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Northeast Ohio Medical University (NEOMED) addresses the Ohio opioid crisis by enhancing training to future physician leaders, with emphasis on primary care and behavioral health, to identify patients suffering from addiction and treat the disease. Using a longitudinal approach in the third and fourth years of medical school, we go beyond pharmacological treatment to put Opioid Use Disorder (OUD) in context of pain management and community to improve outcomes. NEOMED is an Ohio leader in addressing the opioid crisis. Since 2017 We have trained over 250 primary care prescribers in MAT, developed a supplemental training program to improve likelihood that waivered prescribers will add OUD treatment to their practices, led a statewide seven medical school collaborative to develop a longitudinal OUD training curriculum for medical students, and have certified over 300 medical school students in DATA, so they can apply for their waiver to prescribe buprenorphine once they receive their license to practice medicine and prescribe controlled substances. With support from SAMHSA, NEOMED will continue to expand this effort to address the Ohio OUD crisis by improving existing third- and fourth-year medical school curricula and adding an MAT clinic at NEOMED where students can complete shadowing experiences, while providing a valuable service to the community. New SAMHSA support will enable faculty to incorporate OUD content into three required courses, as well as four elective courses. As part of their graduation requirements over 300 medical students are trained on OUD risk assessment, screening, intervention, and referral in a population health context as part of the Prerequisite to the Clinical Curriculum. They will study the environmental and community context affiliated with OUD, including development of a patient case and taking part in a clinical encounter through Ohio Opiate Project ECHO® in Social Determinants of Health. And they will complete DATA 2000 waiver training, plus supplemental content to help providers build their confidence in delivering treatment before graduation, as they transition to residency programs, in Clinical Epilogue and Capstone. Elective courses with required MAT shadowing and hands-on training will be offered to students most likely to match into a field of medicine where buprenorphine or other therapies will be administered to patients suffering from OUD including psychiatry, family medicine, and internal medicine. This includes expanding an MAT elective. Implementation data is collected through attendance at courses where content is presented, course grades, completion of checklists during MAT clinical experiences, and completion of DATA 2000 certification training. Outcome data will be collected through Oasis as student OUD patient experiences throughout medical school are tracked, and we will follow-up with students three years after graduation to determine if they incorporated OUD treatment, specifically MAT, into their practices.

Medication-assisted treatment (MAT), including buprenorphine, is considered the gold standard in addiction care for opioid use disorder (OUD). Rural Michigan is disproportionately impacted by high rates of opioid overdose mortality and low capacity to deliver MAT. In addition to an overall lack of MAT providers in rural Michigan, fewer than 1/3 of waivered providers in Michigan have ever written a single buprenorphine prescription, and the vast majority of providers who are waivered do not prescribe to capacity. Saginaw Valley State University intends to improve access to evidence-based MAT for OUD patients by increasing the number of nurse practitioners and other eligible providers in rural Michigan who prescribe buprenorphine, and by removing obstacles that prevent waivered providers from initiating and expanding their use of MAT in caring for patients with OUD. We will address educational gaps within the Family Nurse Practitioner (FNP) and Psychiatric Mental Health Nurse Practitioner (PMHNP) programs through the development, implementation, and evaluation of Core Addictions and Recovery Education for Nurse Practitioners (CARE4NPs). Specifically, we will establish an “addictions” curricular thread across the core and specialty courses within the FNP and PMHNP curricula to ensure that all NP students develop the requisite practice knowledge, skills and attitudes to provide compassionate, evidenced-based care to those with substance use disorders. A key component of this curricular enhancement will be the inclusion of buprenorphine waiver training for a minimum of 25 FNP and 30 PMHNP students annually, for a total of 165 waivered NPs over the life of this 3-year project. This grant will also support capacity-building efforts among all types of eligible buprenorphine prescribers in rural Michigan through an expansion of SVSU’s SUD Project ECHO. We will extend our outreach to the most remote parts of Michigan, partner with the American Society of Addictions Medicine to gain approval of SVSU’s SUD Project ECHO curriculum to meet eligibility criteria for buprenorphine waiver training, and finally, we will expand the ECHO curriculum to include relevant topics that continue to limit buprenorphine prescribing practices, such as stigma, practice-related issues, and reimbursement concerns. We propose the following four goals: 1) to decrease the educational gap in substance use treatment through the development and deployment of CARE4NPs, an integrated addictions-focused curriculum for FNP and PMHNP students; 2) to improve competence, confidence and readiness of FNP and PMHNP students to assess, diagnose, and treat individuals with OUD through didactic, simulation and clinical immersion experiences; 3) to build capacity and expand state-wide expertise among rural primary care teams to implement best practices in MAT; and 4) to reduce stigma and other barriers that limit buprenorphine prescribing practices. We are confident that approaches that addresses both the education gap and obstacles to buprenorphine prescribing will improve access to MAT for OUD patients in rural Michigan.

