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The UW-PCSS-U project will provide DATA waiver training to medical students and residents with the goal of encouraging fledgling physicians to utilize buprenorphine in the treatment of opioid use disorder (OUD). To accomplish this goal, we will build on our institution's existing curriculum that addresses pain and addiction, including pre-clinical and clinical experiences. Specific project goals include 1) To increase the number of trainees (medical students and residents) completing approved DATA waiver training to prescribe buprenorphine, 2) To increase the proportion of trainees (medical students and residents) who acquire their DATA waiver after attending an approved waiver training course, 3) To increase the confidence of trainees in treating patients with OUD using buprenorphine, and 4) To increase the number of patients being treated for OUD using buprenorphine by trainees (medical students or residents). Supported by many faculty members with expertise in addiction medicine and our successful expansion of clinical programs for the treatment of persons with OUD, we will use SAMHSA-approved curriculum to provide DATA waiver training. This strategy will allow trainees to carry waiver status across jurisdictions, avoiding challenges that might arise with other curricula. Objectives include, but are not limited to, 1) holding four DATA waiver training sessions per year (1 targeting medical students and 3 targeting residents) in each year of the project, 2) ensuring 50 medical students and 50 residents complete DATA waiver training each year, 3) supporting at least 50% of medical students and 75% of residents in obtaining their DATA waiver, 4) increasing the self-reported confidence of trainees for treating persons with OUD, and 5) enabling at least 50% of trainees to prescribe buprenorphine to treat OUD. This project will support key program staff including the multiple project directors, a project coordinator, and a co-investigator. We will work in collaboration with the UW School of Medicine and UW Internal Medicine Residency Program to achieve our objectives. To identify opportunities for improving the curriculum and track key performance measures we will complete regular assessments of trainees and meet at least annually to review project data.

The UNM-Provider's Clinical Support System (UNM-PCSS) grant will allow the University of New Mexico Department of Psychiatry and Behavioral Sciences to develop a comprehensive training program on Medication Assisted Treatment (MAT) for Opioid Use Disorders (OUD) that will be embedded in the curricula for all UNM medical, Physician Assistant and psychiatric Nurse Practitioner Students. This training program will include classroom instruction on DATA Waiver training as well as clinical shadowing experiences. Specifically, the goals of the UNM-PCSS grants are to: (1) Improve the capacity of UNM health profession students to treat OUD with MAT during their professional careers: (2) Standardize DATA waiver training as part of UNM medical student, PA and psychiatric NP training programs; (3) Ensure medical students, PA students and NP students have the opportunity to meet the requirements to apply for Drug Enforcement Agency (DEA) waiver by time of graduation; (4) Ensure long term sustainability of the training in the educational curricula. These goals will be accomplished by the development and piloting of a comprehensive MAT training that will be approved by the American Academy of Addiction Psychiatry (AAAP) and tailored for UNM medical, PA, and psychiatric NP students. Pilot phase data will be used to refine and standardize the DATA Waiver training, which will be permanently embedded into the programs' curricula. In addition, the UNM-PCSS grant will allow for the development and scheduling of clinical practice teaching, which will afford students to directly observe clinicians who are providing MAT for patients with OUD. The funding also will allow for the development and distribution of marketing materials that explain the importance of DATA Waiver training and normalize treatment of OUD with MAT as a standard component of healthcare. UNM-PCSS will annually train 90 students. By the end of grant year 3, at least 270 students will have received the 8-hour classroom DATA Waiver training and clinical observation training.

Seton Hall University’s (SHU) College of Nursing, School of Health and Medical Sciences, and Hackensack Meridian School of Medicine (SOM) at SHU proposed, “Seton Hall University and Hackensack Meridian Health Interprofessional Medication-Assisted Training Program” will develop, implement, and build into the curriculum an interprofessional DATA waiver training program for Nurse Practitioner (NP), Physician Assistant (PA) and medical students. Faculty from the three schools will collaborate with an expert in medication-assisted treatment (MAT) to develop five training modules consisting of 24 hours of didactic training for NP and PA students, and a condensed eight hours for medical students. Didactic training will be followed by ten hours of clinical training within the Hackensack Meridian Health system. The goals of the proposed project are to: develop an evidence-based interprofessional DATA waiver training program that will be implemented into the standard core curriculum; increase the number of NPs, PAs and medical students at SHU receiving and completing the training requirements for the DATA waiver; and increase the number of NPs, PAs, and physicians practicing in New Jersey who can prescribe MAT to individuals with opioid use disorder (OUD). Objectives include: by August 2019, DATA waiver training will be fully developed and integrated into the NP, PA and medical students’ standard core curriculum; by May 2020, 60 NP students (cohort 1) will have completed 50% of didactic training and 60 PA students (cohort 1) will have completed all didactic training; by October 2020, 60 medical students (cohort 1) will have completed all didactic training; and by May 2021, 60 NP students (cohort 1) and an additional 60 PA students (cohort 2) will have completed all didactic training, and 60 NP students (cohort 2) will have completed 50% of didactic training. Training will continue after the end of the grant project period, with 75 medical students (cohort 2) completing didactic training by October 2021; 60 NP, 60 PA, and 60 medical students (cohort 1) completing all clinical training and will be eligible to obtain a DATA waiver; and 60 NP students (cohort 2) will have completed didactic training by May 2022.

