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The Agency for Healthcare Research and Quality has released a new webinar focusing on lessons learned about conducting primary care research during the COVID-19 epidemic from grantees participating in its EvidenceNOW: Managing Unhealthy Alcohol Use Initiative. The webinar addresses common challenges and potential solutions with practice recruitment, logistical problems such as data collection and human subjects concerns, and strategies to initiate and maintain engagement with practices. View the “Primary Care Research during the COVID-19 Pandemic: Perspectives from AHRQ's UAU Grantees” webinar here.

In an effort to get evidenced-based treatment to more Americans with opioid use disorder (OUD), the U.S. Department of Health and Human Services (HHS) has released new buprenorphine practice guidelines, effective on April 28, 2021.

The Practice Guidelines for the Administration of Buprenorphine for Treating Opioid Use Disorder create an exemption that allows physicians, physician assistants, nurse practitioners, clinical nurse specialists, certified registered nurse anesthetists, and certified nurse midwives to treat up to 30 patients with OUD using buprenorphine without meeting Federal certification requirements related to training, counseling, and other ancillary services.

Medicaid is the Nation’s largest payer for substance use disorder (SUD) treatment and recovery services, and as a result, plays a significant role in shaping SUD treatment delivery and reimbursement. The following resources, produced in coordination with AcademyHealth’s Medicaid Outcomes Distributed Research Network (MODRN), examine the policy levers available to state Medicaid programs to improve SUD treatment and offer examples of SUD care delivery innovations.

• Julie Donohue and colleagues at the University of Pittsburgh developed a primer for policymakers. This resource outlines how state Medicaid programs can use their role “as payer and contractor; collaborator; evaluator and educator; and as regulator, monitor, and enforcer” to improve SUD treatment.
• AcademyHealth’s Susan Kennedy and Logan Sheets authored a new issue brief describing two important delivery innovations in opioid use disorder (OUD) care. The brief provides an overview of the innovative approaches, “health homes” and “warm handoffs and care transitions,” and recent examples from state Medicaid programs, such as Pennsylvania’s Centers of Excellence Program, which are “designed to engage and retain people with OUD in treatment.

The National Academy for State Health Policy (NASHP) provides ongoing research and resources on the strategies states are using to combat SUD and OUD. These include reports, webinars, and information on Medicaid approaches. In particular, NASHP has established a State Policy Center for Opioid Use Disorder Treatment and Access. NASHP notes, “The opioid use disorder (OUD) epidemic extends beyond the boundaries of traditional state health systems, requiring evidence-based treatment and coordination between state agencies and leaders. To optimize all potential avenues to treatment and reduce overdoses, the National Academy for State Health Policy (NASHP) is working with states to develop a “no-wrong-door” approach to treatment that prioritizes cross-systems policies.”

The Agency for Healthcare Research and Quality (AHRQ) seeks health services research grant applications to advance our Nation's understanding of the substance use disorder (SUD) crisis and provide solutions for preventing, identifying, and treating SUD.

In this SEN, AHRQ is particularly interested in applications that respond to three specific areas of research in ambulatory care and primary care settings:

1. Dissemination and implementation of evidence-based, non-pharmacological and behavioral interventions that can treat multiple substances or polysubstance use
2. Development and testing of healthcare services interventions to address SUD (such as integrated behavioral health care) that consider the social, environmental, economic, psychological, and other contributing factors
3. Understanding and addressing the effect of SUD on whole-person health and the development and/or management of other chronic conditions.

AHRQ is also interested in applications that discuss reducing disparities and improving access to care, quality of care, health behaviors, and patient experiences.

For information on submitting applications in response to this SEN, please refer to the original notice (SEN NOT-HS-21-010). Applicants should consider this SEN active until March 15, 2023.

The AHRQ Academy developed the Medication-Assisted Treatment (MAT) for Opioid Use Disorder (OUD) Tools & Resources Collection to highlight and describe tools and resources available for those who offer or use MAT services, as well as others interested in addressing the opioid crisis in their families, organizations, community, and/or State.

The MAT Tools and Resources are updated on an ongoing basis as new ones become available. Those added most recently include toolkits, instruments and protocols, web-based courses, webinars/videos, guides, and reports. Among the topics included are screening for substance use disorders/opioid use disorder, clinical guidelines, adolescents, pregnant/post-partum women and their infants, program policies and procedures, and COVID-19. The following tools and resources were among the additions.