The Longitudinal Addiction Medicine Curriculum at the Albert Einstein College of Medicine (Einstein) is designed to increase the number of medical students and residents who are prepared and trained to provide medications for addiction treatment (MAT) for opioid use disorder (OUD). Einstein is located in Bronx, New York, a community disproportionately affected by OUD and overdose mortality. Access to MAT has not kept pace with treatment need, and lack of physician knowledge and training is a key barrier to MAT prescribing. The proposed project will address gaps in MAT knowledge and experience among medical students and residents at Einstein by integrating DATA waiver training, implementing case-based learning, and expanding experiential training in the standard curriculum. Project goals and measurable objectives include: (1) integrate required DATA waiver trainings for all fourth-year medical students by offering as elective for 90 MS4s in Project Year 1 then requiring for 180 MS4s per year in Project Year 2-3, for a total of 450 medical students trained over the project lifetime; (2) integrate required DATA waiver trainings for all internal medicine (48 per year), family medicine (10 per year), and psychiatry residents (12 per year) for a total of 210 medical residents trained over the project lifetime; (3) establish and maintain a tracking system to monitor required waiver training completion among medical students and residents, as well as waiver status and buprenorphine prescribing among eligible residents; (4) develop and implement 4.5 hours of required case-based teaching on MAT that will be required for all medical students by the end of the project period (180 first-year medical students per year or a total of 540 medical students unduplicated in prior counts will be trained over the project lifetime); (5) enhance required 4-hour clerkship training at opioid treatment programs for all third-year medical students (180 MS3s per year, included in prior count) by securing 5 clinical sites and 2:1 student-to-faculty ratio; and (6) establish a required 2-week addiction medicine rotation that provides inpatient and outpatient MAT training for all third-year internal medicine residents (48 per year, included in prior count). To augment faculty capacity for MAT training at Einstein, we will also offer DATA waiver trainings for attending physicians in internal medicine, family medicine, psychiatry, hospital medicine, and emergency medicine (target total of 30 attending physicians trained over the project lifetime), provide support for MAT prescribing through virtual case conferences, and create an active directory of waivered preceptors willing to preceptor or mentor trainees. Tiffany Lu, MD, MS, Assistant Professor of Medicine at Einstein and Medical Director of the Montefiore’s Buprenorphine Treatment Network, will direct this project and collaborate with the addiction medicine specialized project faculty to implement didactic and experiential components of the proposed curriculum. We have extensive experience adding new curricular components related to substance use disorders. We also lead a network of community-based methadone and buprenorphine treatment programs at Montefiore Medical Center (the University Hospital for Einstein), which will host MAT training in practice settings for medical students and residents. We will conduct rigorous program evaluation to ensure our curriculum increases the number of individuals who complete the DATA waiver training, obtain waivers, and prescribe buprenorphine in their practices.

We aim to ensure that all physicians graduate from medical school and post-graduate training with the expertise and certification to treat opioid use disorder (OUD). The population of learners will be medical students, residents, and fellows at the University of California San Francisco. The learners will learn to treat the population of people with OUD with a particular focus on historically undertreated groups, including people experiencing homelessness, pregnant women, veterans, and Black/African-Americans. Our project goals are (a) to incorporate DATA2000 waiver curriculum into the required curriculum for all medical students, to (b) increase the number of physicians obtaining the DATA2000 waiver, in order to (c)increase the medication-based treatment of OUD in a variety of settings. Our strategy for achieving these goals is to offer traditional, blended “half and half” waiver courses to all medical students, residents, and fellows while we develop, seek approval for, and implement a longitudinal OUD curriculum across the entire four-year medical school experience. By the end of the project, all students at the UCSF School of Medicine (SOM) will graduate with the necessary certification to obtain the DATA2000 waiver which will allow them to prescribe treatment for OUD. Measurable objectives of the project are: Collaborate with key stakeholders in UCSF School of Medicine (SOM) and Graduate Medical Education (GME) to schedule and teach at least four “half and half” DATA2000 waiver courses by the end of each project year in order to reach learners who graduated medical school prior to complete implementation of the longitudinal curriculum. 1) Collect data on at least 50% of graduates who completed DATA2000 waiver training at least two years prior—including during the preceding project—to assess whether they obtained certification and are treating patients with OUD. 2) Increase the number of SOM students who have completed all of the requirements to apply for the DATA2000 waiver to 90 by the end of year 1, 110 by the end of year 2, and 155 by the end of year 3. 3) Increase the number of GME and faculty learners who complete all of the requirements to apply for the DATA2000 waiver to 60 by the end of year 1, 65 by the end of year 2, and 70 by the end of year 3. 4) Implement ASAM-approved longitudinal curriculum for all SOM students beginning in project year 2.

Western University of Health Sciences (WesternU) Medication Opioid Use Disorders (MOUD) Training for Family Nurse Practitioners (FNP) and Psychiatric Mental Health Nurse Practitioners (PMHNP) includes the American Society of Addiction Medicine (ASAM) approved 24-hour waiver training, plus 6-hours of e-training simulation module of MAT gamification, best MAT and opioid practices, and integrated practice setting experience with addiction specialists. WesternU proposes to prepare 255 trainees over a 3-year period (Table 1) which allows them to obtain their DATA Waiver to become licensed prescribers and prescribe MAT to SUD/OUD individuals to reduce the number of overdose deaths in California. WesternU MOUD will prepare trainees to understand the nature of the disease of addiction, how it presents in patients, best practices approaches, and how to prescribe MAT as a part of recovery treatment. Once educated, the trainees will be capable of offering recovery MOUD treatment as part of integrated health care at primary care settings. Project goals and objectives: Goal 1) Implement approved ASAM Training for MOUD program to provide at least 24 hours of didactic education and additional 6-hour e-learning (gamification, simulation, and other modules) for nurse practitioner (NP) trainees. Objective 1.1. Upon award notification, revise Pharmacology II course through curricular committee change to include ASAM and e-learning training by Year 1, Month 3. Objective 1.2. Establish and convene Advisory Board with at least two healthcare partners. Objective 1.3. Increase of 25% of change in cognitive, motor, and affective skills for trainees, as measured by baseline and post-training during the 6-week MAT gamification training section. Objective 1.4. Increase the number of NP faculty from 10% to at least 50% who complete DATA waiver in the first year of grant activities. Goal 2) Operationalize MOUD Training to include direct clinical and practical application training through shadowing in practice setting for trainees. Objective 2.1. Establish at least one additional clinical practice training site by Year 2. Objective 2.2. Increase the number of individuals completing the training requirements for the DATA waiver by 255 FNP/PMHNPs by the end of the three-year grant period. Objective 2.3. FNP trainees participate in 24 practice hours and PMHNP trainees participate in 135 hours of addictions clinical, as measured by trainee level clinical logs. (Years 1-3) Goal 3) In Year 1, Revise post-graduate survey and implement a data collection plan to measure utility of training experience and extent to which trainees prescribe, once practicing. Objective 3.1 Post-graduate trainees will rate the usefulness of the MOUD training experience as a four (4) or higher on a Likert Scale (1-5), as measured by post-survey. (Years 1-3) Objective 3.2 Post-graduate trainees will report prescribing once in clinical practice. (Years 1-3) Upon completing the WesternU MOUD Training, students will be eligible for the California State Board of Nursing recognition for advanced practice and furnished a prescribing recognition.