The Advancing Drug and Opioid Prevention and Treatment (ADOPT) Project prepares NP and MD students, clinical preceptors, and frontline community clinics to better address Northern California’s opioid epidemic using medication-assisted therapies (MAT). Training innovations include foundational and advanced classroom and online curricula paired with firsthand clinical experiences that fully satisfy DATA and CARA requirements for buprenorphine waivers. Workforce development and systems improvements will be further addressed using the strategic dissemination of opioid prescribing and management tools, online PCSS trainings, and a “stepped care” approach to technical assistance that provides information resources, telephone consultations, near peer and PCSS coaching, and live regional trainings for MAT expansion. ADOPT reaches all medical students at the University of California San Francisco and Family Nurse Practitioner (FNP) and Psychiatric and Mental Health NP (PMHNP) students at the University of San Francisco and Sonoma State University. Approximately 345 medical students, 270 FNP students, and 30 PMHNP students will be trained by addiction medicine physicians, nurses, and psychologists over the project’s three years (n=645 total). Collectively, these health professional training programs are known for attracting and retaining diverse students that train (and eventually practice) in primarily underserved areas. 65% of these trainees are racial or ethnic minorities and/or from educationally or economically disadvantaged backgrounds. MAT training will be bundled with existing preceptor training programs and promoted to over 500 clinical preceptors. Tailored consultations for implementation readiness and MAT sustainment will be offered to over 200 frontline clinical sites. Clinical training sites are dispersed across the San Francisco Bay Area, the rural San Joaquin Valley, and select opioid “hot spots” in Northern California counties reaching all the way to Oregon and Nevada. Workplace settings will include urban and rural FQHC’s, frontline primary care clinics, community hospital and clinics, women’s and adolescent health centers, addiction treatment facilities, and outpatient psychiatric treatment centers. The populations reached will be representative of those found in Northern California and primarily treated in the public health system. These include the homeless, veterans, uninsured, LBGTQ, HIV, those with serious mental illness, women’s and maternal health, recently released inmates, adolescents and older adults. ADOPT will achieve four primary goals over 3 years: 1) improved screening and assessments for the safe use of opioids and the detection of opioid use disorders, 2) prepare MD and NP learners to apply for DEA waivers to prescribe buprenorphine, 3) engage and train clinical preceptors to obtain buprenorphine waivers, and 4) assist training clinics to enhance MAT readiness and/or improve clinic systems and procedures to support MAT delivery and management. Project sustainment will be promoted by mandated curricular requirements, user-centered curriculum design, and participation in ongoing quality improvement and tailoring to ensure local needs are satisfied.

The MGH Institute of Health Professions (MGH IHP) located in Boston Massachusetts, is submitting this grant proposal, Partnering in Recovery, to develop formal and integrated DATA waiver training as a standard core component of the curriculum for all of our nurse practitioner (NP) and physician assistant (PA) students to improve disparate population health outcomes attributable to substance use and to increase the number of DATA waiver prescribers. In three separate enrollment years, the NP program comprises 6 separate NP tracks of specialties and 322 students; the PA program comprises more than 120 students in one program. The Substance Abuse and Mental Health Services Administration's (SAMHSA) Provider's Clinical Support System--Universities (PCSS-Universities) will offer the opportunity for the MGH IHP to build an exemplar interprofessional training experience for all nurse practitioner and physician assistant disciplines, both often serving as primary care providers. By the end of the grant period, DATA waiver training will be well integrated in the MGH IHP curriculum, and 100% of graduate will be DATA waiver trained successfully. The project goals are to: 1) Develop an ongoing curriculum to integrate DATA waiver training to all nurse practitioner and physician assistant programs; 2) Increase the number of MGH IHP NP and PA graduates who are DATA waiver trained and able to deliver MAT in a clinical setting; 3) Increase the number MGH IHP NP and PA faculty who are DATA waiver trained; and 4) Serve as a continuing education resource for the larger healthcare community locally as well as online by offering DATA waiver training information and training to practicing providers (alumni, preceptors) or any interested party. This single proposal involved MGH IHP partnering with Massachusetts General Hospital MGH Addictions Consult Team to accomplish these goals and is requesting $135,649 to expand the reach and use of the basic educational core competencies for the prescription and management of substance misuse. Attainment of these goals will increase the number of MAT prescribers by a minimum of 450 prescribers in a 3-year period substantially expanding the capacity for treatment of substance use disorders. The process and progress of implementing the PCSS-Universities training program will be assessed at beginning and end of learning modules with collaboration across the MGH IHP and clinical partnerships, as well as the SAHMSA Government Project Officer. Also, throughout the duration of the training period, trainee survey data will be collected, reported, and analyzed to contribute to future DATA waiver training initiatives. This proposal has the support of all communities participating in its design, and the project is expected to be sustainable beyond the 3-year funding period by this design.

The proposed North Carolina Provider’s Clinical Support System – Universities Project (NC PCSS U) is a 3 year project to address the opioid epidemic by expanding and enhancing access to medication assisted treatment (MAT) through education and training for NC medical students and building medical school capacity to support these activities. Four medical schools in NC, that collectively produce 545 new doctors each year, will participate: Campbell University School of Osteopathic Medicine (CUSOM), University of NC School of Medicine (UNCSOM), Eastern Carolina University Brody School of Medicine (ECUSOM), and Wake Forest School of Medicine (WFSOM). They have committed to (1) integrating opioid use disorder into their standard curricula such that students will be eligible to apply for the DATA 2000 Waiver to prescribe buprenorphine once they are issued a DEA number and (2) providing expanded opportunities for shadowing and clinical exposure to Office Based Opioid Treatment (OBOT). This clinical exposure will allow students to experience OBOT in action and see/discuss clinical issues, challenges, solutions, and positive treatment outcomes/benefits to increase student “readiness”, dispel stigma, and provide student with knowledge about PCSS and other resources available to assist them in offering MAT. This exposure is critical to increasing the number of trainees who apply for the waiver and actively prescribe. Working with the American Academy of Addiction Psychiatry and The Provider’s Clinical Support System, our expert addiction medicine physicians with waiver training experience will develop training options (e.g. live, remote live, online) and work with school faculty on trainings at their specific schools, providing mentoring and building capacity for the school to provide future trainings and OBOT clinical sites. The training will include the requirements of the 8-hour Waiver course, but will also address pain management and safer opioid prescribing, as well as the broader issues related to substance use disorders. Goals include increasing the supply of physicians trained in NC to provide MAT, increasing the capacity of NC medical schools to train a workforce equipped to prevent and treat OUD, increase the supply of physicians with the DATA 2000 Waiver who actively prescribe, and to develop infrastructure that will ensure sustainability. We expect that approximately 545 future doctors will be trained in years 2 and 3 of the project, with total of 1,090 over the 3 year grant. The impact this will have on future patients, families, communities, and healthcare systems cannot be calculated, but is most likely an excellent return on investment. Three of the schools have strong primary care focus and two of the schools (Campbell and ECU) have been focused on and successful in producing physicians to work in underserved rural areas of NC.

