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University Health (UH) Opioid Treatment and Recovery Services (OTRS) project will expand access to medication for opioid use disorder (MOUD) for 400 adults with an opioid use disorder (OUD) or co-occurring OUD/mental health disorder (COD), across Texas Public Health District Region 8 (R-8). OTRS aims to reduce overall opioid use, dependence, and deaths by providing MOUD in combination with comprehensive services including outpatient counseling, peer recovery support services (PRSS), and Brief Strength-Strength Based Case Management (BSBCM). Population: With a focus on R-8 residents, OTRS will serve 400 racial/ethnic minority adults, ages 18 and older, who have an OUD, or COD and are living in one of 28 counties within R-8. Unduplicated clients served per year is as follows: 65 Year 1; 90 Year 2; 90 Year 3; 80 Year 4; and 75 Year 5. Evidence-based opioid use screening and referrals will be accepted from diverse community sectors, including 12 UH primary care clinics, AIDS Service Organizations (ASOs), Rivercity Rehabilitation Center (RCR), Rosetta's Key (RK), and Bexar County Felony Drug Court (FDC). Interventions: Prospective clients, who screen positive on the Texas Christian University Drug Screener 5 (TCU-DS-5) (only those who report opioid use) or on both the TCU-DS-5 and Patient Health Questionnaire - 9 (PHQ-9) will be referred to the OTRS Program Manager, a licensed behavioral health provider, for clinical assessment and enrollment into OTRS. In partnership with RCR, uninsured/underinsured OTRS clients will receive six months of MOUD. In partnership with RK, uninsured/underinsured OTRS clients will receive either five individual or ten group outpatient-counseling sessions on average. Internally, OTRS staff will provide an average of three PRSS sessions with additional sessions available as needed. Additionally, OTRS staff will prove BSBCM to participants as needed. BSBCM will assist with reducing barriers to care including but not limited to enrollment in health insurance, employment, housing, etc. OTRS clients will receive MOUD from RCR, and rural/UH practitioners trained by the Texas Medication for Opioid Use Disorder training organized by UT Health San Antonio, who have obtained applicable DATA waiver, and comply with Texas' Prescription Drug Monitoring Program. Outpatient counseling, BSBCM, and PRSS telehealth services will be implemented with rural and resources limited counties to improve access and retention in MOUD. Harm reduction services (e.g. HIV testing/Test-Kits, and safe-sex kits) will be coordinated through collaboration with ASOs and Texas Wears Condoms (TWC). Data on key outcome measures will be collected and analyzed to reduce disparities in access, service use, and outcomes. Clients will receive a $30 gift card for completing a six-month follow-up assessment. Goals and Objectives: The primary goal of OTRS is to increase access to and retention in MOUD treatment and related recovery support services and decrease opioid misuse among diverse residents across R-8 (Goal #1). It is expected that at 6-month follow-up participants will report increased access to MOUD treatment and PRSS compared to baseline (Obj 2.3). (Goal #2). It is expected at 6-month follow-up, participants will report decreased days of illicit opioid drug use and opioid misuse, and increased abstinence compared to baseline (Obj. 2.4).

COMAT increases the number of people with OUD receiving MOUD & decreases illicit opioid drug use/Rx opioid misuse in adults with opioid use disorder (OUD) seeking/receiving MAT who are living/being treated in rural Mercer, McDowell & Wyoming counties, WV. The focus pop. suffers high opioid overdose deaths, poor social determinants of health, high infectious disease rates & multigenerational drug use. COMAT serves 200 clients/year (1,000 total). Project goals & measurable objectives (interventions/strategies) are to (1) Increase the number of individuals with OUD receiving MOUD by increasing workforce capacity by (A) Expanding workforce capacity by hiring & training 3 Case Managers, 3 Peer Recovery Support Specialists (PRSS), 1 Project Director, an Evaluation Team & increasing Med. Provider/Director time; (B) Increasing MAT service capacity to increase the number and speed of psychiatric evaluations, thus reducing client wait times by 10% by the end of the 5-year grant period; (C) Expanding the Prescription Drug Monitoring Program (PDMP) use by ensuring that three SHCMHC delegates are trained to use the PDMP & (D) Ensuring that the newly hired Medical Provider obtains a DATA waiver to prescribe buprenorphine to more than 30 patients. (2) Increase the # of individuals with OUD receiving MOUD by expanding community outreach by (A) Conducting a 5-year Overdose Fatality Analysis with the purpose of developing a targeted outreach strategy to reduce community overdose; (B) Partnering with the QRT to apply the Ring Immunization Model to overdose victims; (C) Conducting two culturally competent outreach activities in each county in each quarter; (D) Conducting quarterly specialized disparity group outreach events to engage the disparity populations (LGBT+, African American, Veterans & those in poverty); (E) Providing transportation services to clients who lack transportation or broadband services; (F) Providing services to COMAT client family members; (G) Screening local inmates for OUD, provide service referrals, intakes & transportation to appropriate services upon release; (H) Purchasing Avatar care routing software to maximize on-call workforce capacity & (I) Continuing partnering with One Voice and Community Connections in support of harm reduction. (3) Improve outcomes for adults with OUD seeking or receiving MAT by (A) Serving 200 clients each year; (B) Decreasing illicit opioid drug use and Rx opioid misuse at 6-month follow-up; (C) Empowering clients to experience significant improvement in NOMs mental health outcomes at 6-month follow-up; (D) Empowering 80% of clients to remain in treatment for at least 6-months throughout the life of the grant; (E) Monitoring disparity group outcomes to ensure equal access/outcomes; (F) Partnering with Tug River to provide infectious disease services & (G) Identifying a staff member to be trained in Rx for Change and to develop/implement a tobacco cessation program for clients with OUD who are receiving MOUD. (4) Sustain COMAT Services beyond grant funding by (A) Creating a sustainability plan for each COMAT budget line item to ensure sustainability & (B) Sustaining client/family member engagement in the program by involving clients/family members in the COMAT Advisory Board.

