This page provides tools for organizations and hospitals who are interested in or already implementing medication treatment for opioid use disorder.

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 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.

Office-Based Opioid Treatment Policy & Procedure Manual: Adult Medicine Clinic, Harborview

HMC OBOT manual

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.

Buprenorphine Induction Handout for Patients: Neighborcare

Neighborcare screenshot

Download handout

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
Download this document (pdf)

Summary:

  • 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 logo

By 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.
Helping people who use opioids and stimulants
ADAI logo

By 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 logo

By 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 logo

By 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