Designed for DATA is an initiative to incorporate opioid use disorder education, guided by buprenorphine waiver training, into a traditional four-year medical school curriculum. This initiative seeks to teach medical students about opioid use disorder, consistent with education for other medical disorders, by building upon knowledge from etiology and diagnosis to treatment and complications. Students will graduate with the required knowledge and experience to obtain a buprenorphine waiver. The Designed for DATA project will serve medical students at the University of Toledo College of Medicine; approximately 720 students in the first year, and approximately 180 additional students in each of the subsequent two years. Medical students, in addition to knowledge about opioid use disorder, will rotate through a medically-assisted withdrawal unit and partial hospitalization program. Substance use disorder in physicians and medical students will also be addressed. Many graduates of the University of Toledo College of Medicine currently practice medicine in Ohio, which is among the top five U.S. states with the highest rates of opioid-related overdose deaths. The mission of this project is to increase opioid use disorder education in an undergraduate medical education program, with an end goal of increasing the number of physician providers with buprenorphine training waivers in order to expand access of medication-assisted treatment services for persons with opioid use disorder.

Medication-assisted treatments including methadone, buprenorphine, and naltrexone have been shown to be effective both at promoting abstinence and reducing high-risk behaviors (e.g. injecting) and to be cost-effective. Of these medications buprenorphine and naltrexone are approved for use outside of specialty addiction treatment settings. Although buprenorphine has been a primary care treatment option for 15 years, today only 4 percent of licensed US physicians are approved to prescribe buprenorphine. Despite being ranked among the ten states with the highest number of opioid prescriptions for pain per capita, Michigan maintains a low volume use of buprenorphine per 100 opioid prescriptions and receives meager public funding for buprenorphine treatment. In addition, medical students currently receive a limited education around opioid safety and pain management. This curriculum is currently not sufficient to address treatment of opioid use disorders. By educating medical students early in their professional career, we hope to breakdown stigma and cultural barriers around using this evidence-based treatment as well as promote general knowledge around best practices for screening, evaluating, and treating patients with substance use disorders. The proposed intervention aims to address the critical gap in training by developing an innovative curriculum routed in the four key components of organizational change framework: compelling story, role modeling, reinforcing mechanisms, and capacity building. We will achieve this by building in a session of patient stories, build clinical rotations, rural shadowing opportunities, address CARA throughout the four-year curriculum, building supervisors capacity by supporting behavioral health resources, and work with lawmakers regarding reciprocity across states. To assess progress, we will collect information on specialties of each graduating class and their supervisors, and post-graduation on prescribing, and changes in knowledge and stigma.

The Yale MAT Training Program: Expanding Treatment Access aims to promote the adoption of Medication for Addiction Treatment (MAT) among (1) professional students in Medicine and Advance Practice Practitioners (APP), including Physician Associates (PAs) at Yale School of Medicine (YSM) and Nurse Practitioners (NPs) at the Yale School of Nursing; (2) residents at Yale-New Haven Hospital (YNHH) and (3) faculty and community practicing physicians at YNHH and providers throughout Connecticut (CT). It leverages the expertise of nationally known faculty at Yale with extensive experience in leading SAMHSA and NIDA training programs, developing substance use disorder curriculum and clinical programs and leading CT's Response to the Opioid Epidemic (CORE) strategic plan. The Yale faculty have expertise in program evaluation, serving as mentors to multidisciplinary providers, sustaining programs by integrating them in existing curricula, and disseminating results through presentations, publications and website development. Goal 1 is to expand access to MAT to individuals with OUD by increasing the number of providers (students, residents, APPs, physicians and faculty) that (a) complete the requirements for the DATA waiver training into the respective curricula curriculum for all providers. Our PCSS-approved trainers will provide the SAMHSA half day face-to-face didactic sessions followed by half day on-line instructions for all providers. An additional 16 hours of training available through the PCSS website will be provided for all APPs. We will build on our innovative and enduring instructional strategies, including our medical student OUD curriculum, an on-line web portal (https://medicine.yale.edu/edbup/), and expand CT's network of PCSS mentors and instructors to ensure sustainable support and training for all providers. Collaborating closely with stakeholders identified in each school/program we will ensure integration of all training into the students' and residents' respective curricula and disseminate all teaching materials and tools to the larger community of practitioners regionally and nationally. Champions identified in each program and specialty will work with core faculty to ensure that all programmatic and learning objectives are met. We hypothesize that exposure to the didactic and skills-based simulation workshops coupled with clinical practice environments with high prevalence of OUD and trained faculty will ultimately increase the number of individuals obtaining a DATA waiver and increase buprenorphine prescribing practices. Capitalizing on the ""teaching up"" model, we hypothesize that more teaching and community faculty will subsequently participate in the trainings. We anticipate training 1,029 individuals (200 Med, 200 NP, 120 PA students; 125 Primary Care/ Internal Medicine, 45 Emergency Medicine, 54 Psychiatry, 30 Pediatric residents; 60 YSM faculty, 45 community preceptors, 150 providers throughout CT). The impact for expanding access to MAT is estimated at hundreds of individuals with OUD per year, translating to thousands over the course of the providers' careers.

PCSS-Universities (PCSS-PITT) The opioid epidemic response plan, like any public health crisis, must include nurses. Nurse practitioners (NPs) are uniquely positioned to meet this need because of the implementation of the Comprehensive Addiction and Recovery Act (CARA) of 2016, expanding their prescriptive authority to include buprenorphine. The Provider’s Clinical Support System- Universities at the University of Pittsburgh School of Nursing (PCSS-PITT) will integrate the evidence-based practice of medication-assisted treatment (MAT) for persons with an opioid use disorder (OUD) into its (Pitt SON) Doctor of Nursing Practice, Nurse Practitioner Program (DNP Program). The project addresses the purpose of teaching NPs the skills necessary to provide MAT to patients, through a curriculum infusion. Specifically, the project will provide Adult/Gerontology, Family, and Psychiatric-Mental Health NP students with the 24-hour PCSS-approved training requirements needed to obtain the DATA Waiver. The project will also provide all other students, enrolled in any of Pitt SON’s NP areas of concentration (i.e., neonatal, pediatric), with the 8-hour core training course - so that all students graduating from Pitt SON, will have received up-to-date OUD and MAT information. The PCSS-PITT project proposes to transform, scale up, and strengthen the capacity of Pitt SON’s education programs in order to address the critical need for well-qualified nurses to prescribe MAT. NPs can help to fill the shortage of primary care providers and positively affect patient health outcomes in terms of prevention and population health services, especially when they are able to practice at the top of their education and skill level. The PCSS-PITT program will fully implement an education and training program that includes both didactic and clinical components to ensure NP students fulfill the 24-hour training requirements needed to obtain the DATA Waiver upon graduation. The PCSS-PITT proposes to: 1) implement a sustainable and replicable OUD and MAT education and skill-building program within the DNP Program so that graduating NP students will have the knowledge, skills, and attitudes necessary to obtain the DATA Waiver; 2) add 90 NPs (30/year), including students, faculty, and preceptors, to the workforce who are able to prescribe MAT for patients with an OUD; and 3) ultimately, increase the number of NPs who are prescribing MAT.