This project seeks to increase the number of nurse practitioner (NP), physician assistant (PA), and medical (MD) students at Seton Hall University (SHU), Hackensack Meridian School of Medicine (HMSOM), and Monmouth University (MU) completing the DATA waiver required training and increase the number of NPs, PAs and physicians delivering Medication-Assisted Treatment in NJ by providing an approved interprofessional curriculum and training program. The project will also address health disparities and social determinants of health of underserved, vulnerable populations, including blacks living in urban communities with high mortality rates due to overdose, by revising the curriculum and providing clinicals at sites in Newark, NJ including Integrity House, Broadway House, the Mental Health Association of Essex and Morris, Inc., and Saint James Health. In support of these goals, the proposed “Expanded Interprofessional Medication-Assisted Treatment Training Program” will seek to achieve the following objectives by: December 2021, the curriculum bundle, consisting of the required 24 hours of didactic training modules for NP and PA students, will be fully developed; and 160 HMSOM MD students (cohort 1) will have completed the required didactic training; January 2022, the revised curriculum addressing health care disparities and social determinants of health affecting underserved and vulnerable populations will be ready for implementation into the curriculum; May 2022, 60 SHU PA students (cohort 1) will have completed the required didactic training; August 2022, 70 SHU NP students (cohort 1) and 10 MU NP students (cohort 1) will have completed the required didactic training; December 2022, 160 HMSOM MD students (cohort 2) and 20 MU NP students (cohort 2) will have completed the didactic training; and 10 MU NP students (cohort 1) will have completed all clinical training requirements; May 2023, 60 SHU PA students (cohort 2), 20 MU NP students (cohort 3), and 30 MU PA students (cohort 1) will have completed the required didactic training; and 70 SHU NP students (cohort 1), 160 HMSOM MD students (cohort 1), 20 MU NP student (cohort 2), and 30 MU PA students (cohort 1) will have completed all clinical training requirements; August 2023, 70 SHU NP students (cohort 2) and 10 MU NP students (cohort 4) will have completed the required didactic training; December 2023, 160 HMSOM MD students (cohort 3) and 20 MU NP students (cohort 5) will have completed the didactic training; and 60 SHU PA (cohort 1), and 30 MU NP students (cohorts 3 and 4) will have completed all clinical training requirements; May 2024, 60 SHU PA students (cohort 3), 20 MU NP students (cohort 6), and 30 MU PA students (cohort 2) will have completed the required didactic training; and 70 SHU NP students (cohort 2), 160 HMSOM MD students (cohort 2), 20 MU NP students (cohort 5), and 30 MU PA students (cohort 2) will have completed all clinical training requirements; and August 2024, 70 SHU NP students (cohort 3) and 10 MU NP students (cohort 7) will have completed the required didactic training.

The University of South Carolina School of Medicine - Greenville (UofSCSOMG) Project EXPAND: Enriching eXperiences by Providing addiction learning in New Directions has a goal to expand access to medication for addiction treatment (MAT) services for persons with Opioid Use Disorder (OUD) through ensuring expanded and enhanced education and innovated training of medical students and residents, as well as waivered prescribers in SC who have not prescribed. Measurable objectives designed to increase the number of MAT providers: 1. By September 29, 2024, we will have the AAAP PCSS approved DATA waiver training implemented into the standard four-year medical school curriculum. 2. Provide all medical-students with the required 8-hour PCSS DATA waiver training by graduation. Target is 99% of each year's graduating students - 100/year. 3. Create and implement additional innovative opportunities for M1-M4 that encompass motivational interviewing and trauma-informed care using didactic, experiential, and simulation-based educational experiences. Target is 99% of all medical students (M1-M4) -400/year. 4.Collaborate with FAVOR Greenville to expose a minimum of 100 students annually to recovery and OUD's effect on the individuals, families, and the community. 5. Create an annual train-the-trainer educational opportunity with PCSS and Prisma Health to increase the number of MAT providers and trainers in the region to sustain physicians and faculty's education on MAT. Target is to increase the number of trainers in the region by 2/year. 6. Increase the number of trained individuals who obtain a DATA waiver and the number of trained individuals who prescribe MAT. Target is 20% of all trained - 24/year.

The opioid crisis continues to rage in the United States and is particularly evident in North Carolina. This opioid crisis was made worse by the addition of the COVID-19 pandemic, as evidenced by the increase in opioid overdose deaths over the past year since the beginning of the pandemic. Opioid use disorder is a chronic medical/psychiatric condition that can be effectively treated with cognitive, behavioral, and medication-assisted modalities. However, there are not enough providers of addiction prevention and treatment in the state of North Carolina or across the United States. Rural areas and other locations with disparate populations have an even greater challenge toward receiving prevention and treatment services as there are even fewer providers of these services in those areas than urban and affluent areas. Nurse practitioners can provide addiction treatment services, including medication-assisted treatment, specifically buprenorphine for opioid use disorder. However, there are barriers that prevent nurse practitioners from treating opioid use disorder. First, nurse practitioners must complete 24 hours of specific training in order to obtain a waiver to prescribe buprenorphine. Second, the stigma associated with opioid use disorder may be a barrier toward treating this chronic illness. The overarching goal of this project is to increase the number of nurse practitioners who prescribe buprenorphine to patients with opioid use disorder. We propose to provide the required training to nurse practitioner students as a part of their clinician training. We also propose to frame opioid use disorder as a chronic remitting and relapsing disorder like many other chronic illnesses treated by nurse practitioners. Treating opioid use disorder as a chronic illness will help to decrease the stigma associated with the illness. Using training modules available through the Provider’s Clinical Support System (PCSS), we propose to embed the required 24-hour training into both the family nurse practitioner and psychiatric mental health nurse practitioner curriculum. Further, we propose to institute a 24-hour residency in which interested students will participate in treatment simulations and shadowing experiences with providers who treat opioid use disorder with buprenorphine and cognitive/behavioral therapies. Upon graduation, nurse practitioner students will have completed the required training and will be eligible to apply for the medication-assisted treatment waiver once they meet the Drug Enforcement Agency (DEA) requirements for obtaining a DEA license. We have obtained permission to use the training modules from PCSS.