• Substance Abuse and Mental Health Services Administration - FAQs: Provision of Methadone and Buprenorphine for the Treatment of Opioid Use Disorder in the COVID-19 Emergency (PDF - 202 KB)
• Provider Bridge - ProviderBridge.org telehealth resources
• The Commonwealth Fund - Launching a Toolkit for Safety-Net Clinics Implementing Telemedicine During the COVID-19 Pandemic
• National Action Alliance for Suicide Prevention - Mental Health & Suicide Prevention National Response to COVID-19
• Institute for Healthcare Improvement and Well Being Trust - A Guide for Health Systems to Save Lives from “Deaths of Despair” and Improve Community Well-Being (PDF - 4.5 MB)

The Generations Journal of the American Society on Aging published a recent special issue addressing the growing problem of substance use in older adults. Among the issues addressed in the journal are the growing problems of unhealthy alcohol and opioid use among older adults, who are at increased risk for harms from both alcohol and opioid use. The Agency for Health Research and Quality (AHRQ) was invited to submit an article on the Agency’s work in this area. The authors discuss the importance of addressing these issues in primary care, and the evidence-based interventions that could help primary care clinicians address substance use disorder in their patients.

The authors also provide information on two AHRQ initiatives that support these efforts to implement evidence. These initiatives are the AHRQ Unhealthy Alcohol Use Initiative and the AHRQ Opioids and Older Adults Initiative, which support primary care practices in implementing evidence to address unhealthy alcohol and opioid use in older adults, respectively.

In October 2019, AHRQ launched the Unhealthy Alcohol Use Initiative. This 3-year grant program aims to disseminate and implement into primary care practices evidence-based approaches to improve the use of screening for unhealthy alcohol use, brief intervention for those at risk, and medication therapy for alcohol use disorder.

The AHRQ Academy produced the Unhealthy Alcohol Use Tools & Resources collection to highlight and describe the tools and resources available for providers, organizational leadership, other team members, patients, and others. The tools and resources are updated on an ongoing bases as new items become available. Those added most recently include guides, webinars and videos, toolkits, and websites on Health Information Technology & Telehealth.

The following tools and resources were among the additions.

• APA Services - Telehealth Guidance by State During COVID-19
• American Medical Association - Telehealth Implementation Playbook (PDF - 9.87 MB)
• National Frontier and Rural Telehealth Education Center - Telehealth Capacity Assessment Tool (TCAT) (PDF – 1.69 MB)
• Center for Applied Research Solutions - Telehealth Clinical and Technical Considerations for Mental Health Providers (PDF – 1.29MB)
• The Addiction Technology Transfer Center Network, the Center for Excellence on Protected Health Information, the National Consortium of Telehealth Resource Centers, and the Center for the Application of Substance Abuse Technologies at the University of Nevada - Reno - Telehealth Learning Series for SUD Tx and Recovery Support Providers

A recent AHRQ article provides a brief recap on the synergistic effects of the COVID-19 pandemic and the opioid crisis. Among this recap includes Findings of an NIH analysis of electronic health records that show people with substance use disorder (SUD), including those with opioid use disorder (OUD), are more vulnerable to the coronavirus than individuals without SUD and those with SUD are more likely to both develop COVID-19 and experience worse outcomes (e.g., hospitalization and death).

In a recent survey of primary care clinicians, one-third of respondents reported an increase in patients with substance use disorder during the COVID-19 pandemic. Preliminary data indicate the rate of overdose deaths involving opioids increased nationally during the first few months of the COVID-19 pandemic, and modeling suggests opioid overdose rates will remain elevated long after physical distancing orders end. It is essential to ensure treatment for opioid use disorder (OUD) is accessible during and after physical distancing precautions.

A recent JAMA Network article warns of the “synergistic effects” of the COVID-19 pandemic and the opioid epidemic and how those effects will exacerbate existing health disparities. Some social determinants of health and factors that play a role in those (e.g., racism, discrimination, poverty, lack of access to quality healthcare) contribute to both increased risk of substance use and overdose, and to preexisting chronic conditions that increase risk of poor COVID-19 outcomes.

The Agency for Healthcare Research and Quality commissioned a rapid evidence review (1.6MB) on the effectiveness of interventions, to promote a broader understanding of the published literature on MAT retention among adults with opioid use disorder (OUD). The study team searched MEDLINE and the Cochrane Library from February 12, 2009, through August 20, 2019, for systematic reviews (SRs) and randomized controlled trials (RCTs). They summarized evidence for six retention intervention types and reported the following key findings from 2 SRs and 39 primary studies:

• Care setting interventions that initiated MAT in soon-to-be-released incarcerated patients improved retention following release.
• Contingency management improved retention when combined with antagonist MAT but not with agonist forms of MAT. Applicability, however, may be limited due to implementation challenges.
• Preliminary trials suggest that retention in MAT supported with health IT approaches may be no worse than in-person approaches.
• Early studies suggest no difference in retention with XR-buprenorphine in either injectable or implant formulations compared with daily buprenorphine. Studies showed conflicting results with XR-naltrexone injection compared with daily buprenorphine.
• The addition of psychosocial interventions did not improve retention; however, many studies included some form of counseling in the control groups, potentially obscuring evidence of effectiveness.