Worcester has the 3rd highest rate of opioid-related overdose deaths in Massachusetts, with a disproportionate increase among Hispanic/Latino and Black/African American individuals. Among those with an opioid overdose, 50% had a co-occurring mental health disorder. Local data suggest that individuals with co-occurring opioid use and mental health disorders (COD) compared to those with opioid use only experience greater challenges in accessing and engaging in medication for opioid use disorder (MOUD) and limited culturally responsive wraparound for those with a COD. This proposed program, Supporting Treatment Access and Recovery for Opioid Use Disorder (STAR-OUD), intends to fill a program gap by integrating MOUD with an evidence-based multicomponent wraparound approach called Maintaining Independence and Sobriety through Systems Integration, Outreach, and Networking (MISSION) for adults with COD. The MISSION model is delivered by case management/peer support specialist teams, and systematically integrates Critical Time Intervention case management, Integrated Mental Health and Substance use Disorder Treatment, Peer Support, Vocational Rehabilitation, and Trauma Informed Care. MISSION has been extensively researched and is listed in the Substance Abuse and Mental Health Service Administration-National Registry for Evidence Based Practices (SAMHSA-NREPP). In this proposed project, the University of Massachusetts Chan Medical School (UMCMS), the lead agency and evaluator, in collaboration with Family Health Center of Worcester (FHCW), a Worcester clinical provider and UMCMS affiliate, aims to improve engagement in MOUD and behavioral health outcomes. The 2-case manager/peer specialist clinical teams funded through this grant will deliver MISSION services to 250 individuals (Year 1=50, Year 2=50, Year 3=50, Year 4=50, Year 5=50). STAR-OUD participants will receive rapid assessment, and 12-months of culturally responsive wraparound COD treatment and support, including group therapy and community outreach. Wraparound supports will also include key linkages to community-based, state, and federal mainstream benefit programs such as the Massachusetts Medicaid, and state funded Department of Mental Health and Public Health services. This project will also prioritize Hispanic/Latino and Black/African American individuals who have been historically underrepresented and underserved in Worcester. We anticipate that 250 individuals with a COD who receive STAR-OUD services will: 1) gain access to MOUD; 2) have fewer days of opioid use and prescription opioid misuse; 3) improvements in mental health symptoms; and 4) improved engagement in culturally responsive community/wraparound supports. This project has been developed with input from local and state agencies, providers and consumers and is consistent with Massachusetts Comprehensive Strategy to End Opioid Addiction, and statewide approach to Health Equity for All.

Gotham Health FQHC, Inc. (GH) is proposing a program to increase the number of persons with OUD receiving MAT and decrease illicit opioid drug use and prescription opioid misuse. The population of focus will be African Americans and Latinos with Opioid Use Disorder (OUD), in Brooklyn, NYC. GH will serve 300 unduplicated individuals annually (250 in year one) with grant funds and 1,450 over the entire project period. Project name. Brooklyn MAT Program Populations to be served. The populations of focus (POF) will be African Americans and Latinos with an Opioid Use Disorder (OUD), including vulnerable populations such as homeless individuals, the formerly incarcerated, and those with co-occurring disorders such as HIV and hepatitis C. The geographic catchment area where services will be delivered will be Brooklyn with a focus on the high need areas of Central Brooklyn, East New York, East Flatbush, and Bushwick. Strategies/interventions. Program activities will include: 1) Provide MOUD; 2) conduct assessments to determine whether patients meet the diagnostic criteria for OUD relative to MAT; 3) check the New York Internet System for Tracking Over Prescribing (I-STOP/PMP) or each new patient admission in compliance with any relevant state rules or regulations; 4) conduct screenings and assessments (including SBIRT) to determine co-occurring substance use and mental disorders, and will provide counseling, referral and coordination of services; 5) conduct outreach and engagement strategies within its harm reduction and SEP to identify clients in need of MAT; 6) ensure all applicable practitioners working on the grant-funded project obtain a DATA waiver to prescribe buprenorphine to more than 30 patients; 7) coordinate with other organizations and municipal agencies to ensure coordination of care and increase access to MAT services; 8) provide telehealth services via cell phone (texting and phone calls) for counseling, support and referrals to encourage retention in care and to monitor clients for additional service needs; 9) provide RSS, including peer recovery support services designed to facilitate long-term recovery; 10) harm reduction services; 11) implement evidence-based contingency management interventions to; 12) education, HIV/STI/HCV testing and screening, and risk reduction programming; and 13) develop and implement a low threshold approach that offers services and makes minimal requirements of patients. GH will implement the following EBPs: Motivational Interviewing (MI); Cognitive behavioral therapy (CBT); and Contingency Management (CM). Project goals and measurable objectives. The program's goals are 1) Increase the number of POF with OUD receiving MAT; and 2) Decrease illicit opioid drug use and prescription opioid misuse at six-month follow-up. The program's objectives are to: Conduct outreach activities, recruiting at least 500 persons from the POF per year and enroll 300 into the program each year (250 in year one); Conduct screening and assessments of substance use disorders with 300 persons from the POF per year (250 in year one); Provide MAT and comprehensive OUD psychosocial services to at least 200 enrolled clients per year; Provide evidence-based practices to at least 80% of program participants; Conduct telehealth services with at least 70% of program participants to encourage retention in services; Provide recovery support services for at least 80% of program participants; Provide tobacco cessation programming for at least 50% of program participants; and Provide education, screening, care coordination, risk reduction interventions, screening, testing, and counseling for HIV/AIDS, hepatitis, and other infectious diseases programming for at least 75% of program participants.

Healthcare Alternative Systems, Inc., will expand outpatient Methadone Assisted Treatment services in combination with mental health services for adults with Opioid Use Disorder and co-occurring mental disorders. Over the five-year project period, the NEXA MAT Program will serve 400 individuals in the City of Chicago, with a focus on communities of color. Program goals include increasing access to care among the population of focus and improving participant outcomes related to illicit substance use (opioid and non-opioid), opioid-related overdoses, mental health symptoms, housing stability, and employment. Strategies to expand access to care will include: Hiring additional addiction counselors and on-site therapists; Hiring case managers; Contracting for additional physician hours to complete admission prerequisites; and Conducting outreach among the population of focus. Strategies to improve participant outcomes will include: Providing evidence-based, trauma-informed, person-centered services; Prescribing methadone to participants with Opioid Use Disorder; Providing individualized and group counseling and therapy; Integrating the principles of harm reduction; Providing recovery support services; and Addressing the social determinants of health.

The goal of the RMOUD-MS project is to strengthen the continuum of care for opioid use services by expanding and enhancing access to medications for opioid use disorder (MOUD) services for persons with an opioid use disorder (OUD) seeking or receiving MOUD. MS retains the unenviable ranking of having the fourth highest opioid prescription rate in the US. MS has seen significant increases in extremely potent high morphine milligram equivalent prescriptions. Prescription duration (days supply) is also unusually high. Between 2014 and 2017, hospital admissions for opioid poisoning increased by 23.3% and admissions for adverse effects increased by 119.3%. In Mississippi, the total number of drug overdose deaths increased sharply, rising 49%, from 2019 (393) to 2020 (586). During the same period, the number of deaths involving synthetic opioids (e.g., fentanyl) spiked by 125%. The RMOUD-MS project intends to (1) increase the number of individuals with OUD receiving MOUD; and (2) decrease illicit opioid drug use and prescription opioid misuse at six-month follow-up. The objectives for RMOUD-MS have been determined as follows: Objective 1.1. By the end of year 1, foster MOUD-focused infrastructure enhancement at state, local and community levels through the establishment of RMOUD-MS key positions (Project Director and Project Evaluator), Advisory Council, a coordinated care approach, and a MOUD-specific training curriculum; Objective 1.2: Enhance providers MOUD skills and utilization statewide and in-service region, with emphasis on culturally responsive implementation designed to address treatment needs of focal population, by offering a minimum of four (4) MOUD training sessions among providers annually, ultimately reaching a minimum of 50 clients during year 1; Objective 1.3: By the end of year 1, conduct a rigorous evaluation to ensure compliance with all data collection and reporting requirements while fostering catchment region and statewide MOUD-related quality improvements, as indicated by the completion of required data collection tools and dissemination of related reports; Objective 1.4: By the end of quarter 1 of year 1, complete all required grant management activities effectively, as indicated by documented and executed implementation, quality improvement, and sustainability plans; meeting attendance; and partnership agreements. Three interlinked service delivery healthcare channels, self, primary, and specialist, will be implemented as a means of achieving these outcomes. This three-pronged, team-based approach to care will incorporate DOJ COSSAP-funded Peer Support Specialists and Specialty Pharmacist; a RMOUD-MS funded MSDH MOUD Physician and Pharmacy Technician; FR-CARA-funded LCSWs; county health department providers; a board-certified Addiction Specialist; and the Mississippi Public Health Institute to employ a collaborative, coordinated continuum of care based on a framework of evidence-based interventions, stressing the establishment of partnerships between client and service providers, as well as equitable access for the whole population. RMOUD-MS providers will establish and implement a plan to mitigate the risk of diversion of buprenorphine and ensure the appropriate use/dose of medication by clients. SBIRT will be implemented to enhance and expand the continuum of care to populations with significant health disparities due to low socioeconomic status, limited access to care in rural counties, lack of insurance, and limited or no financial resources. The evaluation team will collect and report RMOUD-MS data on all required performance measures using the GPRA Tool.