We aim: (1) to develop and implement a nursing education curriculum to teach future Advance Practice Registered Nurses (APRNs) to prescribe medication assisted treatment (MAT) for opioid use disorder (OUD) under the DATA2000 waiver; and (2) to increase the number of APRNs providing MAT for OUD within their practice. The targeted population of learners includes future APRNs studying at the UCSF School of Nursing, plus nursing faculty supervisors and preceptors who do not possess the waiver. The learners will learn to treat affected persons with OUD with a focus on undertreated groups with high morbidity and mortality, including Black/African-Americans, indigenous persons and other persons of color, rural populations, and adolescents/transition-age-youth. Our project goals are to: (a) develop and implement a curriculum called “Treatment of Opioid Use Disorders: Closing the Gap” that delivers 24 hours of DATA-waiver education to APRN students, as well as clinical faculty preceptors and supervisors; (b) integrate DATA waiver training into the standard APRN training curriculum; and (c) increase the provision of MAT by APRNs in a variety of treatment settings, especially for under-served/marginalized populations. We will train at least 90 students in the first year of the project, at least 100 students in the second year, and at least 100 students plus 20 faculty in the project’s third year. Measurable objectives of the nursing curriculum are: (1) assess trainee satisfaction with curriculum upon completion of course; (2) increase the number of trainees completing the federal DATA waiver training requirements over the three-year life of the grant; (3) assess the number of trainees possessing the DATA waiver license after graduation; (4) assess the number of patients that trainees are providing MAT for, and if that number is close to their waiver-defined patient limit; (5) assess trainee diversity characteristics; (6) assess diversity characteristics of patients for whom trainees are providing MAT; (7) assess if trainees report self-rated sufficient knowledge for providing MAT for OUD; and (8) assess if trainees report satisfaction in providing MAT for OUD.

Ranking 7th in the United States for drug overdose deaths, Kentucky is uniquely poised to demonstrate the impact increasing access to Medication Assisted Therapy (MAT) will have on communities. Kentucky Physician Assistants (PAs) are in a distinctive position to provide access to such life-saving treatment as Kentucky is the 50th state to grant prescriptive authority to PAs for schedule III-IV medications. The current COVID-19 pandemic illuminates the need to expand MAT services as according to the CDC, by May 2020, eighty-one thousand drug overdose deaths were reported with opioids being a major contributor. Prior to the pandemic in 2019, 1,380 Kentuckians lost their lives as a result of opioid overdose. At the University of Kentucky alone, the number of patients receiving treatment for opioid use disorder related health complications more than quintupled over 9 years leading up to 2018. Moreover, Medicaid expenditures average $18,511 per patient evaluated in Emergency Departments for opioid use disorder related health needs and as of July 2020, Medicaid serves 1.5 million Kentuckians. Healthcare costs combined with barriers related to social determinants of health create an environment in Kentucky rich for change. Integration of MAT waiver training into curriculum at the University of Kentucky Physician Assistant (UKPA) Program will propel transformation in our communities by graduating competent, compassionate PAs to expand MAT services in our state. In the Fall of 2020, UKPA initiated 8 hours of MAT waiver training into our didactic curriculum. With support of this SAMHSA grant, we propose to add additional training to our curriculum to include completion of the total 24 hours of MAT waiver training prior to graduation, standardized patient simulations prior to students’ clinical year, and expand training to our alumni, faculty, and preceptors. To measure the impact of our initiatives to expand MAT waiver training, PAs pursuing DATA waivers and prescribing MAT, we will distribute voluntary surveys with monetary incentive to respond. First, we will invite UKPA alumni at their one-year graduation anniversary to complete a voluntary survey to collect data regarding the number of alumni obtaining DATA waivers. This contact also provides an opportunity to offer support and guidance to alumni about delivering MAT services to fellow Kentuckians. Then, at their second anniversary, we will distribute a voluntary survey to capture how many alumni prescribe MAT and an approximate number of patients that are being reached by these initiatives. We will follow similar methods to expand MAT waiver training to our faculty, other alumni, and MAT trainers to reach over 168 professionals and pre-professionals. A pathway to a healthier Kentucky will be created by increasing the number of PA faculty, students, alumni, and UKPA preceptors trained, obtaining their DATA waiver, and prescribing MAT.

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 obtain their DATA waiver, 4) increasing the self-reported confidence of trainees for treating persons with OUD, and 5) enabling at least 50% of trainees prescribe buprenorphine to treat OUD. This project will support key program staff including the multiple project directors, a project coordinator and 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.

Integration of the Drug Addiction and Treatment Act (DATA) waiver training in the University of Washington MEDEX Northwest physician assistant (PA) training program will increase access to medication-assisted treatment (MAT) for opioid use disorder (OUD) by training 164 PA students per year (492 for the grant period). Upon graduation and receipt of state licensure, new graduates will be able to obtain their DATA waiver, allowing them to utilize MAT. The Comprehensive Addiction and Recovery Act of 2016 (CARA) allows physician assistants (PA) the authority to obtain a DATA waiver to use MAT for 30 OUD patients. Therefore, through the integration of MAT training in the MEDEX Northwest curriculum, there will be an increase in providers throughout the Washington, Wyoming, Alaska, Montana, Idaho, and Hawaii (WWAMI+H) region will be able to directly impact the opioid crisis. MEDEX Northwest has a well-documented tradition of recruiting students from WWAMI + H, with most graduates remaining in the region to practice. Dimensions of justice, equity, diversity, and inclusion will be considered to assess and address social determinants of health leading to health disparities and subsequent health outcomes in the patient populations in this region, with specific attention to rural and veteran populations. By preparing students for the complexities of treating patients with OUD, we will be able to increase access to care while simultaneously reducing stigma that is often associated with substance use disorders. Integration of the DATA waiver training will occur during the didactic and clinical phases of the program. After three consecutive quarters of behavioral medicine, students will receive the first 8 hours of the DATA waiver training live. This first phase will be taught by 2 DATA-waivered faculty who will undergo training requirements to teach the course. Students will then go on to complete the remaining 16 hours of training asynchronously, using pre-approved online modules by entities named in law as eligible to certify that the training meets the DATA waiver requirements. Upon graduation, students will be prepared and eligible to submit their notice of intent to SAMHSA, which allows them to implement MAT for OUD into their clinical practice. Data collection and performance evaluation will occur over several critical time periods in the program. Through a combination of mixed methods approach, we will survey attitudes, knowledge, confidence, and interest in working with patients with OUD at the beginning, middle, and end of the 2-year program. Additionally, we will track the numbers of actual DATA waivers obtained, where these PAs go on to practice, and how this training changed perceptions of and willingness to work with this complex patient population. Finally, over the course of the grant period, we will also increase the number of current MEDEX faculty that can deliver the MAT curriculum at all 5 campuses in order to demonstrate sustainability of the new curriculum.