Project Name: Expanding Opioid Treatment Through Interprofessional Education Summary: We aim: (1) to develop and implement an interprofessional (IP) education curriculum to teach future health care providers to prescribe medication assisted treatment (MAT) for opioid use disorder (OUD) under the DATA2000 waiver; and (2) to increase the number of practitioners providing MAT for OUD within their practice. The population of learners includes future Nurse Practitioners (NPs) and Medical Doctors (MDs) studying at the UCSF Schools of Nursing and Medicine. The learners will learn to treat a clinical population of people with OUD with a focus on undertreated groups with high morbidity and mortality, including the uninsured, Black/African-Americans, pregnant women, veterans, and people experiencing homelessness. Our project goals are to: (a) develop an IP curriculum called UCSF Diagnosis, Brief intervention and Offer Treatment (DBOT) to train future NPs and future MDs to diagnose and treat OUD; (b) integrate DATA2000 waiver training into the foundational curricula for both future NPs and MDs; and (c) increase the provision of MAT for OUD in a variety of treatment settings. Our strategies to reduce barriers to our learners’ utilization of MAT for OUD include: (a) training providers before graduation (b) teaching federally-approved didactics with cases adapted to emphasize team-based care by highly experienced teachers; (c) clinical immersion experiences to shadow interprofessional teams who are using MAT to treat OUD in diverse settings; and (d) addressing the stigma attached to OUD and MAT Implementation of this intervention will proceed in a stepwise fashion toward the goal of training all future NPs and future MDs: we will train at least 89 students in the first year of operation, at least 132 students in year 2, and more than 200 students in the third and subsequent years, with plan for subsequent dissemination of our curriculum. Measurable objectives of the UCSF DBOT curriculum are:(1) Enhance IP trainee perceptions of caring for individuals with OUD; (2) Improve IP trainee knowledge, skill, and attitude of diagnosing and treating OUD; (3) Enhance IP trainee perceptions of interprofessional clinical practice and team-based care; (4) assess IP trainee understanding of self and situation within the context of interprofessional clinical immersion through a critical reflection exercise; (5) assess IP trainee and faculty satisfaction with IP curriculum; (6) increase number of graduating NPs and MDs eligible to apply for DATA2000 Waiver; (7) increase number of IP graduates completing DATA2000 waiver licensing after graduation; (8) assess the number of graduates who are providing MAT for OUD.

Oklahoma State University for Health Sciences (OSU-CHS), acting through the Center for Wellness and Recovery and the Department of Psychiatry and Behavioral Science, seeks to expand and enhance existing addiction training efforts to better prepare physicians to treat the opioid epidemic. Untreated opioid use disorder has a devastating affect on generations of area families. In 2016 813 Oklahomans died from overdoses resulting in a rate of 21.5 p/100,000 (CDC). Nationwide, the rate was 19.8 p/100,000. The Trust for America’s Health reports that the rate could well increase to 31.7 p/100,000 by 2025 in the state if drastic steps are not implemented. Opioid misuse is a serious and growing problem. A major gap is the lack of available trained, certified, and funded providers of medication assisted treatment (MAT). According to SAMHSA, in 2018 Oklahoma has only 42 certified physicians in their first year of buprenorphine waiver and 4 certified physicians in their second year or beyond. The total buprenorphine treatment capacity of these physicians is 1,660 patients. In 2017, 112 Oklahoma physicians were in their first year of waiver, and an additional 12 had been practicing for multiple years – a service capacity of 4,560 patients. Lack of available and appropriate training for additional certified physicians has created a significant gap in the provision of service. Consequently, the capacity to treat patients in Oklahoma with an opioid use disorder has declined by 2,900 patients in one year. The major barrier is the lack of integration of waiver training into graduate medical education. This project will allow integration of DATA waiver training into the second year of graduate medical education for all residents in the OSU system. The evaluation plan was developed with great consideration for the needs of the target population in our large and complex service area. OSU-CHS has a proven ability to collect and report GPRA data in similar populations at the individual and program levels (NIAAA, DOJ, and HRSA). Specifically, the project will collect data including number of people in the workforce trained in mental health practices, number who received prevention and mental health promotion training, and the number referred for mental health services. Data will be collected reported into SPARS as required and the evaluation team will develop and conduct routine structured reviews of collected GPRA performance data.