Alaska has seen a 68% increase in opioid overdose deaths in the last two years, and the Yukon Kuskokwim Health Corporation (YKHC), a tribal organization representing 58 Federally recognized Tribes in Southwest Alaska, has seen a similar rise in overdoses primarily by fentanyl. YKHC is seeking to increase MAT-PDOA services for the Alaska Native (Yup'ik, Cup'ik and Athabaskan) residents of our region, using a combination of Western and Indigenous treatment methods. With this funding we will double the number of clients we serve. Project Name: Yukon Kuskokwim Health Corporation's Medication-assisted Treatment—Prescription Drug and Opioid Addiction Project Population to be Served: The residents of the Yukon—Kuskokwim Delta region of Southwest Alaska, population 26,917 predominately Yup'ik, Cup'ik and Athabaskan residents. Our program will serve 40 inpatient clients during the life of the grant, a 100% increase. Strategies and Interventions: Evidence-based practices will be utilized, including Cognitive Behavioral Therapy, Motivational Interviewing, Interactive Journaling, Family Systems Therapy, Living in Balance, and Calricaraq, an Indigenous intervention recognized as our local best practice developed by our elders teaching Alaska Native traditional and ancestral knowledge. Project Goals and Measurable Objectives: Our MAT-PDOA Program will increase the number of unduplicated clients served by 100% over the life of the grant using both outpatient and inpatient behavioral health services using strategies to encourage participation, including: increased case management, peer support services, community outreach, and improving the referral system to help identify and engage new clients. Our MAT-PDOA Program will decrease illicit opioid drug use and prescription opioid drug misuse in our service area by expanding the capacity of YKHC and its partners increasing treatment services available for our clients. Our MAT-PDOA Program will increase local, regional and statewide partnerships to provide robust treatment and recovery support services in the region. This will be accomplished by implementing outreach and engagement strategies to our communities, development of regional partnerships and collaborations resulting in additional resources for clients in need of treatment. Our MAT-PDOA Program will utilize an Alaska Native culture-based treatment program, Calricaraq, along with the main treatment milieu. The Calricaraq Wellness Curriculum will be used with our clients to teach Indigenous healthy living and coping skills. Clients will also participate in a 3-day Calricaraq Gathering, where they will learn about historical trauma, how to heal from trauma, and the Calricaraq wellness wheel showing how to start living a healthy life.

Catholic Charities Neighborhood Services, Inc. (CCNS) is one of the largest behavioral health (BH) and social service providers in Brooklyn and Queens. We provide outpatient mental health and substance use disorder (SUD) treatment and support to individuals from every walk of life. Through OPT into Recovery, CCNS will expand and enhance access to Medications for Opioid Use Disorder (MOUD) and psychosocial services for individuals over the age of 16 living with opioid use disorder (OUD) in Brooklyn and Queens. While CCNS will serve individuals from across the two boroughs, we will prioritize outreach to and engagement of those living in the high risk, very high poverty neighborhoods of Far Rockaway and Central Brooklyn. Our population of focus is racially and ethnically diverse. CCNS anticipates that about half of individuals served by OPT into Recovery will identify as Black, with 22 percent identifying as white, and 23 percent identifying as bi-racial. Half will be of Latino origin, with many speaking Spanish as a primary language. We anticipate serving an approximately equal number of females and males, with about 5 percent of those served identifying as LGBTQ. Participants will be over the age of 16 years, with most being between 21 and 64. In addition to OUD, the majority of those served by this program will have experienced histories of trauma or be living with co occurring mental health conditions. Additionally, many will be adversely affected by an array of social drivers of health (SDOH), such as poverty, unstable housing, and un or underemployment. Our program will integrate a broad range of trauma-informed, recovery oriented psychosocial supports and community-based BH treatment with MOUD. We will accomplish this by integrating OPT into Recovery into our two CCBHC locations (in Flatbush (a neighborhood in Central Brooklyn) and Far Rockaway), with additional access points at our three other mental health clinics located across Queens. All five of these site locations are in or accessible to the Brooklyn and Queens communities disproportionately impacted by OUD. We will serve the following numbers via OPT into Recovery: 100 individuals in Year 1 and 125 unduplicated individuals in each subsequent year, for a total of 725 individuals served over the five years of the program. Our goals and objectives include the following: Goal 1. Increase the number of individuals with OUD receiving MOUD in Brooklyn and Queens, including: 1.A: Expand staff MOUD capacity, supporting 100% of CCNS prescribers to obtain their DATA Waiver to prescribe buprenorphine to more than 30 patients; 1.B: Provide MOUD to 725 unduplicated clients over the five years of the grant; 1.C: Engage 100% of clients served at our five BH clinics in SBIRT, providing a brief intervention using Motivational Interviewing (MI) and ensuring that those living with OUD are referred to MOUD, counseling, and other psychosocial services; and 1.D: Conduct one targeted outreach campaign monthly to priority target populations, including individuals who are Black/Latino and those in very high poverty areas. Goal 2. Decrease illicit opioid drug use and prescription opioid misuse at six-month follow-up, including: 2.A: Offer 100% of clients integrated psychosocial services to build recovery capital; 2.B: Ensure that 75% of clients participate in support groups offered by a Certified SUD Peer Specialists within 6 months of program engagement; and 2.C: Achieve a 50% reduction in the number of clients who indicate that they are engaging in opioid misuse after six months in the program. Goal 3. Reduce opioid overdose deaths and disparities for priority Brooklyn and Queens populations, including: 3.A: 100% of clients, along with their families if they are engaged in treatment, will receive Narcan, and training on how to respond to an overdose; and 3.B: 60% of clients will report having increase in recovery capital.