Training Expansion in Addiction Medicine and Medications for Addiction Treatment at the University of Iowa (TEAM-MAT-UI) The University of Iowa (UI) Department of Psychiatry in conjunction with the Carver College of Medicine (CCOM) proposes the TEAM-MAT-UI project to create, implement, and study an expanded addiction medicine curriculum for medical and physician assistant (PA) students starting in July 2021, including dedicated training towards Drug Addiction Treatment Act (DATA)-waiver eligibility. The funds for this project will provide salary support for current CCOM staff with expertise in curriculum development and UI Addiction Medicine staff with expertise in clinical care, education, and evaluation. The goal is to increase the competency of CCOM graduates in the care of people with substance use disorders (SUDs) and improve the treatment of SUDs throughout Iowa. Partnerships will be formed with the University of Iowa College of Nursing. Training will be provided to 531 medical and PA students over the lifetime of the project, targeting 177 students each year for three years. The project goals will be achieved by accomplishing the following objectives: • Implement a longitudinal, sustainable curriculum in Addiction Medicine through the pre-clinical and clinical years of undergraduate medical education beginning July 2021. The curriculum’s effectiveness will be evaluated by changes in knowledge, skills, and attitudes of participants and the completion of DATA-waiver training requirements. By completion of the grant project, UI CCOM will have created an individualized Addiction Medicine curriculum for their student population, which will be reviewed by Providers Clinical Support System (PCSS) for approval by May 2023 as being DATA-waiver eligible for all participating medical and PA students in the future. • Deliver PCSS-approved DATA waiver trainings for all medical and PA students every 4-6 months between July 2021 and June 2024 to ensure all graduates will be eligible for the DATA-waiver by graduation, prior to the finalization of the newly expanded and certified Addiction Medicine curriculum. • All medical and PA students will complete at least 1 half-day clinical experience with a DATA-waivered provider who utilizes medications for opioid use disorders. The project will create a research database to inform the effectiveness of the curriculum expansion and DATA-waiver training in undergraduate medical education, including the number of graduates who go on to obtain their DATA-waiver. This research database and the partnerships formed between the UI CCOM and Department of Psychiatry will ensure sustainability of the curriculum past project completion.

Medications for opioid use disorder (MOUD), including methadone, buprenorphine, and naltrexone, have been shown to be effective at promoting recovery and reducing high-risk behaviors (e.g., injecting) and cost-effective. Limited access to providers who are trained and willing to prescribe MOUD remains a major barrier to care. Advance practice registered nurses (APRNs) and physician assistants (PAs) who are X-waivered to prescribe buprenorphine can help fill this provider gap. However, many APRN and PA students, including those at our institution, currently receive little education on caring for patients with opioid use disorder (OUD) and therefore do not meet the 24-hour CARA and SUPPORT Act licensing requirements to prescribe buprenorphine upon graduation. By expanding our existing medical school X-waiver curriculum to our APRN and PA programs, we will promote knowledge around evidence-based practices for this patient population, increase the number of providers able and willing to prescribe buprenorphine, and increase confidence and interprofessional collaboration in treating OUD. We propose to address this critical gap in training by developing an innovative curriculum with four key goals: 1) expand and tailor our previously developed medical school curriculum to APRN and PA students; 2) decrease provider stigma by developing didactics that specifically address barriers to treatment, including topics such as criminalization of addiction, structural racism and its effects on addiction treatment, and disparities in MOUD receipt by race; 3) expand opportunities for interprofessional clinical observership throughout Michigan in virtual (telehealth) and/or in-person settings; and 4) build supervisor capacity by expanding X-waiver training amongst interested clinical preceptors and teaching faculty and match students with waivered faculty for elective clinical experiences. The initial phase will focus on tailoring the medical school X-waiver curriculum for primary care nurse practitioner students (family and adult-gerontology) and PA students by adding the 16 hours of training beyond the initial 8 hours developed by the medical school. Then, we will further expand the curriculum to other APRN programs (acute care, midwifery, and pediatric programs). To assess progress, we will collect student feedback on new educational initiatives, assess student comfort, knowledge, and stigma regarding OUD treatment, and track the number of graduating students and faculty members who are X-waivered each year. We anticipate by September 2024, we will have trained 300 APRNs, 136 PAs, and 510 medical students who will meet the DATA waiver, CARA, and SUPPORT Act licensing requirements upon graduation.

The UNM-PCSS NP & Expansion (UNM-PCSS NP/E) will allow the University of New Mexico (UNM) 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 nurse practitioner students and residents in adolescent medicine. This is an expansion of the successful PCSS program at UNM for Medical, Physician Assistant (PA), and Psychiatric Nurse Practitioner students (PNP). The UNM-PCSS NP/E initiative will include classroom instruction on DATA waiver training and clinical shadowing experiences. Specifically, the goals of the UNM-PCSS NP/E are to: (1) Improve the capacity of UNM health profession students to treat OUD with MAT during their professional careers, with emphasis on nursing students and adolescent medicine residents; (2) Standardize DATA waiver training as part of UNM Nurse Practitioner student programs and adolescent medicine residency; (3) Ensure students and residents 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 implementation of comprehensive MAT training approved by the American Academy of Addiction Psychiatry (AAAP) and tailored shadowing experiences. The UNM-PCSS NP/E initiative will develop and schedule opportunities for clinical practice teaching (shadowing), which will allow students to directly observe clinicians providing MAT for patients with OUD. The funding also supports 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, with materials focusing on the role of Nurse Practitioners (NP) and adolescent medicine physicians in addressing the OUD crisis. The UNM-PCSS NP/E initiative will annually train 95 learners. By the end of grant year 3, at least 285 learners will have received the 8-hour classroom DATA Waiver training and the clinical observation experience.