During late June 2020, 40 percent of U.S. adults reported struggling with mental health or substance use issues. Among those experiencing disproportionately worse behavioral health outcomes were racial and ethnic minorities, younger adults, essential workers, and unpaid adult caregivers.

A recent Study from from the Centers for Disease Control and Prevention, found that intervention and prevention efforts to address COVID-19-associated behavioral health conditions should be part of the public health response to the pandemic. Community-level efforts, including communication strategies, should target those at increased risk for psychological distress and unhealthy coping mechanisms.

The Forum on Mental Health and Substance Use Disorders of the National Academies of Science, Engineering, and Medicine (NASEM) hosted a virtual public workshop on primary care approaches to delivering essential components of care for people with mental health and substance use disorders. Due to COVID-19, the workshop was held virtually via webinars on June 3, July 29, and August 26, 2020. Among the workshop presenters were two members of the National Integration Academy Council (NIAC), Frank Verloin deGruy III, M.D., MSFM, Chair; and Parinda Khatri, Ph.D. These experts, along with the many others who participated, provided an excellent overview of how far integrated behavioral health in primary care has come. They also addressed pitfalls and obstacles that need to be addressed and suggested strategies for going forward.

The Forum on Mental and Substance Use Disorders was convened by NASEM’s Health and Medicine Division. Information on the workshop, as well as links to all associated materials, including videos of the webinars, and the report are available.

As part of healthcare transformation in response to the COVID-19 pandemic, telehealth has greatly expanded. Many see this rapid expansion of telehealth not only as a solution to the current problem, but also as “an innovation whose time has come.” Rapid legislative and regulatory changes to payment and privacy requirements have been implemented. Of particular note are the Centers for Medicare & Medicaid Services temporary waivers and new rules that expanded access to care and facilitated payment for a wider range of telehealth services, including various behavioral health services. Changes in State policy and payment have also been important to expanding the delivery of behavioral health care via telehealth.

AHRQ has produced a white paper commentary summarizing the evidence from AHRQ-funded reports on telehealth published in 2016 and 2019. This commentary identifies two high-level findings:

• Telehealth is beneficial for specific uses and patient populations, and
• The evidence of benefit was concentrated in specific uses.

The Substance Abuse and Mental Health Services Administration (SAMHSA) has released a guide to support healthcare providers, systems, and communities seeking to treat stimulant use disorders. The guide describes relevant research findings, examines best practices, identifies knowledge gaps and implementation challenges, and offers useful resources with the goal of distilling this research into recommendations for practice.

Join the HRSA Center of Excellence for Behavioral Health Technical Assistance (COE for BHTA) for a webinar on medication-assisted treatment (MAT) for opioid use disorder (OUD) during COVID-19 and how the AHRQ Academy Playbook can support this work. Presenters will share:

• Tips and strategies that health centers can use at each stage of implementation
• Emerging treatment models
• Technologies and challenges of managing poly-substance use
• Resources included in the AHRQ Academy Playbook
• A case study from a health center in Maine (Penobscot Community Health Care).

Register for this webinar today - new users will need to first create an account. HRSA-funded Federally Qualified Health Centers, Primary Care Associations, Health Center Controlled Networks, and National Training and Technical Assistance Partners, as well as health center look-alikes, are invited to register for this webinar.

The U.S. Department of Health and Human Services (HHS), through the Health Resources and Services Administration (HRSA), recently awarded $20.3 million to 44 recipients, to train addiction specialists at facilities in high-need communities that integrate behavioral and primary care services. HRSA’s Addiction Medicine Fellowship (AMF) program builds on the Agency’s efforts to combat the opioid crisis, and the new AMF program will increase the number of fellows these programs can train.

For a list of June 2020 award recipients, visit:  https://bhw.hrsa.gov/grants/medicine/addiction/fellowship-awards-fy20

A recent commentary in the Annals of Internal Medicine addresses the negative physical and psychological effects of the COVID-19 pandemic on healthcare workers (HCWs). The authors share lessons learned from observations of HCWs during the SARS and H1N1 outbreaks and summarize possible best practices to help reduce adverse effects for HCWs and promote institutional resilience.

Check out three new AHRQ-funded reports that assess the effectiveness and harm of different kinds of chronic pain treatments. These systematic reviews present the current state of the science on treatments for the most common types of chronic pain.

Register for an upcoming webinar series beginning on June 3 hosted by The National Academies of Sciences, Engineering, and Medicine. The first webinar will explore the landscape of evolving models of care, such as accountable care organizations, patient-centered medical homes, and collaborative care arrangements. The second webinar, will feature our very own Academy NIAC member Dr. Frank deGruy Dr. deGruy will highlight approaches to facilitate the delivery of essential components of care for people with mental health and substance use disorders in primary care settings.