AltaMed is proposing to leverage its existing Patient Centered Medical Home (PCMH) capacity to further expand behavioral health services at its clinics and develop a deeper integration of MAT services within its primary care scope by: (1) Expanding its mental health and substance abuse screening to include an assessment for substance misuse or abuse (2) Provide on-site training for physicians and behavioral health members of the PCMH care team on using the evidence-based protocol, Screening, Brief Intervention, and Referral to Treatment (SBIRT) to identify and manage patients with alcohol and opioid misuse disorders, and refer them to with MAT services within AltaMed, and, (3) Expand availability of MAT services to all of AltaMed's 22 clinics for patients identified as needing intervention or treatment for opioid misuse/abuse. This model will support coordination and referrals to existing community behavioral health and substance abuse treatment resources. In addition, AltaMed providers will be trained to provide medication assisted treatment for patients with alcohol and substance misuse/abuse to better integrate these services into the primary care setting. This program will leverage AltaMed's existing infrastructure and community partnerships to provide close, fully integrated behavioral health services to safety net communities in Los Angeles and Orange County, improving care quality and reducing the wide disparity in health outcomes between low-income, Latino populations and other groups. This project will improve patient continuity of care for all behavioral health patients, improve access to care for alcohol or substance misuse/abuse, and improve the ability of primary care providers to provide seamless treatment for patients with behavioral health and substance abuse needs, specifically opioid use disorders. In order to support the aims of this project, AltaMed will continue to coordinate with community providers and local health agencies serving Los Angeles and Orange Counties to facilitate referrals for treatment. The target population will be low income, medically-vulnerable Latinos in Los Angeles and Orange Counties, California. Over the 5 year project period, AltaMed will serve 200 participants in Year 1 and 500 participants in Years 2-5, for a total of 2,200 participants.

The East Tennessee Medication Assisted Treatment (MAT) Program addresses the epidemic of prescription drug and opioid addiction for adults living in the healthcare shortage areas of Appalachian Tennessee through the expansion and enhancement of treatment services capacity. In conjunction with support from the University of Tennessee Medical Center and the Mobile Rural Health Clinic, the program will provide direct Medication Assisted Treatment and Recovery Support Services while utilizing the Community Reinforcement Approach (CRA) and Assertive Continuing Care (ACC). Over a five year period, the treatment capacity expansion is expected to serve an additional 375 adults who are un/underinsured and unable to afford quality services through alternate means. The national opioid crisis has had an unequivocal impact on the rural Appalachian areas of East Tennessee. Higher rates of poverty, in combination with a historical shortage of outpatient medical providers, lack of public transportation in the region and stigma surrounding substance use and co-occurring mental health issues has created disproportionate disparities in access to care. The program's goal is to address those disparities and alleviate unmet needs of individuals struggling with an Opioid Use Disorder who have otherwise been unable to access quality care. Specific focus will be placed on patients who've been initiated on MAT within the Regional Hospital's Emergency Department and patients presenting to the Mobile Rural Health Clinic. Priority populations include IV drug users, pregnant and post-partum women and individuals with co-occurring mental health disorders. Peer navigators, already situated within the University of Tennessee Medical Center ED, will engage, screen and transport patients initiated on Buprenorphine in the ED directly to outpatient services. Both Telehealth services and community-based recovery support will be utilized to access substance use treatment for clients presenting to the Mobile Rural Health Clinic. A Recovery-oriented, trauma-informed and equity-based approach will be utilized via an integrated services team consisting of a Physician, Nurse Practitioner, RN, Recovery Specialist/Case Manager, Peer Recovery Specialist and MS level prepared clinicians. Clients will have access to comprehensive substance use and co-occurring treatment services, including coverage of medication, therapy, intensive case management, harm-reduction services, psycho-education and peer recovery support services. While approved medications will be used to address the physiological components of addiction, CRA and ACC will address the psycho-social determinants and will teach clients and families how to build recovery skills, find/use positive reinforcers for staying substance-free, access community resources to support positive change and strengthen the individual's natural support system. The program will result in the following positive outcomes: abstinence or significant reduction in substance use, improved social connectedness, engagement in mental health or pre-natal services when needed, and improved level of psycho-social functioning as evidenced by acquisition of skills, stability of housing and/or employment.

The Modoc Nation's Lost River Treatment Center will implement their Medication Assisted Treatment program within Ottawa County and throughout the four-state area of Oklahoma, Kansas, Missouri, and Arkansas. The main goals of the Lost River Treatment Center's (LRTC) MAT program are to increase the number of individuals with OUDs receiving MAT through increased capacity, foster inter-agency collaboration across a broad network of social services, and improve quality of life of MAT patients through a decrease in illicit and prescription opioid misuse. As a licensed center with a full array of medical and behavioral health services, LRTC has a history of providing integrated care to Natives, Non-Natives and their families seeking assistance. Tribe recognizes that there is a need for additional supportive services, especially to treat rurally located and lower income patients. The solution sought here is the development of a systematic recovery support program that assists clients in meeting their basic needs, promotes sober and healthy living as the norm, individual responsibility is accepted by the community, and an overall decrease in overdoses from heroin and opioids. Our program is under the direction of Dr. Jack Doney, our X-Waivered Chief Medical Director, who oversees the medical management components in addition to a team comprised of a Director of Behavioral Health, MAT Program Director, three LPNs, a LCSW, a LMSW, three counselors, three Peer Recovery Specialists, and two transportation coordinators. This dynamic team manages the on-going treatment, outreach, support, and access components of the project. Our treatment regimen for MAT services adheres to the evidence-based National Practice Guidelines from the American Society of Addiction Medicine (ASAM). Our clinic operates as an Office-Based Opioid Treatment Clinic that relies on a collaborative care model overseen by a director of behavioral health. To increase the capacity of our tribe to address our opioid crisis long-term and consistent with the Modoc Nation's commitment to sustainable development, we have adopted a Recovery Oriented System of Care (ROSC). The ROSC is realized through improving the collaboration and communication between local medical, behavioral health, prevention, and career services departments. The ROSC supports our MAT efforts with added components of outreach, development of recovery support and telehealth services, formal collaborations, community education to reduce stigma, and professional workforce development.