Abstract: The University of the Sciences (USCI) Physician Assistant (PA) Medication Assisted Treatment (MAT) Training Integration Program (USCI-MAT) will provide PA students with the necessary training to deliver effective MAT, including buprenorphine, to substance use disorder (SUD) and opioid use disorder (OUD) patients within diverse clinical settings. MAT for OUD includes the provision of three main medications: methadone, buprenorphine, and naloxone. It is a key intervention known to help patients with OUD, but providers require additional training and a DATA-waiver to prescribe certain medications for OUD treatment (i.e., Drug Addiction Treatment Act of 2000). The purpose of the USCI-MAT Program is to fully integrate the complete 24-hour American Academy of Addiction Psychiatry (AAAP) DATA 2000 waiver training program as well as Screening, Brief Intervention, and Referral to Treatment (SBIRT) training into the core curriculum of the USCI PA program. A combination of self-study, in-class facilitated discussion, and clinical placement approaches will be employed to ensure all students are prepared to treat patients with opioid use disorder (OUD) upon graduation from USCI. The primary goal of the project is to increase the number of providers who are certified to provide MAT. This project will be implemented using a highly detailed strategic integration plan developed by a program Executive Committee and aims to train 119 PA students over the three-year grant period (i.e., approximately 40 students each year). A combination of surveys, trainee tracking sheets, proficiency checklists, and qualitative interviews will be used to collect data throughout the length of the program. The collected data will be used to ensure all training goals and requirements are achieved, for evaluating PA student perceptions, attitudes and satisfaction towards the program, and to evaluate implementation of MAT services within clinical practice settings post-graduation from the USCI PA program. In 2019, Pennsylvania had one of the highest rates of age-adjusted drug overdose deaths in the nation, with 35.6 deaths per 100,000 population and 4,377 total deaths reported that year. According to the 2018-2019 National Survey on Drug Use and Health, only 6.3% of individuals in Pennsylvania needing SUD treatment received it, and while there are 168,450 MAT treatment slots in Pennsylvania, 20 of 67 counties within Pennsylvania lack MAT providers (DATA-waivered) within their borders. Although PAs work across many different clinical practice settings and are in an opportune position to address substance use with their patients, many do not hold a DATA-waiver to prescribe these medications for OUD. Reasons for not obtaining the waiver include a lack of training, a lack of confidence in their ability to manage OUD, a lack of available mental health or psychosocial services, and time constraints. Training PAs through this program will lead to an increased capacity to provide evidence-based treatment for patients in Philadelphia and surrounding areas hit hard by the opioid crisis.

The Addiction Workforce Expansion Through Buprenorphine Waiver Training and Longitudinal Interdisciplinary Education in Opioid Use Disorder (ABLE) Initiative is a unique educational intervention targeted to health professional students in Maryland, which will expand buprenorphine waiver training and facilitate interdisciplinary, longitudinal experience in addiction care. The primary purpose of the ABLE Initiative is to increase the number of DATA-waivered providers in Maryland and facilitate access to addiction treatment. This goal will be accomplished through three primary objectives. Objective 1 is to diversify the provider workforce able to provide addiction-related care and meet the social and cultural needs of individuals with OUD in Maryland. We will target training activities to nurse practitioner (NP), physician’s assistant (PA), and medical students, as well as medical residents, in order to develop a novel interdisciplinary workforce. Furthermore, we will provide both buprenorphine waiver training and experiential learning to enhance and operationalize didactic training. Experiential training will occur at our many inpatient, outpatient, and telemedicine settings, exposing students to urban, rural, and corrections populations. Finally, through the significant minority representation in our student body and faculty, we will expand diversity, equity, and inclusion within addiction medicine. Objective 2 is to create a model of interdisciplinary, technologically driven education which will parallel team-based provision of addiction care, remove educational silos, and maximize sustainability. We will train faculty members across the MD, NP, and PA schools to become buprenorphine waiver trainers. For students in their initial years of training, we will create a case-based monthly telelearning session to provide didactic education as well as simulated and standardized patient encounters specific to the level of student training. Finally, Objective 3 is to integrate buprenorphine waiver training into the educational curriculum across the health professional schools in Maryland, and to systematically track waiver-related outcomes. The ABLE Initiative will create systemic and sustainable change in health professional education, by making waiver training a mandatory requirement for graduation. We will work with program directors and curriculum committees across the Nursing, Graduate, and Medical Schools to facilitate this process. All program activities and outcome measures will be gathered through existing tracking mechanisms developed by the Maryland Addiction Consult Service (MACS), a unique program which seeks to expand and support buprenorphine prescribing. To this end, MACS has an extensive administrative team which interfaces regularly with the Provider’s Clinical Support System to conduct DATA-waiver trainings and longitudinally measure outcomes through an IRB-approved protocol, which will be modified for the unique challenge of tracking students. In this manner, the ABLE Initiative will become a model of addiction training nationally, and produce the next generation of providers able to combat the opioid epidemic in Maryland.

We are currently in the midst of one of the most severe drug epidemics in recent history. Alcohol misuse, illicit drug use, misuse of medications, and substance use disorders (SUD) are estimated to cost the United States annually more than $400 billion in lost workplace productivity (in part, due to premature mortality), health care expenses, law enforcement and other criminal justice costs (e.g., drug-related crimes), and losses from motor vehicle crashes.1,2 Until recently, substance misuse problems and SUD were viewed as social problems, best managed at the individual and family levels, and sometimes through the existing social infrastructure-such as schools and places of worship, and, when necessary, through civil and criminal justice interventions.3 In the 1970s, when rates of substance misuse increased, including by college students and Vietnam War veterans, most families and traditional social services were not prepared to handle this problem. Despite a compelling national need for treatment, the existing health care system was neither trained to care for nor especially eager to accept patients with SUD.4 However, the past decade has seen an increasing awareness of the importance of substance use education for medical students, residents, and practicing physicians with greater emphasis on SUD training corresponding to a wider perception of SUDs as chronic medical conditions. This evolution has led in part to an expansion in formal SUD training.5 For example, faculty from the Department of Psychiatry and Human Behavior of Thomas Jefferson University in 2020 initiated an ACGME approved fellowship training program in addiction psychiatry with the expectation that expansion of the addiction psychiatry workforce will increase access to evidence-based prevention services, reduce the prevalence of SUD, and increase access to evidence-based treatment and recovery services. The DATA 2000 Waiver is another means by which access to OUD and substance-use disorder (SUD) treatment can be improved by allowing clinicians to dispense or prescribe buprenorphine in settings other than an opioid treatment program (OTP). The goal of the proposed project is the training of all students enrolled in Thomas Jefferson University's Sidney Kimmel Medical College in the effective treatment (pharmacologic, biopsychosocial) of opioid use disorder. If funded, by project completion in Fall 2024, we will have developed sustainable standardized training materials and procedures that will have been delivered minimally to three cohorts of graduating physicians. A direct outcome of this newly implemented training sequence is that in excess of 800 graduating physicians will have been educated on the administration/implementation of evidence-based medication assisted treatment (MAT) and have submitted necessary documentation to the DEA to be DATA waivered. In addition to the didactic element, all students will receive hands-on, experiential training via the use of observed simulated encounters. The educational program will also include specialty training in delivering MAT to pregnant and parenting women.