Clemson University School of Nursing in Greenville (CUSON) and University of South Carolina School of Medicine Greenville (USCSOMG) will develop and implement Project EMPOWER (Engaging Medicine Providers on Ways to Enhance Recovery) to increase the number of providers with waivers to prescribe Medication Assisted Treatment (MAT) to patients with Opioid Use Disorder (OUD). The project will train up to 100 medical students and 50 nurse practitioner students annually to meet waiver requirements and will assist them in obtaining the waivers. In 2012, South Carolina practitioners dispensed more opioid prescriptions than there are people in South Carolina. Neighboring SC counties Greenville, Spartanburg, and Pickens are documented as having among the highest levels of opioid deaths in the state. In Greenville County, South Carolina, we have identified a need to increase the number of MAT providers - particularly providers who provide care to underserved populations (uninsured and underinsured). Providing MAT training to medical and nurse practitioner students early in their careers is urgently needed to increase the MAT workforce in Upstate South Carolina, including rural counties, as recent graduates are often more willing to integrate MAT within their scope of work. Project EMPOWER will train up to 450 medical or NP students over the 3-year project period and will meet the following objectives to address this need: 1) Offer education and training to up to 100 medical students and 50 nurse practitioner students annually on medication assisted treatment (MAT) to meet the requirements for DATA waivers. This will include didactic and clinical training opportunities. 2) Increase the number of trained individuals who obtain a DATA waiver and the number of trained individuals who prescribe medication assisted treatment. 3) Create and implement interdisciplinary physician and nurse practitioner opportunities for learning about MAT for addiction that encompasses motivational interviewing and trauma informed care using didactic and simulation-based educational experiences. 4) Create a train the trainer educational opportunity with PCSS to increase trainer capacity in the region to sustain the education of physicians and nurse practitioners on MAT. 5) Collaborate with FAVOR Greenville to expose students to Recovery and the effect of OUD on families. 6) Evaluate the effectiveness of the curriculum through multiple surveys over time assessing attitudes, confidence, self-efficacy and perceived barriers related to medication assisted treatment.

Overdose deaths involving opioids in Monroe County, NY are rising at an alarming rate. The Nurse Practitioner DATA Waiver training program will reduce opioid-related overdoses and deaths by increasing the capacity of the NP workforce to provide Medication Assisted Treatment (MAT), and of all advanced practice nursing students, faculty and preceptors to diagnose opioid use disorders, identify opioid prescription misuse, and prevent opioid overdose and death. To achieve these goals, the Data Waiver training program, in conjunction with the American Society of Addiction Medicine (ASAM), will immediately offer current students, faculty and preceptors the ASAM online training for DATA Waiver at no cost, so that a minimum of 20 students, faculty and preceptors will be eligible for a waiver within the first two years of the grant. At the same time, the standard curriculum for students admitted after fall, 2018 will begin to integrate the DATA waiver competencies into specific required graduate level nursing courses, drawing upon the expertise of our faculty from Nursing, Mental Health Counseling, and Pharmacy, our physician MAT consultant/trainer, and our clinical partners who will provide each NP student with a substantive MAT shadowing experience. As a result, 100% of NP students will be eligible to apply for a DATA waiver upon graduation, adding 75 DATA waiver eligible practitioners to the workforce in 2021 and each year thereafter. In addition, building upon our experience in integrating and sustaining SBIRT (Screening, Brief Intervention, and Referral to Treatment), the curriculum for all advanced practice nurses will be enhanced to include adolescents, older adults, and pregnant women, advanced skills in motivational interviewing and cultural competence, sources and effects of stigma, self-help and peer coaching, the NYS Department of Health certified opioid overdose prevention training, and practice delivering MAT with standardized patients. The SBIRT website will be updated to include MAT resources, and faculty and preceptors and other community practitioners will be able to take the enhanced training each year of the grant at no cost. Marketing of the program will begin in year one, so as to recruit NP students with an interest in acquiring DATA Waiver training as part of their course of study. To measure success in achieving these goals, the data collected and analyzed each semester will include: number of individuals trained in classroom setting; number receiving practical application training through shadowing; types of students trained; utility of training experience; extent to which curriculum has changed to incorporate DATA waiver training as a meaningful part of standard curriculum, intent to apply for a Waiver, the number who apply for a waiver and extent to which students prescribe once practicing. A minimum of 90% of students will report an increase in perceived effectiveness in MAT and satisfaction with their training and the relevance and usefulness of the training to their career. Students will also be queried about their interest in a DATA waiver each semester and intent to apply for waiver after graduation, and a baseline will be established in year 2 to determine the benchmark for future waiver applications.

Project Summary: Access to treatment services in the management of opioid use disorders is the number one barrier to care in the state of Virginia. George Mason University has designed a four-pronged approach to preparing nurse practitioner graduates with the essential DATA-waiver content as well as the ability to understand their value and navigate the multitude of systems variables (team, organization, culture, implementation) at play. Special attention is also paid to training the preceptors of these students. Population to be Served: Approximately 165 nurse practitioner students in all concentrations of the MSN and DNP programs will be impacted by the curriculum transformation and training efforts in the TIMI project. Students will rotate through two county-wide Medication Assisted Treatment clinics and work with teams, who see a diverse population of males and females ages 18 and over diagnosed with opioid use disorders. Strategies: George Mason University will 1) directly partner with the American Society of Addiction Medicine (ASAM) to infuse their DATA-waiver training curriculum into the curriculum for the MSN and DNP programs and prepare faculty trainers over the life of the grant and 2) collaborate with the Virginia Department of Health to expose students to a variety of opioid teleECHO programs across the state. Leveraging the infrastructure already developed through a Screening, Brief Intervention, and Referral to Treatment (SBIRT) training grant, the TIMI project will orient students early in their programs to the value of MAT and need for MAT service providers in SBIRT infused courses. In their clinical year, students will then be trained in the DATA-waiver content along with systems variable competencies including 1) behavioral health integration, 2) working with interprofessional addiction teams, 3) managing culture change, and 4) implementing MAT in practice. Clinical preceptors will be trained in mentoring students as an MAT service provider. Students and graduates will engage in interactive teleECHO coaching sessions, which will offer experts in various fields to support student in thinking through MAT service delivery pre- and post-graduation. Project Goals: #1 Train: Infuse comprehensive DATA waiver training requirements and essential support competencies into nurse practitioner curriculums in the MSN and DNP programs. #2 Immerse: Offer immersion experiences in MAT administration to all nurse practitioner students. #3 Motivate: Motivate nurse practitioner graduates to apply for the DATA waiver. #4 Integrate: Support students and graduates in advocating for and integrating MAT services into appropriate practice settings. Numbers Served: The TIMI Project will impact approximately 200 individuals diagnosed with opioid use disorders annually and 600 individually collectively over the life of the grant. The majority are male (61%), white (68%), and in the 26-35 age range (43%).