Indian Health Council, Inc. (IHC) is a healthcare consortium of nine federally-recognized tribes located in north San Diego County, a 1,500 square mile service area. The majority of American Indian/Alaskan Native (AI/AN) residents speak English as their primary language. IHC's primary and satellite clinic facilities deliver culturally appropriate health care and related services to 12,598 registered and 6,830 active clients who account for about 31,000 visits yearly. The annual household income of at least 60% of clients is within 200% of the federal poverty level. Within IHC's client population, youth under age 18 comprise 34% of all patients. The population of focus for the MAT PDOA program is primarily tribal members and their spouses residing in the north San Diego County catchment area. Induction into the treatment program will target individuals aged 16 and older with a diagnosis of opioid dependence/abuse. According to the California Department of Public Health, San Diego County experienced 528 opioid-related overdose deaths in 2020, the most recent calendar year of data available and the annual crude mortality rate for 2020 was 15.77 per 100k residents. This represents a 97% increase from 2018. Notably, in 2020, Native American/Alaskan Native opioid-related death rates were the highest among all races/ethnicities, at 30 per 100k residents. From 2019 (Q2) to 2021(Q2)), synthetic opioid overdose death rates soared from 4 to over 16 per 100k residents, along with any opioid Emergency Department visits. In a scan of IHC’s client data from 2019 to current (4/2022) of patients with at least one clinic visit, 130 unique individuals with a diagnosis of opioid dependence/abuse were recorded by IHC Providers. Of these, 20 received MAT services, with one opioid-related death after prematurely leaving the treatment program. In the past, the tendency was to diagnose the underlying medical condition for which a patient sought treatment and not to add opioid dependence or abuse. However, with four years of MAT experience, IHC providers have improved screenings to minimize this issue. Stigma is a key barrier to accessing treatment and we believe the actual number of clients with opioid use disorder continues to be much higher. Another barrier to clients accessing services is IHC's capacity to provide financial coverage for uninsured patients needing MAT services. The MAT-PDOA funding will allow IHC to address service delivery gaps and expand beyond our current level of services by allocating more resources to medication, laboratory expenses, and contracts with outside treatment organizations for induction and rehabilitative services. IHC's overarching goal and objectives for the proposed MAT project are: GOAL: Reduce unmet treatment need and opioid overdose-related deaths through the provision of medication-assisted treatment (MAT) and recovery activities for opioid use disorder (OUD) OBJECTIVE 1: Increase participation in culturally appropriate and evidence-based treatment, including MAT using buprenorphine/naloxone for the treatment of opioid use disorder OBJECTIVE 2: Provide a robust suite of medication assisted treatment and Recovery Support Services (RSS) based on the HUB service delivery model to effectively identify, engage, and retain individuals in OUD treatment and facilitate long-term recovery

The Scioto Paint Valley Mental Health Center is seeking funding through the SAMHSA Medication-Assisted Treatment-Prescription Drug and Opioid Addiction for a project titled Second Change Medication-Assisted Treatment (MAT) and Recovery Program. The proposed project is a treatment approach that provides screening, assessment, MAT treatment, substance use disorder treatment (SUD), referrals to treatment, and Recovery Support Services to individuals who are incarcerated in local county jails. In the first year, this program will serve at least 100 individuals in the primarily rural, primarily Appalachian area: Pike, Pickaway, Highland, Fayette and Ross counties. Adults who are experiencing Opioid Use Disorder (OUD) and co-occurring mental health (COD) disorders and are currently incarcerated in the local county jails will be the target population. Over the course of a five-year period, this grant will serve over 575 clients. The overall goal of this project will be to engaged individuals with OUD in treatment, primarily MAT services, prior to their release from incarceration to increase the likelihood of follow-up treatment post incarceration and will aim to decrease recidivism rates in regard to number of clients returning to jail. Licensed staff will be trained to provide screening tools and Comprehensive Assessments to inmates. Assessments will be utilized to identify possible OUD and COD concerns and to then refer these individuals to appropriate treatment services that can be provided by this agency within the county jails. Evidenced-based and population appropriate treatment approaches will then be provided by licensed and trained staff such as quality individual counseling, MAT services, case management services, recovery supports, and referral to residential treatment programs, outpatient treatment, and recovery housing as appropriate upon release from incarceration. Telehealth services will be utilized as needed to provide counseling services which will allow these services to continue and eliminate barriers to success. Once the person is stabilized and ready for release from incarceration, recovery support services such as vocational, educational, and transportation services will be provided to assist clients. Upon release from incarceration, SPVMHC staff will assist clients in attending appointments in the community, help prepare them for seeking and obtaining employment, assist them in obtaining their GED and accessing other educational resources, and assisting them in seeking appropriate housing. These recovery supports will assist clients in better meeting their basic needs and will likely assist in treatment retention and success.

The University of Iowa Addiction and Recovery Collaborative (UI ARC) at the University of Iowa Hospitals and Clinics (UIHC) will implement the Recovery and Empowerment to Combat Opioids delivered by telehealth and collaboration across Iowa (RECOVER-IA) project to provide resources to help expand and enhance access to medications for opioid use disorder (MOUD) to individuals with opioid use disorder (OUD) throughout the State of Iowa. OUD treatment services will be provided to at least 240 unduplicated patients using evidence-based practices during the 5-year project. Goals and objectives include 1) Increasing the capacity to provide MOUD in Iowa. Education and training will be provided for health care providers about OUD treatment and harm reduction, including DEA X-waiver trainings for 150 providers; presentations for 150 providers to encourage application allowing them to prescribe buprenorphine to up to 30 patients at a time; and education about OUD and MOUD for 75 pharmacists. RECOVER-IA will launch and operate a TeleMAT-IA helpline to offer low barrier access to MAT and establish a mobile MAT clinic, the Iowa MAT Mobile, to travel to rural areas of Iowa to provide substance use screening, MAT care, education, and outreach. During the project, UI ARC will become an accredited and certified Opioid Treatment Program and begin providing methadone. 2) RECOVER-IA will increase the number of Iowans with OUD receiving MOUD and improve patient outcomes including reduction in opioid and other drug use, reduction in injection drug use, increase patient recovery capital, and increase patient quality of life and satisfaction. 3) Reduce drug use and harms associated with substance use among people with OUD by screening all patients for HIV and hepatitis C and providing treatment and referral for those who test positive. Patients will receive information about harm reduction including safe use kits, overdose education, prevention, and access to naloxone. A contingency management program will be implemented for individuals with OUD and stimulant use disorder. 4) RECOVER-IA will build a team of specialists and provide recovery supports for individuals with OUD or other substance use disorders, including parents in recovery and people with co-occurring post-traumatic stress disorder (PTSD). We will hire an additional Case Manager and Peer Recovery Support Specialists. Transportation assistance will be provided for patients experiencing transportation barriers. The project will partner with the IA Center for School Mental Health to provide counseling to parenting participants to strengthen OUD recovery and parenting skills. We will train providers to deliver the Seeking Safety curriculum to individuals with OUD and PTSD. Information, expertise, and partnerships achieved through this project will ensure the sustainability of MAT in Iowa, including rural areas, following the five years of grant funding.