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. 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 overarching goal of the UT-PCSS program is 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 goals, the UT-PCSS program has the following objectives: (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. We plan to train 100 students per year for a total of 300 over the course of the project.

Essex County in Newark, NJ ranked 1st in the state in lab submissions of suspected heroin and 2nd in the state for fentanyl submissions and naloxone administrations. At our institution, University Hospital (UH) in Newark, NJ, at least half of the addiction medicine consultations for Medication Assisted Treatment (MAT) occur in patients with Opioid Use Disorder (OUD) who have surgical complications as a result of trauma and/or intravenous drug abuse. Moreover at least one third of all MAT consultations occur in the medical intensive care unit or stepdown yet there are no dedicated X waiver workshops or MAT training for most of these medical and surgical residents, Nurse Practitioners (NPs) and Physician Assistants (PAs) who are primarily managing these patients. Our goal is to train NP and PA students, and residents from the various medical and surgical backgrounds on safe prescribing of MAT, harm reduction and obtaining the DATA waiver by creating tailored educational workshops, clinical rotations, and simulations videos that are designed to be relevant to the learner’s specialty and training background. We will modify an existing published X waiver curriculum and assessment tool that was designed for the Emergency Medicine audience to deliver it to the residencies at UH who lack dedicated training on MAT (e.g. Internal Medicine (IM), IM-Pediatrics, General Surgery, Anesthesiology, etc.) and create additional modifications for the NP and PA students. We will also create and tailor an addiction medicine rotation for the various medical and surgical residencies, NP and PA training programs to enhance bedside training and also include a DATA waiver component. Finally, we will also create tailored educational clinical scenario videos and assessment tools for commonly encountered clinical situations involving patients with OUD to enhance communication skills and provide case-based simulation style learning that is relevant to the learner’s clinical practice. To our knowledge there are no published X waiver workshops or clinical simulation videos that are tailored to the resident’s specific medical or surgical discipline that also include modifications for students from PA and NP training programs.

Title: Medication Assisted Treatment Education Dissemination in WV (MAT ED) This collaborative project between all three medical schools in West Virginia, the Joan C. Edwards School of Medicine, West Virginia University School of Medicine (WVU), and the West Virginia School of Osteopathic Medicine (WVSOM), with support from the West Virginia Higher Education Policy Commission will dramatically increase the number of educated providers who can provide Medication Assisted Treatment (MAT) by imbedding MAT training into the standard or elective medical school curriculum. The need to train medical professionals on addiction treatment in West Virginia has never been more important. West Virginia has been ravaged by the impacts of opioid addiction epidemic. For the past decade, West Virginia has had the highest per capital death rate from opioid use and has shown the largest increase in neonatal abstinence syndrome (NAS) cases in the nation. Currently, the number of MAT providers in WV falls far short of the need for services. By improving education around addiction treatment, including awareness, recognition, and stigma, this project will also help develop a more compassionate and equipped generation of health care providers. Additionally, this project will seek to expand MAT training into other prescriber disciplines including Nurse Practitioners and Physician Assistants. Due to the current obligations placed on medical faculty, it is necessary to establish a single coordinator for the state who is able to assist in curriculum development and help programs and students overcome the barriers to MAT training and establishing their MAT waiver. The project will also promote faculty champions at the medical schools who know the inner workings of their programs and are committed to implementation success. This collaborative project is uniquely positioned to improve the provider pipeline in a high need region through a sustainable model for curriculum integration.

The opioid epidemic has escalated during the Covid-19 pandemic, with a sharp rise in fatal and nonfatal opioid overdoses particularly among non-Hispanic Black individuals. The TEACH UP Program proposes to implement enhanced training in the care of patients with opioid use disorder (OUD) by developing a pipeline of students (future clinicians) as well as residents and faculty better prepared to guide and mentor this care. First, we propose mandatory DATA waiver training to medical students (MS) and select nurse practitioner (NP) students supplemented by practical experiences during clinical training to increase the numbers of future clinicians prepared to "TEACH UP" and equitably offer buprenorphine for patients with opioid use disorder (OUD). This will be accomplished by implementing an 8-hour Provider's Clinical Support System (PCSS) DATA waiver training into the core curriculum for all first year MS (150/year) and NP students (20/year) beginning in Project Year 1, providing corresponding clinical experiences in Years 2 and 3, and providing DATA waiver training to select 4th year MD students during a pre-IM residency "boot camp" training (40MS/year) and an optional harm reduction elective. Second, we will require DATA waiver training for all residents in Internal Medicine (IM) (70/year), Emergency Medicine (EM) (13/year) and Family Medicine (FM) (9/year) at our two Penn Medicine teaching hospitals (302 trained/year). Third, we will offer training to faculty physicians and advanced practice providers (APPs) to improve their readiness to supervise students and trainees who will "TEACH UP" with their new knowledge and support increased buprenorphine prescribing. In partnership with PCSS, we will deliver a hybrid DATA waiver training (four hours live taught by Perelman School of Medicine (PSOM) DATA waivered faculty/ four hours virtual) supplemented with 4 hours of experience with clinicians (physicians and APPs) providing buprenorphine in outpatient settings. We will develop a pathway for tracking faculty DATA waiver credentialing to assist in buprenorphine prescribing and to identify those who can serve as preceptors for MS/NP student experiences. Fourth, we will develop an institutional list-serve and website to disseminate resources including DATA waiver trainings (at least 4/year) and other related OUD events (didactics, speaker series and experiences). The number of IM, FM and EM faculty clinicians with DATA waiver training and prescribing will increase with TEACH UP and following implementation of report cards and other peer comparison tools. To measure outcomes of "TEACH UP", we will collect numbers of students, (NP and MS) and trainees (IM, FM and EM) who have fulfilled the DATA waiver requirements as well as the number of new faculty and APPs with DATA waivers. We will also track institutional buprenorphine administration and prescribing rates including patient demographic information to assess our goals of enhancing equitable OUD care. We anticipate at least 800 individuals will be trained over the lifetime of the project.