Opioid use disorder (OUD) is a national public health crisis, and New Jersey is an epicenter. Cooper University Healthcare in Camden cares for between five and thirty opioid overdoses every day. This cycle is driven by the extreme deficit in providers trained in evidence-based practices for treating OUD longitudinally. The Multidisciplinary Longitudinal Opioid Use Disorder Curriculum for Students and Faculty will develop champions among currently practicing primary care providers while creating the system to train the providers of tomorrow. This program is novel in its multidisciplinary approach to developing trainee and faculty expertise. Directed at both physician and nurse practitioner trainees, it utilizes pre-existing training programming to effectively deliver material, assess efficacy, and certify practitioners. Through simulation training in motivational interviewing, sessions on trauma informed care, and an online curriculum, students will receive a comprehensive knowledge base. Through required clinical rotations on an addiction medicine service in both the inpatient and outpatient settings, students will internalize evidence based approaches to clinical decision making and patient interactions. Through observed clinical simulated encounters and rapid process improvement, the students will be assessed and opportunities for improving the curriculum will be realized. Finally, through development of mentors among the primary care faculty, students will have longitudinal relationships with clinical models while the current desperate need is being immediately addressed. Supporting these newly developed faculty mentors with telemedicine, financial incentives, and practice support will overcome many of the barriers to primary care utilization of medication assisted treatment (MAT). The Addiction Medicine Division at Cooper represents a concentrated group of experts who span multiple specialties, including internal medicine, emergency medicine, family medicine, psychiatry, and behavioral health. Once successfully implemented, this project's intended outcomes will include the following outcomes: of 416 total medical students, 375 (90%) will have attended workshops, simulations, clinical rotations, and drug addiction treatment act waiver training by their final year, 290 (70%) will have received advanced training in motivational interviewing and trauma informed care, 90% of primary care core faculty at both the medical school and the school of nursing will have undergone multimodal training in OUD treatment, 15 champion primary care faculty will receive buprenorphine x-waivers, and 10 faculty will initiate MAT in primary care. In conclusion, the Multidisciplinary Longitudinal Opioid Use Disorder Curriculum for Students and Faculty represents a novel, feasible, and impactful way to directly address the provider shortage for patients with OUD. A history of success and strong partnerships makes this setting ideal for the project, and meaningful outcomes from both an educational and societal perspective will drive sustainable, longitudinal change for patients in the southern NJ region.

The proposed University of Pittsburgh Physician Assistant Program Medication Assisted Treatment (MAT) Training Integration Project will integrate the full 24 hours of Drug Abuse Treatment Act (DATA) waiver training required for physician assistants (PA) across two semesters of courses that will focus on care for patients with addiction, specifically opioid use disorder (OUD). This is an application in response to Funding Opportunity Announcement (FOA) TI-18-004 from the Substance Abuse and Mental Health Services Administration (SAMHSA). The population of focus includes 168 physician assistant (PA) students at the University of Pittsburgh School of Health and Rehabilitation Sciences (SHRS), which is the applicant organization. This project is a collaboration between SHRS and the University of Pittsburgh School of Pharmacy-Program Evaluation and Research Unit (PERU). Key objectives and goals of this project are to increase the number of providers who are DATA certified to provide medication assisted treatment (MAT), fully integrate a DATA waiver training curriculum and MAT clinical experience opportunity with MAT providers into the current PA student curriculum at SHRS, increase access to care for OUD in underserved areas, and improve clinical coordination and SUD/OUD management. To achieve these objectives, the project will do the following, (1) SHRS will integrate the American Society of American Medicine (ASAM) 24-hour DATA waiver training course for PAs into three current courses at SHRS (Pharmacology 1 & 2 and Clinical Medicine 2) over two semesters during the first year of coursework; (2) SHRS will provide engaging facilitated discussions in the three aforementioned courses so that the self-learning material can be reinforced; (3) SHRS will provide the opportunity for students to gain clinical MAT experience under the supervision of an experienced preceptor at Western Psychiatric Institute and Clinic (WPIC) and Magee Women’s Hospital of University of Pittsburgh Medical Center (UPMC) by providing students the opportunity to: (i) conduct patient assessments for OUD, (ii) observe the administration of pharmacotherapy with buprenorphine, naltrexone, and/or methadone, (iii) communicate with patients about their substance use and treatment progression using motivational interviewing, (iv) conduct activities with patients to address diversion and adherence (e.g., urine drug screens), and (v) manage various types of clinical cases and OUD patient populations (e.g., pregnant and postpartum women with OUD, and adults and children with OUD); (4) SHRS and PERU will train students in care coordination and SUD/OUD management by optimizing SBIRT practices and education; and (5) the project team will collect qualitative and quantitative data to evaluate the outcome and impact of the program and improve the curriculum for future cohorts. This project will span September 2018 to December 2022.

Northeast Ohio Medical University (NEOMED) seeks to address the largely unmet treatment needs of the 2.1 million Americans who have opioid use disorder (OUD), including the escalating numbers of Americans who are part of the opioid-overdose epidemic. To do so, NEOMED will work to ensure that all 150 of its College of Medicine students receive training in topics outlined in the Comprehensive Addiction and Recovery Act, including DATA waiver training, and that they have opportunities to shadow physicians providing Medication-Assisted Treatment (MAT) for OUD in clinical settings representing multiple specialties before completing their medical education. During the first year of the project period, an MAT Curricular Planning Team will work with NEOMED faculty and curricular subcommittees to identify the most appropriate College of Medicine course or clerkship for MAT didactic training. The planning team and the course or clerkship director will seek approval to integrate MAT didactics into the standard curriculum from the University’s Curriculum Management and Assessment Committee. The planning team will also identify community-based psychiatry, family medicine, internal medicine, pediatrics and emergency medicine sites that are providing treatment for OUD, including MAT, and that are open to hosting third-year medical students as part of their clerkship training. The planning team will oversee the implementation of the activities planned, developed and approved during the initial planning year in years two and three. Faculty members with appropriate credentials and experience will deliver MAT didactics to all medical students. The didactic will include the DATA waiver training and other topics outlined in CARA, and will place special emphasis on conveying information, such as addressing stigmas and misconceptions surrounding MAT, that allow physicians to be comfortable delivering MAT. All students will complete a self-assessment about skills and attitudes related to MAT and OUD before and after the didactic training, and they will indicate if they plan to apply for a DATA waiver when they are eligible to do. Students will shadow clinicians prescribing MAT during clerkships that cross multiple specialties and enhance their clinical skills related to MAT with standardized patients in simulated learning environments. NEOMED expects that these educational and training activities will help the physicians it trains – regardless of specialty – to be equipped to and comfortable with treating patients with MAT. NEOMED will survey its graduates after they complete residency training to determine how many apply for DATA waivers.