Lutheran Family Services of Nebraska (LFS) proposes to expand Medication for Opioid Use Disorder (MOUD) service provision at two of its Eastern Nebraska clinics. Its target population is Nebraska adults suffering from Opioid Use Disorders (OUD) including those already receiving substance use evaluations or treatment from LFS. LFS will place emphases on reaching and serving justice-involved adults suffering from OUD, Ryan White HIV/AIDS Program (RWHAP) funded clients, and clients referred by LFS primary care partner, Bluestem Health, an experienced provider and a Federally Qualified Health Center (FQHC). Nebraska overdose deaths jumped nearly 43% in 2020 (CDC, 2020). Nebraska is ranked the #9 state where overdose deaths increased the most during COVID-19. Drug overdose deaths (March 2020–March 2021): 214 (+44.6% change from March 2019–2020) Lutheran Family Services developed 7 measurable objectives aligned with the Required Activities and formulated a comprehensive and cohesive five-year action plan to achieve the program's goals: Goal 1: Program Implementation Fidelity. Provide Medications for Opioid Use Disorder (MOUD) services using one of the FDA-approved medications (buprenorphine products and/or long-acting injectable naltrexone) to treat OUD combined with comprehensive OUD psychosocial services and a team-based care approach. Goal 2. Client Outcomes. Reduce illicit use of opioid drugs and improve outcomes for individuals receiving MOUD services at six-month follow-up. Goal 3. Outreach and Engagement. Develop and implement outreach and engagement strategies to increase access to MOUD and related services for diverse populations with OUD. Using well-known EBPs shown to be effective for opioid use disorder (OUD), Lutheran Family Services will serve 1,775 unduplicated individuals through screening as well as 550 engaged in MOUD treatment and care and 2,000 served through outreach events over the five-year project period. The EBPs are Motivational Interviewing (MI), Brief Motivational Interventions (BI), Solution-Focused Therapy (SFT), Cognitive Behavioral Therapy (CBT), Eye Movement Desensitization and Reprocessing (EMDR), Interpersonal Therapy (IPT), and Medication Assisted Treatment (MAT).

Services for the Underserved (S:US) proposes to launch a Medication Assisted Treatment (MAT) program at our Brooklyn Wellness Works Certified Community Behavioral Health Clinic to expand and enhance access to medications for opioid use disorder (MOUD). The target population will be individuals with OUD in the geographic catchment area of Brooklyn with a focus on serving high-needs communities. The proposed program will replicate the success of our MAT program at our East Harlem Wellness Works Clinic, by providing targeted outreach to identify and engage 100 individuals with OUD in collaboration with community-partners, and provide flexible, person-centered interdisciplinary treatment and recovery supports (including medication assisted treatment, behavioral health therapies, peer supports, and more).

Ohio Health Grant Medical Centers (GMC) Addiction Medicine Service will provide enthusiastic leadership to the PRO-MAT (Providing Robust Outpatient Medication Assisted Treatment) project that will provide needed addiction treatment services to up to 1560 individuals in Franklin County. Ohio who lack health insurance or cannot afford to pay for medical care, transportation and medications needed to treat addiction to opioids, will save lives. Medications and behavioral health counseling are key to treatment designed to decrease the use of illicit opioid drugs like heroin or fentanyl and/or misuse of prescription opioids, which can lead to serious problems and results in death. Ohio is in the top five states for the highest number of unintentional drug overdoses in the United States since 2014. Of the 88 counties in Ohio, Franklin County had the highest number (803) of overdose deaths in 2020 and saw an increase in unintentional drug overdose deaths from 15.3 in 2014 to 35.7 in 2020 per 100,000. Grant Medical Center (GMC) and the PRO-MAT referring hospitals of Riverside, Doctors, and Grove City, in 2021 saw a total of 25,065 patients with substance use disorder (SUD) including opioid use disorder (OUD) of which an average of 6.5-7% were uninsured. In 2020 in Ohio, the Black non-Hispanic male rate was 55.2 deaths per 100,000, was higher than other races, sex and ethnic group; In Franklin County uninsured was 7.7% similar to 6.5-7%. Of SUD/OUD patients served below federal poverty line: 15.1%, higher than the percentage for Ohio that is 13.6%. ADAMH Alcohol, Drug and Mental Health 2020 Franklin County needs assessment identified service gaps in Addiction and Mental Health services including Psychiatry, Outpatient Counseling and Psychotherapy; need for affordable, appropriate level of care and treatment services including MAT that are affordable, timely, with appropriate level of care; lacking means to pay for services, copays, medications and transportation. PRO-MAT aims to serve 1,590 unduplicated individuals: Years one and two 340 served, year three 320 served, year four 300 served, and year five 290 served. Measurable project goals follow. Goal 1: Expand and enhance access MAT to individuals suffering from OUD particularly who lack access to care. Objective 1a: By the end of year 1, Addiction Medicine Outpatient clinic at GMC will expand patient coverage from the current 2 days a week to 5 days a week. Objective 1b: By the end year 1, outpatient clinic at GMC will accept referrals from all OhioHealth care sites. Objective 1c: By the end of year 2, will have an additional 50 DATA waivered providers within OhioHealth system and 75 by the end of year 3. Objective 1d: By the end of year 1, GMC will provide Technical Assistance to DATA waivered providers, to get answers to patients questions and deliver evidence-based care. Objective 1e: By the end of year 1 provide inpatient hospital consultation to patients admitted to the hospital. Goal 2: Decrease the use of illicit opioids and misuse of prescription opioids by offering MAT to patients suffering from OUD in the community. Objective 2a: By the end of year 1, offer MAT to 100% of patient referrals who are appropriate candidates and meet the criteria for OUD. Objective 2b: By the end of year 1 offer comprehensive psychological services to 100% of patient referrals with OUD. Objective 2c: For patients receiving MAT increase average number of days staying abstinent from substance misuse by 75% from baseline during a period of 6 months following the start of MAT service. Goal 3: Decrease risk of opioid overdose by improving access to MAT and implementing harm reduction strategies, there by resulting in decrease in overdose related deaths in the community. Objective 3a: Offer naloxone to 100% of patients receiving MAT; Objective 3b: Decrease overdose incidence by at least 75% for patients receiving MAT in specified patient years compared to baseline before starting MAT.

The ACTS for OUD Initiative addresses the array of opioid use challenges in the MA Western region to strengthen the design and implementation of the components of a community partnership-driven continuum of treatment and recovery support. We will make services more accessible, scalable and more effective and will innovate methods to improve the replication and spread of evidence-based practices, particularly MAT delivered in an OBOT and Hub/Spoke model. ACTS services will be provided to 250 individuals suffering OUD per year. Specifically, CSO will support the ACTS participants in achieving and maintaining recovery from addiction and/or mental health disorders and improve their quality of life through connection with a broad range of services. The program will offer a comprehensive range of recovery support services in conjunction with housing and benefits, health care and behavioral health treatment. Population to be served: The ACTS program will serve rural, low income, homeless or unstably housed, individuals and veterans with OUD and mental health disorders in CSO's 6 clinic locations and homeless shelter across 5 counties with a focus on creating capacity to reach out and serve residents of rural areas in the region. Number of individuals to be served: The ACTS for OUD program will serve 250 participants in year 1 and an additional 250 in each of years 2 - 5, for a total of 1250 participants over the 5 year project duration. Project goals are to: Goal 1: Improve access to opioid treatment; Goal 2: Increase and enhance patient screening, treatment options, care coordination and risk reduction for OUD; and Goal 3: Provide training and education on OUD, MAT, harm reduction and overdose prevention.

