified program barriers via telemedicine, streamlined ED procedures, and provision of cell phones and transportation vouchers as needed. We will also utilize innovative collaborations to enroll OUD patients that previously would have been excluded both prehospital (refusing transport to ED) and after hospital admission. By the end of this five-year project timeline, a minimum of 312 unduplicated individuals will be served with grant funds as outlined in our proposal. The data collected from each participant will include diagnosis, self-report measures of illicit drug and alcohol use, housing status, employment status, criminal justice system involvement, access to services and engagement, retention in services, and social connectedness, including measures of disparities in access, service use, and outcomes across subpopulations. We will record the number of clients served (including new clients served from this funding) and the receipt of medications for OUD in the ED and outpatient care. Data will be collected at baseline, 6 months, and discharge. Data from the GPRA will be entered into the SPARS on-line data system. Additional outcomes will include Treatment Needs Questionnaire (TNQ), Tobacco, Alcohol, Prescription medication, and other Substance use Tool (TAPS-1, TAPS-2), and the Locator Form.
HHS’ Tracking Accountability in Government Grants System (TAGGS) website provides access to detailed descriptions of grants, loans, aggregated direct payments and other types of financial assistance awarded by the HHS Operating Divisions (OPDIVs) and the Office of the Secretary Staff Divisions (STAFFDIVs).