The goal of this project is to increase the number of medical, physician assistant, and nursing (FNP) graduates trained to provide OUD screening, education, referral, and medication-assisted treatment in underserved communities. TUC is a private, not-for-profit university, located in the city of Vallejo within Solano County. Solano County is one of the most racially diverse counties in the US, with high rates of poverty, a 10 year trend in increasing OUD associated emergency department usage, and rising overdose deaths while also being medically underserved. Growing recognition of the opioid epidemic, excessive opioid prescribing practices, and a shortage of access to opioid use disorder (OUD) treatments has led to a call for more pain, opioid, and OUD training in health professional schools. This creates an opportunity for health profession schools to reexamine how they train future providers in regards to OUD and medication assisted treatment (MAT) with a focus on reducing stigma and closing the treatment gap. For counties like Solano County this means addressing health disparities and foundational access to primary care. TUC focuses on training primary care providers with an emphasis on underserved populations. Recognizing that student attitudes and confidence are best impacted by experiential learning and peer education, we are implementing a multi-year Interprofessional Opioid Use Disorder (IP-OUD) Fellowship program. Within the first 90 days, we will implement the IP-OUD Fellows program and recruit the first cohort of 17 IP-OUD Fellows. In year 1, we will implement the IP-OUD Fellows Program elective course and the experiential learning component reaching 80% of medicine, physician assistant, and nursing students. In years 2 and 3, we will implement the focused clinical experiences in OUD and MAT reaching 100% of the IP-OUD Fellows and continue to reach 80% of medicine, physician assistant, and nursing students. The measurable outcomes will be increased knowledge of OUD and MAT, recognition of bias and decreased stigma around OUD and MAT, increased confidence in recognizing and managing OUD, increased positive attitude around MAT treatment efficacy, and increased willingness to provide services. Validated measurement tools used include the drug and drug problems perceptions questionnaire (DDPPQ), Short Alcohol and Alcohol Problems Perception Questionnaire adapted for OUD, interprofessional professionalism assessment (IPA), and Students’ perceptions of interprofessional clinical education revised (SPICE-R). The strength of the current proposal is the foundation in interprofessional OUD and MAT education woven together with a public health lens. This framework is rooted in our TUC values of service, diversity, inclusion, and social justice which the foundation for closing the treatment gap for patients with OUD. In year 1, 17 students from nursing, physician assistant studies, and osteopathic medicine will be named as the first cohort of IP-OUD Fellows, and they will provide peer training to 108 medical students, 32 nursing students, and 38 PA students. In year 2, and annually thereafter, an additional 17 Fellows will be added to the program and will provide peer education to 324 students and over 525 students and >510 community members will be served.

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 2019 National Survey on Drug Use and Health (NSDUH), there were an estimated 9.7 million past year nonmedical users of prescription pain relievers and 745,000 past year users of heroin. Opioid related deaths represent a significant cause of national and local concern, including that the final tally of 2020 fatal overdoses will show a marked increase in overdose death rate during the COVID-19 pandemic. 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 ongoing 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 withdrawal management 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 and residency levels of training. Introduction to this treatment modality during medical school and residency 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 BEARS 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 and residency curricula, to incorporate a full 8 hours of DATA waiver training as well as provide clinical experiences to students and residents with treating patients who have OUD with MAT in the ambulatory care setting. Each student graduating BCM medical school and every resident graduating from BCM family medicine and psychiatry residency programs 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 600 medical students and residents and provide ongoing support to faculty providing OUD MAT clinical services, with the goal of increasing OUD MAT treatment availability.

The proposed Provider's Clinical Support System - Universities: Expanding Medication Assisted Treatment (MAT) Capacity in NC Project (PCSSU-MAT in NC) is a 3-year project to address the opioid epidemic in NC by expanding access to MAT through education and training for nurse practitioners and physician assistants (collectively known as advanced practice providers/APPs) and building school capacity to support these activities. Three APP schools in NC, the together produce approximately 180 graduates each year, will participate: Winston Salem State University Nurse Practitioner Program (WSSU), East Carolina University Nurse Practitioner Program (ECU) and Pfeiffer University Physician Assistant Program (PU). All of the schools have a strong primary care orientation and focus of producing clinicians more likely to work in rural areas and underserved areas. One of the schools is and HBCU that explicitly prepares is graduates to be leaders in assuring health equity of underserved individuals and communities. Leadership at these schools have committed to integrating the 24-hour online PCSS Student Waiver Training into their standard curricula such that students will be eligible to apply for the DATA 200 Waiver to prescribe buprenorphine once they are issued a DEA number. Students will also be provided live/live remote training with office-based opioid treatment (OBOT)experts; and will be strongly be urged (if not required)to take advantage of opportunities for shadowing and clinical exposure to 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 students 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 go on to apply for the Waiver and actively prescribe. Because of the mismatch between need and capacity is most pronounced in non-white populations, the project includes a racial equity training/technical assistance component as well. Goals include increasing the supply of APPs trained in NC to provide MAT (particularly in rural areas and underserved populations); increasing the capacity of NC schools to train a workforce equipped to prevent and treat OUD; increase the supply of APPs with the DATA 2000 Waiver who actively prescribe; and to develop infrastructure at the schools that will ensure sustainability. Additionally, as faculty are trained and supported, we expect this project will lead to greater inclusion of more general substance use disorder education throughout the curricula. We expect that approximately 170 APPs will be trained in Year 1 and that a total of 543 will be trained over the 3 years. The impact this will have on future patients, families, communities and healthcare system cannot be quantified but is sure to have ripple effects for many years.