This project will build and deliver a curriculum to all four medical schools in Massachusetts as well as nurse practitioner and physician assistant programs in the state. The curriculum will qualify students for their DATA Waiver, allowing them to prescribe medication (buprenorphine) to effectively treat patients with Opioid Use Disorder. The project has partnered with the Massachusetts Department of Public Health and is led by the University of Massachusetts Medical School. Project name: DATA Waiver Training for Massachusetts Students Population to be served: Medical students at the University of Massachusetts Mass Medical School, Tufts Medical School, Harvard Medical School, and Boston University Medical School will be served. Students of the University of Massachusetts Graduate School of Nursing and the Boston University Physician Assistant Program will also be served. Strategies/interventions: The University of Massachusetts’ Center for Integrated Primary Care (CIPC) will build the Waiver Course for Massachusetts Students (WCMS). The WCMS will consist of 8 hours of web- based, asynchronous training modules designed for students. The curriculum will qualify students for their DATA Waiver, allowing them to prescribe medication (buprenorphine) to effectively treat patients with Opioid Use Disorder. This project has partnered with the Massachusetts Department of Public Health and the American Society for Addiction Medicine for DATA waiver approval of the WCMS. Project goals: To increase the number of Massachusetts medical, nurse practitioner, and physician assistant program graduates providing buprenorphine to patients with Opioid Use Disorder. Project objectives: 1) For 100% of students in participating medical schools in Massachusetts to complete the training requirements for their Drug Addiction Treatment Act (DATA) 2000 waiver prior to graduation. 2) For 100% of students in participating nurse practitioner (NP) and physician assistant (PA) programs to complete a minimum of 8 of the 24 hours of training requirements for their DATA waiver prior to graduation. 3) For 50% of all graduating students to report an intent to apply for a DATA waiver. 4) For 50% of graduating medical students pursuing a residency in General Internal Medicine, Family Medicine, Pediatrics, OB/GYN, Psychiatry, or Emergency Medicine to report an intent to prescribe buprenorphine post-residency? Number of students trained annually and lifetime of project: Year one = 0 served; Year two = 162 served; Year three = 754 served; Total served = 916 students The online curriculum will continue to serve 700+ students annually even after the final year of funding.

The University of Saint Francis Academic Opioid Education Initiative will train Family Nurse Practitioners (FNPs) in the USF MSN program to provide medication-assisted treatment (MAT) services for persons with opioid use disorder (OUD), primarily in Northeast Indiana. USF Nurse Practitioner graduates are prepared to practice in primary care facilities so this training is expected to address the opioid crisis on the front lines. The project will integrate training into the curriculum which will enable FNPs to complete education required for DATA waiver by graduation. All MSN faculty also will complete the DATA waiver education program. Clinical rotations at the two MAT sites in Fort Wayne, IN will become part of required clinicals for these students. By the end of the project, approximately half of the 2019 graduating cohort and all FNP students graduating in 2020 and 2021 will have fulfilled the training requirements needed to obtain a DATA waiver to prescribe MAT in office-based settings. USF will conduct post-graduation surveys to determine how this training is being used in clinical practices. The DATA waiver training will be embedded into the curriculum and the clinical sites’ participation in clinicals is ensured to carry this project beyond the grant period. 15-30 FNP students will be trained annually and approximately 100 during the project. The first cohorts will be able to integrate MAT into their practices after graduation during the grant period.

The Provider Clinical Support System at UTHealth (UT-PCSS) is a three-year initiative to provide training and mentoring for medical students, residents and nurse practitioner (NP) students in the treatment of opioid use disorders (OUD) using medications approved by the Food and Drug Administration. The primary activities of this program will include designing and implementing a curriculum that meets the training requirements outlined in the Drug Addiction Treatment Act of 2000 (DATA 2000) and working to integrate the training into the core curriculum of each of the training programs. The overall aim of this project is to increase the number of UTHealth trained clinicians who obtain a DATA waiver for the treatment of OUDs and who go on to be actively involved in the use of evidence based pharmacological interventions in the treatment of OUD. The UT-PCSS Project has a goal to train 275 individuals over a three year period. Activities will include a collaborative curriculum development, workshop-based training, and clinical shadowing experiences. Curriculum development will be guided by a multidisciplinary team of clinicians, researchers and educators with experience in treating addiction and training students and clinicians. The UT-PCSS program aims to contribute to the expansion of the future pool of clinicians with training in the provision of medication assisted treatment (MAT) for OUD and to enable trainees to increase their comfort with prescribing MAT in medical office settings. Towards these aims, the UT-PCSS program has the following goals: (1) Increase the capacity of UT-Health to provide MAT for OUD training to residents, advanced medical students, and NPs; (2) Increase the number of physicians and NPs trained at UTHealth who meet the eligibility requirements for the DATA waiver; (3) Increase the number of UTHealth-trained clinicians who obtain the DATA waiver; (4) Increase the number of physicians and NPs trained at UTHealth who prescribe MAT as part of a comprehensive treatment program for OUD; (5) Increase trainee confidence in providing MAT for patients with OUD; (6) Reduce stigma and misconceptions regarding the treatment of patients with OUD.

