UNC-Chapel Hill initiative will combat opioid use disorders and overdose deaths

A new research initiative at UNC-Chapel Hill will seek to combat the opioid epidemic by helping to reduce barriers to rural physicians treating opioid use disorders in North Carolina. The project is the first focus of a new effort to increase North Carolinian’s access to specialty care through an innovative medical education model that gives rural health practitioners access to training, experts and resources not usually available to them.

The UNC Extension for Community Healthcare Outcomes for Rural Primary Care Medication Assisted Treatment (UNC ECHO for MAT), in collaboration with University of New Mexico Project ECHO, will reduce barriers to primary care providers offering medication assisted treatment (MAT) to persons with opioid use disorders and reduce deaths from accidental overdose in North Carolina, which exceeds the national average and has been steadily increasing over the past 10 years.

“One effective way to combat opioid addiction and thereby opioid overdoses is MAT,” said Sherri Green, a research fellow at the Sheps Center for Health Services Research and assistant professor in the Gillings School of Global Public Health. “There is both a shortage of MAT providers, especially in rural counties, and a need to support MAT providers through case-based learning, practice supports, and a collaborative community response with treatment and other social and medical supports for patients receiving MAT.”

The UNC-ECHO for MAT will seek to better understand what prevents primary care providers from offering MAT in their practices, evaluate strategies to overcome those barriers, and work closely with providers and community and state partners to expand access to MAT with associated community supports in 22 rural and underserved counties. Furthermore, the UNC ECHO for MAT will serve as a venue for Project ECHO capacity building in North Carolina. The three-year, $2.9 million project is funded by the Agency for Healthcare Research and Quality (AHRQ).

Some of the barriers to physicians providing MAT include lack of training for primary care providers, concerns about a patient’s ability to follow through with treatment, workload practice resource limitations, isolation or lack of support for the practitioner, difficulties in connecting patients with community treatment resources, and stigma associated with substance use disorders and use of MAT. The UNC ECHO team will collaborate with Local Management Entity-Managed Care Organizations for mental health and substance use disorder services (LME/MCO) staff and providers, Community Care of North Carolina, the Governors Institute, AHECs and the NC Harm Reduction Coalition to address these concerns.

The project will offer participating providers continuing medical education (CME) credits to be certified as MAT providers, physician to physician case consultation, CME through tele-trainings and tele-case conferences to help implement a MAT program, as well as practice based office staff support. The research team will track how many practitioners prescribe MAT and the effectiveness of provider level interventions to reduce barriers to providing MAT. Medicaid and Blue Cross Blue Shield claims data and a robust systematic qualitative research plan will help the team evaluate the intervention.

“AHRQ has provided North Carolina with a unique opportunity to leverage the good work and knowledge of many partners working across systems in the state, from behavioral health to public health, concerned about and invested in finding solutions to this public health crisis,” said Green.

The Centers for Disease Control estimated the national opioid overdose death rate for 2014 to be 9.0 per 100,000. In 2014, 45 counties in North Carolina had overdose death rates over 9.0 per 100,000. According to the North Carolina Division of Public Health, 1,101 people died in 2012 from unintentional poisoning in the state, with 92 percent of all unintentional poisoning deaths being drug or medication related.