Health engagement programs

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“Health engagement program” is a broad term for a range of models providing low-barrier substance use treatment, harm reduction, and basic medical services for people who use drugs (primarily opioids and stimulants). The central goal of this model is to provide a range of coordinated services in a single, easy to access point of care where clients can build trusting relationships that encourage them to engage—and stay engaged—with health care and support services.

Learn more about health engagement programs.

Treatment medications for fentanyl use disorder

ADAI logoDownload report. (pdf)

Fentanyl use disorder can make starting treatment medications more challenging. This report provides insights from prescribers about what they are finding works, and what does not seem to work, for people with OUD who use fentanyl. Prescribers also share questions they have about caring for these patients and what supports they and their teams need.

Information about low-barrier buprenorphine

Goal: The goal of low-barrier buprenorphine, a new and growing model of care for opioid use disorder (OUD), is to reduce opioid overdose deaths and improve health and quality of life for all people with OUD.

Strategy: Increase access to buprenorphine for people with OUD by creating patient-centered programs that are easy to access, offer a high quality of care, and eliminates hurdles to access or stay in care for OUD.

Rationale: Medications are the front-line treatment for opioid use disorder and are underutilized.

Read more about low-barrier buprenorphine here.

Examples and protocols of buprenorphine programs in Washington State

There are many ways to set up your buprenorphine program. This article provides a helpful overview of clinical protocols that can help, or get in the way of, care prior to and during treatment.

Below are examples of policies and procedures for buprenorphine programs in Washington State.

HMC OBOT manualOffice-Based Opioid Treatment Policy & Procedure Manual: Adult Medicine Clinic, Harborview

Download full manual (pdf)
Download patient agreement (pdf)

  • Team based approach that focuses on “patient engagement, patient retention in care, and patient progress in one or more life domains.”
  • Counseling is optional but strongly encouraged.
  • Patients are not discontinued from treatment if they continue to use opioids or other drugs.

Low Barrier, High Capacity Buprenorphine Treatment for High Risk/Low Access Population: Olympia Bupe Clinic, Capital Recovery Center

History and Current Status: July 2019 | Policy and Procedures

  • Low-barrier clinic.
  • Peer-delivered model that includes onsite dispensing and pharmacy support.
  • Team of rotating buprenorphine prescribers, each utilizing their own DEA waiver.
  • Co-located with a syringe exchange program, offers case management as well.
  • No commitment to “recovery” and no counseling required. Patients set their own goals for treatment.

Neighborcare screenshotBuprenorphine Induction Handout for Patients: Neighborcare

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Neighborcare, a network of Federally Qualified Health Centers in King County, offers appointment-based primary care buprenorphine as well as a low-barrier buprenorphine program within community-facing clinic settings.

This handout describes the process for at-home induction of buprenorphine for patients.

Other states' guides for implementing buprenorphine or medication first programs

Implementing Transmucosal Buprenorphine for Treatment of Opioid Use Disorder

From New York State
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  • Counseling should be offered but not required.
  • “An extensive assessment is not necessary.” A focused assessment should include patient history, physical exam, relevant lab tests, HIV/HCV testing.
  • Patients should not be discontinued from buprenorphine for the use of other drugs.
  • “Patients, particularly those opting to stop medication, should also be referred to harm reduction, peer, or other supportive services.”


Provider Implementation Guide: Using a Medication First Model

From Missouri Department of Mental Health, Division of Behavioral Health
Download this guide (pdf)

This implementation guide describes Missouri’s State Targeted Response program goals, and implementation of their medication-first model. The goal of the program is to save lives through patient-centered care involving medications for opioid use disorder.

Background on opioids and stimulants: What are they and how are people using them?

ADAI logoBy K. Michelle Peavy, Caleb Banta-Green, and Mandy Owens, UW Addictions, Drug & Alcohol Institute (2021)
Download this brief (pdf)

The purpose of the brief is to provide an overview of why people = use stimulants and opioids together. It also provides some basic information about how opioids and stimulants work in the body, and people’s motivations for using them.

Key points:

  • Methamphetamine involved deaths are increasing in the US and WA State. About half of these deaths also involved an opioid.
  • Methamphetamine is widely available in Washington State and the Western US. This has led to a wave of people with OUD who started to use methamphetamine, and an increase in co-use of methamphetamine and opioids.
  • People report many reasons to co-use opioids and stimulants, including practical reasons like to function better or avoid withdrawal, or for pleasurable effects. Co-use of stimulants and opioids is associated with negative physical and social outcomes, and lower substance use disorder treatment retention.
  • Stimulant use is common among people in treatment for opioid use disorder. Stimulant use is not a reason to discontinue someone from a treatment program. However, treating someone’s opioid use disorder may not be sufficient to address their stimulant use.