Nationally recognized leaders in addiction medicine and addiction psychiatry at the University of Wisconsin have developed a curriculum to span health professional training from early medical, PA, and NP school through completion of residency training. This curriculum will develop familiarity and comfort with the assessment and management of opioid and other substance use disorders, with a focus on improving the uptake of DATA waiver training in all of these health care disciplines at UW. Introductory didactic sessions (2) during the pre-clinical training years will develop early understanding of opioid and other substance use disorders, co-morbid issues, and their management in general health care settings. Introductory material will specifically include an overview of medication-assisted treatment (MAT) for opioid use disorders and information regarding DATA waiver training. During the early pre-clinical years, full versions of DATA waiver training modules, approved by the American Society of Addiction Medicine, will be made available to interested students. (At this stage of training, the module will not be required, since health professional trainees at this level are not eligible to obtain the waiver.) In the next phase of health professional training, when eligible for the DATA waiver and MAT prescribing, ASAM-approved DATA waiver training will be integrated into the clinical training of UW primary care residency programs including family medicine and internal medicine and into advanced NP and PA programs. The full DATA waiver training will comprise 24 hours for NP/PAs and 8 hours for MDs. To facilitate a more interactive (and, hence, likely more effective) learning experience, 4 hours of this training will be delivered in person and led by the Director of the proposed program, Dr. Randall Brown, a nationally recognized expert in addiction medicine and in physician training in addictions. To enhance the effectiveness of the waiver training, and increase the likelihood of active MAT prescribing as trainees enter practice, supervised experience (no less than 8 hours) caring for patients with opioid use disorders will also be integrated into NP, PA, and MD curricula. Participant surveys at all stages of the proposed curriculum will comprise an important component of evaluation of the programs acceptability and success. Additionally, attendance data provided by the training programs and peer debriefing sessions with training program administrators will facilitate evaluation, continuous quality improvement, and inform sustainability efforts.

In the United States, opioids are second only to cannabis as the class of substances with the highest rates of illicit use. According to the 2016 National Survey on Drug Use and Health (NSDUH), there were an estimated 11.5 million past year nonmedical users of prescription pain relievers and 948,000 past year users of heroin. Opioid related deaths represent a significant cause of national and local concern. In the state of Texas, deaths related to opioids are increasing, particularly related to illicit synthetic opioids such as fentanyl. Despite the public health consequences and significant mortality related to OUD, there remain significant gaps in access to treatment Medication-assisted treatment (MAT) of OUD focuses on use of FDA-approved agents which are becoming increasingly available in light of the current opioid crisis. These medications are the opioid agonist, methadone; opioid partial agonist, buprenorphine; and opioid antagonist, naltrexone, administered as a long-acting intramuscular injection. Buprenorphine has demonstrated efficacy in both opioid detoxification as well as maintenance therapy, but widespread access to this medication remains a challenge. Barriers to buprenorphine prescribing exist at the individual/patient level as well as the physician and healthcare systems levels. This proposal seeks to improve access to MAT by shifting the requirements to obtain the Drug Abuse Treatment Act (DATA) 2000 waiver to learners at the medical school level of training. Introduction to this treatment modality at the medical school level may change the paradigm of physicians receiving DATA waiver training but not obtaining DEA certification and incorporating buprenorphine MAT into their clinical practice. The BCM BEAMS project leverages existing faculty expertise in substance use disorders treatment and curriculum development, as well as the existing curricular time dedicated to SUD screening and management in the mandatory undergraduate medical education curriculum , to incorporate the full 8 hours of DATA waiver training as well as provide clinical experiences to students with treating patients who have OUD with MAT in the ambulatory care setting. Each student graduating BCM medical school will be DATA waiver eligible by the time of graduation and will have clinical experiences in OUD MAT to inform their future decisions to incorporate OUD MAT into their clinical practice. Throughout the 3 years of grant funding we will train nearly 600 medical students and provide ongoing support to faculty providing OUD MAT clinical services, with the ultimate goal of increasing OUD MAT treatment availability.

The West Virginia Advanced Nurse’s Education on Waiver (WV ANEW) project will educate West Virginia University (WVU) School of Nursing (SON) Nurse Practitioner (NP) students about medication-assisted treatment (MAT) for opioid use disorder (OUD). Annually, WVU has 40-50 students that graduate as candidates for NP certification, making the prospective impact of this project a minimum of 100 new potential Drug Addiction Treatment Act (DATA) waived NPs through the project period. Opioid use disorders have been on the rise; the National Institute on Drug Abuse (NIDA) estimated that 2 million people in the United States suffered from substance use disorders related to prescription opioid pain relievers in 2015. According to the Center for Disease Control (CDC) National Vital Statistics, there were approximately 64,000 drug overdose deaths in 2016. West Virginia (WV) experiences the highest morbidity per capita, with 52 deaths per every 100,000 occurring due to a drug overdose. This is 1.33 times higher than even the state which has the second highest rate of overdose death rates. Unfortunately, these dire statistics highlight the need for the state of WV to present better treatment for drug addictions. There is a significant need to expand access to medication-assisted treatment (MAT) services for persons with an opioid use disorder (OUD) to prevent drug overdose deaths as well as provide care for these patients. One solution is to ensure education and training of students in healthcare provider fields. In preparation for treating the state’s significant at-risk population, all NP students will be trained on didactic and clinical content for MAT. Goals for the project include: 1) Determining the strategy for integrating DATA waiver content into the existing curricula for WVU NP students. 2) Incorporating DATA waiver content into the curricula. 3) Evaluating the efficacy of DATA waiver training with revisions as necessary for sustainability. Performance measures will include the number of students receiving the training, the number of students that become DATA waived, and the extent to which the training increases NP DATA waived prescribing of MAT.

OUD has especially impacted NH: in 2016, the opioid-related overdose death rate was 35.8 per 100,000, almost three times higher than the national rate. (1) Currently there are fewer than 65 waivered nurse practitioners throughout the state and it is unclear how many are engaged in providing MAT services; large gaps exist across counties. The University of New Hampshire's College of Health and Human Services, Department of Nursing, and the Institute on Health Policy and Practice's Citizens Health Initiative propose to expand access to Medication-Assisted Treatment (MAT). The project goal is to increase the number of nurse practitioner students in graduate and post-graduate programs who receive waiver training, apply for a DATA waiver, and subsequently prescribe MAT. Secondarily, the project seeks to increase NP self-efficacy in managing patients with Opiate Use Disorder. Along with incorporating the DATA waiver training requirements into the curriculum for graduate Family Nurse Practitioner and post-graduate Psychiatric Nurse Practitioner students, the Project ECHO(c) model will be used to link community-based sites, providers, and student to teach and spread best practices. The focus is on integrating DATA-waived providers who are actively providing MAT in the education of pre-licensure NP students, as well as other DATA-waived providers who are not actively providing MAT. The combined approach provides both a short-term and long-term strategy for increasing the numbers of providers offering MAT in New Hampshire and neighboring states.