The Inter-Tribal Council of Michigan, Inc. Anishnaabek Healing Circle Medications for Opioid Use Disorder (MOUD) Initiative will provide evidence based and culturally responsive MOUD services to American Indians with an opioid use diagnosis residing in the combined tribal service areas of the three Michigan tribes (11 of the 83 counties in Michigan). Over the five-year project, September 30, 2022 through September 29, 2027, the project will enroll 225 uninsured or underinsured clients at a rate of 45 per year. Clients will be members of the 12 federally recognized tribes in Michigan and members of other federally recognized tribes. Non-native family members and descendants will also be eligible, in a manner consistent with the local tribal policy. The purpose of this project is to provide resources to help expand/enhance access to Medications for Opioid Use Disorder (MOUD). It is expected that this project will help to 1) increase the number of individuals with Opioid Use Disorder (OUD) receiving MOUD; and 2) decrease illicit opioid use and prescription opioid misuse. Project objectives: -By September 30 of each year, the project will enroll at least 45 uninsured or underinsured clients with an opioid use diagnosis; client enrollment will start November 1, 2022. -By September 30, 2023, each participating tribe will have at least one physician, nurse practitioner or physician assistant available to implement MOUD using an integrated health/behavioral approach; all health care providers' prescribing privileges will be consistent with federal law. (Section 303 CARA) -By October 31 of each project year, the evaluation team will produce an outcome study that describes the progress on the capacity building measures identified in each tribal action plan and examines client outcomes. The project will assist in the expansion and support of tribal efforts to fully implement an integrated Medications for Opioid Use Disorder Initiative. If a tribal clinic already offers MOUD services, this project will help support the cost of sustaining and expanding the services. If a tribal clinic does not currently offer MOUD services, the project will help identify a local provider or help support the training for a tribal health clinic provider. Budget The project will provide sub-contracts to three participating tribes in the amount of $150,000 annually per tribe; $750,000 for each tribe over the five-year initiative. The project will also support the cost of the required GPRA data collection, evaluation and training to expand and integrate MOUD services as needed.

Meta House's Medication for Opioid Recovery and Engagement (MORE) program will provide medications for opioid use disorder (MOUD), substance use disorder and co-occurring mental health disorder treatment, recovery support services, peer support services, and overdose prevention for a diverse population of women with opioid use disorders. The geographic catchment area is southeastern Wisconsin, focused on Milwaukee County. Based on recent Meta House client data and community demographics, we expect to serve a population that is English-speaking and racially diverse, approximately 50% White, 30% Black/African American, 10% Native American, and 10% multiracial/other. Ethnically, we expect our population to be approximately 15% Hispanic/Latinx. Most clients will be 20 to 44 years old. Based on past data, we expect that 85% of the clients served will be heterosexual, 10% bisexual, and 5% lesbian. Meta House's programs are welcoming to transgender clients, although typically transgender women make up only about 1% of our client population. Families served by MORE will be low-income (90% of clients have incomes below the federal poverty level) and have multiple special needs in addition to their opioid use disorders and co-occurring mental health disorders, such as other substance use disorders, unstable housing, trauma histories, low literacy, and employability concerns. A substantial number of women served will be parenting minor children. Most will be involved in multiple systems, including child welfare, TANF, and criminal justice. Meta House, a treatment provider with over 50 years of experience serving the population of focus, will integrate MOUD into substance use disorder treatment for women with opioid use disorders and co-occurring mental health disorders, provide peer and recovery support services, and implement overdose prevention strategies for women across Meta House's continuum of care. The MORE program will integrate the following evidence-based practices into our continuum of care to support recovery for women with opioid use disorders: 1) Motivational Interviewing for treating opioid use disorders, substance use disorders, and co-occurring mental health disorders; 2) Seeking Safety for treating opioid use disorders/substance use disorders and trauma; 3) Peer Recovery Support Services for recovery support and engagement; and 4) Naloxone and Fentanyl Test Strip Distribution for harm reduction and overdose prevention. The goals of the MORE program are to 1) increase Meta House's capacity to provide MOUD through hiring Nurse Practitioners and collaborating with a newly established Opioid Treatment Program, 2) increase the number of individuals with opioid use disorders receiving MOUD, serving 250 women over the five-year grant (30 in Year 1, 40 in Year 2, 50 in Year 3, 60 in Year 4, and 70 in Year 5); 3) provide screening, assessment, treatment planning, and services to support long-term recovery from substance use disorders and co-occurring mental health disorders; 4) decrease misuse of opioids and other substances and provide harm reduction services for overdose prevention; 5) improve women's level of functioning related to mental health and trauma symptoms; and 6) improve access to MOUD for diverse populations. In collaboration with IMPACT, the experienced external evaluator for the project, a program evaluation will be implemented that will measure how the project meets all program goals and objectives as well as additional process evaluation questions and will collect and report data on all required performance measures. GPRA and local evaluation data will be collected in interviews at intake, discharge, 6 months post-intake, and 12 months post-intake.

The United Keetoowah Band of Cherokee Indians in Oklahoma (UKB), seeks to expand and enhance access to medication assisted treatment (MAT) and other treatment and recovery support services for individuals with an opioid use disorder (OUD) within our complex, under-served, and rural and urban population. The UKB headquarters is located in the northeastern region of the state in Tahlequah. This project will serve 2,724 square miles within four counties of its functional service area with a large urban area on the western boundary (Tulsa). Within this area, there is a mixture of urban, rural, and very rural locations. According to US Census data, the total American Indian population (AI only) in the service area is 42,266 or 27.7% of the total population of 152,371. There are 54,015 AI only and in combination with other races.

Cook Inlet Tribal Council, Inc. (CITC) proposes its FY 2022 Medication-Assisted Treatment: Prescription Drug and Opioid Addiction (MAT: PDOA) project. The project's overarching purpose will be to expand the accessibility of OUD-focused MAT services in the Mat-Su borough. Ultimately, the project will improve Alaska's behavioral healthcare system and will reduce SUD and COD prevalence and opioid-related overdose deaths. The project's population of focus will be Alaska Native and American Indian (AN/AI) adults (18+ years of age) who have OUDs or CODs with OUDs and seek MAT and/or MAT-complementing services. The project's catchment area will be Alaska's Matanuska-Susitna (Mat-Su) borough, which has an estimated 107,081 residents, 14,052 (or 13%) of whom are AN/AI (race alone or in combination). The project will benefit 80 participants. -Goal 1. Establish formal partnerships between CITC and identified local entities in order to expand the accessibility of OUD-focused outpatient MAT, outpatient detoxification, and other treatment and recovery services in the Mat-Su borough. -Objective 1.1. By the end of month 4, prepare and have signed 4 memoranda of agreement between CITC and each of 4 local partners for mutual referrals. -Goal 2. Establish formal partnerships between CITC and identified local entities in order to prevent medication diversions in the Mat-Su borough. -Objective 2.1. By the end of month 4, prepare and have signed 1 memorandum of agreement between CITC and 4 local partners that defines specific policies, protocols, and commitments for preventing medication diversions. -Goal 3. Provide OUD-focused outpatient treatment and recovery services to participants who are actively receiving OUD-focused outpatient MAT services via partners. -Objectives 3.1 and 3.2. By the end of the year 5, provide ongoing intensive case management, peer recovery support services, and supportive services to 80 (or 16 per year) unduplicated participants. -Goal 4. Provide OUD-focused outpatient treatment and recovery services to participants who are actively receiving OUD-focused outpatient detoxification services via partners. -Objectives 4.1, 4.2, and 4.3. By the end of year 5, provide ongoing intensive case management, individual counseling sessions, transitional housing assistance, and supportive services to 50 (or 10 per year) unduplicated participants. -Goal 5. Provide integrated outpatient SUD and COD treatment and recovery services to participants who are actively receiving OUD-focused outpatient MAT or outpatient detoxification services via partners. -Objectives 5.1 and 5.2. By the end of the year 5, provide regular mental health-focused counseling sessions and/or referrals to local mental health providers to all participants who have CODs and require or would benefit from those sessions. -Goal 6. Decrease substance use prevalence and recidivism among participants and improve the quality of behavioral healthcare in the Mat-Su borough. -Objectives 6.1, 6.2, 6.3, and 6.4. Various GPRA-based measurements.