Methadone: An Old Medication with Untapped Potential

By K. Michelle Peavy, Caleb Banta-Green, and Mandy Owens, UW Addictions, Drug & Alcohol Institute (2022)
Download this brief (pdf)

The report explains what methadone is and how it works, the history of both methadone and opioid treatment programs (OTPs) in the United States, the impact of systemic racism on OTPs, and explores new opportunities for methadone and OTPs, including the potential for continued loosening of restrictions on a historically strict and over-regulated environment. In addition to policy changes, innovative strategies for meeting the needs of people with opioid use disorder are considered: mobile medication units, increased use of telehealth, and more.

Key Points:

  • Methadone and buprenorphine are more similar than not in their biological effects and effectiveness in treating opioid use disorder. Yet we’ve constructed different stories about when, how, and who gets which treatment medication.
  • Racism and associated stigma against OTPs have affected how and when people of color access treatment for opioid use disorder.
  • Methadone and its clinics became associated with the reputation of the neighborhoods in which they were placed, often poor neighborhoods of color. Buprenorphine carved out a different reputation and a different market, concentrated among White people paying with private insurance or self-pay.
  • Long-term maintenance of medications for opioid use disorder may be misaligned with American Indian and Alaska Native healers. Western medical providers typically encourage long-term use of medications to manage opioid use disorder. Time in treatment is not necessarily the same as “success” in treatment for American Indian and Alaska Native communities.
  • Mobile medication units are vans that can travel from a home OTP to other communities, bringing medication and services directly to the people that need them.

Helping people who use opioids and stimulants

ADAI logoBy K. Michelle Peavy, Caleb Banta-Green, and Mandy Owens, UW Addictions, Drug & Alcohol Institute (2021)
Download this brief (pdf)

This research brief discusses ways to address ongoing stimulant use among individuals who are also being treated with medications for opioid use disorder (MOUD). Ideal for a broad range of professionals, this summary describes the research supporting the most effective therapeutic approaches for stimulant use and offers practical tips for using these approaches with clients and patients.

Key Points:

  • Keeping individuals engaged in OUD treatment is critical. Discharging individuals for ongoing stimulant use cuts off important connections.
  • Contingency Management is an approach that uses incentives to increase change in substance use. Research shows it’s the most effective intervention to target stimulant use.
  • Motivational Interviewing is a type of therapy that can help people explore ambivalence around changing stimulant use. Providers can use it at every encounter with MOUD patients.
  • Cognitive Behavioral Therapy can help individuals identify and explore patterns of thoughts and emotions, and how they may relate to stimulant use.
  • Professionals can use the Ask-Explore-Plan-Support framework, outlined in this brief, to help clients identify other personal goals which may have an effect on stimulant use

Group counseling for people in medication treatment for opioid use disorder

ADAI logoBy K. Michelle Peavy and Caleb Banta-Green, UW Addictions, Drug & Alcohol Institute (2021)
Download this brief (pdf)

The info brief is for providers who work with people on the medications for opioid use disorder (MOUD). The purpose of the brief is to help providers adapt group counseling for people on MOUD.

Key points

  • Many patients on MOUD may want and benefit from group counseling. However some group counseling is not always inclusive or supportive of MOUD.
  • How can providers create groups that work and are desirable for people on MOUD?
    • Lower the barrier to participation by offering drop-in group counseling, or through group counseling paired with group prescribing. Telehealth can also make group counseling more accessible.
    • Create diverse options for groups including ones that offer classes on financial literacy, housing, exercise, mental health or other topics of interest. Ask patients about their preferences for different group options, and how they should be structured.
    • Offer evidence based psychosocial treatments like contingency management and cognitive behavioral therapy.
    • Make group counseling optional rather than mandatory. Many patients may be interested in group counseling, but mandating counseling is not patient-centered.

Understanding and supporting adolescents with an opioid use disorder

ADAI logoBy K. Michelle Peavy and Caleb Banta-Green, UW Addictions, Drug & Alcohol Institute (2021)
Download this brief (pdf)

This info brief is for providers working with adolescents and young adults with opioid use disorder, as well as loved ones of adolescents who use opioids. The purpose of this is brief is to provide an overview of the scope of the problem of opioid use disorder in adolescent and young adults and identify treatment options and challenges.

Key points:

  • Opioid use disorder and overdose deaths have increased in young people in the US. Overdose risk in young people is heightened by the rise of illicit fentanyl in pills.
  • Medications for opioid use disorder (MOUD) are the standard of treatment for adolescents and young adults with opioid use disorder. Among these, buprenorphine is the only FDA-approved medication for people under 18, and it has the best evidence. Buprenorphine remains under-prescribed for adolescents and young adults. There are complex reasons for this including misconceptions about the use of buprenorphine in young people, and a lack of youth-serving providers who prescribe or dispense these medications.
  • Compared to treatment that does not include medication, MOUD has better outcomes for adolescents including less drop out and less opioid use.
  • Programs that serve adolescents and young adults should be adapted to their unique needs and stage of life. Programs should offer rapid access, have low barriers to entry and return, be available in settings where young people already seek care, and involve adolescents in program development.

Providing medications for OUD during COVID-19

Local Examples of Washington State Organizations Providing Medications for Opioid Use Disorder During COVID-19, Addictions, Drug & Alcohol Institute (ADAI), University of Washington, April 2020