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(051) A Novel Approach to Increase Accessibility to Medication-Based Treatment for OUD


Authors:

Eric Weintraub, MD – Division Head, Alcohol & Drug Abuse; Acting Division Head, Adult Psychiatry, Univeristy of Maryland, Baltimore

Jessica Anane, MPH – Program Coordinator, University of Maryland School of Medicine

Alexander Pappas, MD – Visiting Assistant Professor, University of Maryland School of Medicine

Chamindi Seneviratne, MD – Assistant Professor, University of Maryland School of Medicine

Kelly Coble, LCSW-C – Program Director, Univeristy of Maryland, Baltimore

Abstract:

Introduction: In 2018, 46,802 Americans suffered fatal opioid overdoses, and 1,985 of the overdose deaths were in Maryland, ranking in the top five states for opioid-related overdose death rates1,2. Individuals living in rural areas have significantly less access to medication-based treatment (MBT) than in urban areas, resulting in higher mortality rates3. We present data from an ongoing project designed to test feasibility of a novel approach in reaching underserved rural populations, with the overarching goal of reducing opioid use in the population and create an evidence-based knowledgebase to further our understanding of management and treatment of OUD.


Methods: Based upon our existing office-based telemedicine capabilities, we conceptualized utilizing a mobile treatment unit (MTU) for providing MBT services to individuals with an OUD, in rural Caroline County, in the Eastern Shore of Maryland. The MTU is a recreational vehicle (RV) equipped with medical supplies and telecommunication devices where patients can teleconference via a monitor screen that links the patient with a physician specialized in addiction medicine/psychiatry at UMSOM in Baltimore, who will provide point-of-care diagnosis at the initial visit and consultations during subsequent follow-up visits. Patients are enrolled into the treatment program by various efforts including local advertisements, scheduling through appointments, referrals from Emergency Departments and local jails, and walk-ins to the MTU. Patients coming on the MTU for their first appointment are greeted by the Addictions Counselor who will administer questionnaires, urine drug screens and vital signs before being “seen” by a Physician. The Program Coordinator then enrolls consenting patients into an optional research study gathering prospective data on global improvement of mental and physical health and demographic characteristics to be added to the OUD knowledgebase.


Results: Since the onset of study in January 2019 until February 2020, we have enrolled 115 patients to receive MBT in the MTU. A 38.9% of patients seen on MTU reported that they would not have sought treatment for OUD, had the MTU was not available. Another 13.9% and 22.2% reported some or moderate likelihood of seeking treatment at the nearest available treatment center, respectively. Thirty-five of the 115 patients also consented to the optional research study (2:1 male: female). Their baseline characteristics included (mean + 95% CI), 9.46 + 1.56 total score on PHQ-9 depression severity, 9.96 + 1.23 on GAD-7 anxiety severity, and 9.46 + 1.56 on DUDIT (Drug Use Disorders Identification Test) scales. Furthermore, on average, patients have saved 9.93 travel miles (St.Dev.= 6.21miles) by receiving MBT on the MTU rather than in their nearest clinic.


Conclusion: Via the MTU, MBT services are now brought to areas that did not have any prior treatment clinics. This project is ongoing and will continue to expand to surrounding counties to meet the growing demand. By project’s end, in collaboration with Health Resources and Services Administration (HRSA), the collected data will be made available to addiction researchers, health care providers, patients, and other interested parties.

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