The Eastern Shoshone Tribe is located on the Wind River Reservation (WRR) located in central Wyoming. With more than 2.2 million acres of land, the WRR is home to the Eastern Shoshone and Northern Arapaho tribes. With separate governance structures, tribes operate independently of one another the Eastern Shoshone Recovery (ESR) Program of the Eastern Shoshone Tribe developed this proposal. According to the 2018 tribal enrollment records, there are 4,368 enrolled Eastern Shoshone tribal members living on the WRR. A review of SPARS data from active ESR SAMHSA-funded grants indicates that 32% of all clients report alcohol-related disorders, 10% opioid-related disorders, 8% cannabis-related disorders, and 10% other stimulant-related disorders. Additionally, 27% of clients experience mental health diagnoses. Marijuana is the most commonly reported drug used in the past 30-days, with 18% of clients reporting use, followed by alcohol (16%), methamphetamines (11%), and oxycontin/oxycodone (7%). Trauma and violence are shared among clients; 100% of transgender clients and 71% of female clients report lifetime trauma. Fremont County is a designated healthcare provider shortage area, and low pay, burnout, and COVID-19 have compounded issues related to OUD treatment. The proposed project will address these issues and fill gaps in services with the activities described in this proposal. The ESR MAT Program will address the opioid crisis on the WRR from the growth of opioids and OUD on the reservation. The project has one primary goal and three objectives. The overall goal of the ESR MAT Program is to increase the number of individuals with OUD receiving MOUD and decrease illicit opioid use and prescription opioid misuse. The Program will provide MAT and mental health services to at least 20 individuals with OUD per year for all five years for a total of 100 unduplicated individuals served. ESR will provide evidence-based services to participants and their families during the project period, totaling 500 hours of service and reaching 50 unduplicated individuals per year impacted by OUD. ESR plans to utilize a three-pronged approach to reach participants with office locations in Riverton, Fort Washakie, and one mobile outreach unit.

We will expand and improve our successful program of Emergency Department (ED)-initiated medications for opioid use disorder (MOUD) to include an innovative methadone treatment pathway, improve screening to better identify OUD, remove barriers to ED MOUD enrollment and follow-up in community addiction recovery programs, improve critical supports for participant success in follow-up recovery, and widen the distribution of harm reduction kits in the prehospital and ED settings. Our population of focus includes patients in a large rural and urban catchment area who present to EMS or the EDs of the University of Vermont Medical Center (UVMMC) or Champlain Valley Physicians Hospital (CVPH) in upstate New York with an acute opioid overdose or other signs of opioid use disorder (OUD) who are candidates for starting Medication for Opioid Use Disorder (MOUD). With the continued rise in opioid-related overdose fatalities in these areas, our goal is to address the need to increase the number of individuals with OUD that are screened for risk, offered MOUD and harm-reduction kits, and are successfully enrolled and maintained in certified MOUD community addiction recovery programs, thereby decreasing illicit opioid use, prescription opioid misuse, and risk of opioid overdose. The presentation of patients with OUD both to EMS after a 911 call and at the ED are critical opportunities to identify individuals in need and engage them in MOUD. ED-initiation of MOUD has been found to consistently lead to increased enrollment and maintenance of outpatient treatment programs. The objectives of our fully revised program are built on important lessons learned during the first 4 years of STAR. In our most innovative revised objective, we will include a new ED-initiated methadone treatment arm in addition to revising buprenorphine/naloxone dosing. These are evidence-based responses to improve MOUD success with increased incidents of buprenorphine precipitated opioid withdrawal in the community due to the increased use of fentanyl. There are multiple other areas of improvement addressed in our revised objectives. Our expanded STAR program will identify and offer treatment initiation and harm reduction kits to more prehospital and ED patients with OUD by initiating better screening procedures. We will improve both ED-initiated MOUD program enrollments and community addiction recovery program retention with our expanded ability to link participants to one-on-one peer recovery coaches in the ED, as well as increased options for follow up in additional linked community addiction recovery programs. We will further decrease identified program barriers via telemedicine, streamlined ED procedures, and provision of cell phones and transportation vouchers as needed. We will also utilize innovative collaborations to enroll OUD patients that previously would have been excluded both prehospital (refusing transport to ED) and after hospital admission. By the end of this five-year project timeline, a minimum of 312 unduplicated individuals will be served with grant funds as outlined in our proposal. The data collected from each participant will include diagnosis, self-report measures of illicit drug and alcohol use, housing status, employment status, criminal justice system involvement, access to services and engagement, retention in services, and social connectedness, including measures of disparities in access, service use, and outcomes across subpopulations. We will record the number of clients served (including new clients served from this funding) and the receipt of medications for OUD in the ED and outpatient care. Data will be collected at baseline, 6 months, and discharge. Data from the GPRA will be entered into the SPARS on-line data system. Additional outcomes will include Treatment Needs Questionnaire (TNQ), Tobacco, Alcohol, Prescription medication, and other Substance use Tool (TAPS-1, TAPS-2), and the Locator Form.

The CCH MAT-PDOA project will serve people with Opioid Use disorder (OUD) who are experiencing or at-risk of homelessness in the City & County of Denver, Colorado. The people served by the project are anticipated to be nearly 25% Hispanic, predominately male, between the ages of 25 and 44 years. The project goal is to expand and enhance access to Medications for Opioid Use Disorder (MOUD), while decreasing illicit opioid use and decreasing prescription opioid use, and improving the health status of the people served. Project services will be offered on the streets, in encampments, in a mobile medical vehicle, and in a Health Care for the Homeless health center setting. The project will serve 774 people during the 5-years of project implementation. During project Year 1, 137 people will be served. In Years 2, 3, and 4, 182 new people will be served annually. During the final project year, Year 5, 91 new people will be served. In addition 50% of people served in any project year is anticipated to be retained in services for more than one year. Peer Recovery Support Services, as well as harm reduction activities that include Contingency Management and distribution of Fentanyl test strips, and Narcan nasal kits will be offered. The project measurable objectives include: 1) Retain at least 50% of participants in treatment six months after start; 2) Retain at least 65% of participants receiving contingency management in treatment six months after start; 3) Engage at least 50% of project participants in peer recovery support services; 4) Decrease frequency of illicit opioid use at six months among at least 50% of participants who report illicit opioid use at intake; and 5) Improve overall health among at least 40% of participants from intake to six-month follow-up.