EVALUATING VIRGINIA'S STATE OPIOID RESPONSE GRANT (SOR) | PART III: Treatment

Welcome to part three in a four-part series in which we share findings from year one of Virginia’s State Opioid Response (SOR) Grant. This week, we continue our series with a look at progress related to Virginia's treatment efforts. We also share reflections on how treatment practitioners have responded to the emerging COVID-19 crisis, and how their work has quickly adapted to avoid disruptions in treatment services. 

SOR funding has significantly expanded Medication-Assisted Treatment (MAT) and access to other substance use disorder treatment services in Virginia. Thanks to SOR funding, all 40 community service boards (CSBs) in Virginia are now providing MAT services, compared to just 18 CSBs in 2017. MAT is defined by SAMHSA as the use of FDA-approved medications, in combination with counseling and behavioral therapies, to provide a "whole-patient" approach to the treatment of substance use disorders. MAT is an important focus of SOR treatment efforts because it has been shown to decrease opioid use, opioid-related overdose deaths, criminal activity, and infectious disease transmission among patients as well as to increase social functioning and retention in treatment[1]. 

In addition to treatment services, SOR funds are deployed for harm reduction strategies including the distribution of naloxone. Naloxone, also known as Narcan®, can treat narcotic overdoses. Through SOR funding, more than 5,000 naloxone kits have been distributed to community members, health departments, law enforcement agencies, and corrections facilities staff. Increasing the supply of naloxone can help ensure it is available during an overdose.

Highlights of Service Needs

In year one, over 90% of individuals receiving SOR-funded treatment reported they had engaged in treatment at least once before, underscoring the chronic nature of addiction and the need for comprehensive and sustained treatment services across Virginia. Many CSBs have also utilized SOR funds to pay for wraparound services such as transportation or childcare, which enables individuals to more easily engage in treatment. 

The data also highlights the need for cross-sector collaboration to comprehensively address opioid use disorders and its consequences. Sectors that will be needed to work alongside treatment providers include:

• Mental health professionals: 77% of treatment recipients surveyed have co-occurring mental health and substance use disorders.

• Public health preventionists: Among treatment recipients who reported injecting substances, 74% said they shared injection equipment, posing a significant public health risk for communicable diseases.

• Community members and first responders: 40% of treatment recipients surveyed have overdosed at least once in their life, and more than 15 individuals surveyed reported they had been revived from an overdose with naloxone. Continued efforts to educate first responders and the public, including friends and family members of those with an opioid addiction, is essential to ensure naloxone is available when and where it's needed to save lives.

Treatment Services in the Time of COVID-19

Cross-sector collaboration has become even more important as the opioid epidemic continues to be a challenge for many during the COVID-19 pandemic. Disruptions in addiction treatment can have significant impacts on an individual's stabilization or recovery. As such, Virginia's CSBs have worked hard to quickly shift services to remote settings and ensure that their clients are supported during this challenging time. Adjustments made by the CSBs to ensure they continue to provide comprehensive care include:

• shifting to telehealth treatment services and group therapy sessions to follow physical distancing guidelines

• coordinating medication pick-ups at CSBs that do not require individuals to enter the building

• prescribing at-home drug testing kits and reviewing results during remote treatment sessions

OMNI, in partnership with DBHDS, hosted a COVID-19 Roundtable for CSBs to share how their agencies have adapted to telehealth. While many CSBs are adjusting smoothly, there have also been some challenges, particularly around access to phones or internet. Some clients do not have regular access to these methods of communication and are unable to receive remote services. Creative solutions for this are in the works, including setting up remote stations within CSBs that allow clients to come in and have a telehealth visit with a provider while adhering to appropriate physical distancing guidelines. Unemployment has also impacted many clients, and needs for wraparound services such as transportation and housing have increased.

Unexpected benefits of the shift to telehealth also emerged in the roundtable discussion. CSBs reported decreased no-show rates for appointments because transportation is no longer a barrier. One client was able to attend a therapy session during his lunch break because he didn’t need to travel to the clinic. Therapists are also able to see clients in a setting outside of the clinic and have a more complete picture of what is going on in clients’ lives. For example, after seeing a client with her children, a therapist was able to add family activities to the client's individual therapy. This has allowed the CSB to more fully meet clients' needs. 

We will continue to examine the impact of MAT and COVID-19 on CSBs and their clients over time, but we know that the treatment services they receive are not the only piece of the puzzle. It will take continued comprehensive effort from many sectors to make the systems-level changes needed to address the opioid epidemic, and to ensure that current progress can continue despite other emerging public health needs. 

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Survey for Treatment Providers

Are you a treatment provider who wants to learn more about the impact of COVID-19 on your patient population? OMNI has developed a brief survey for our treatment partners designed to assess the impact of COVID-19 on patient experience in substance use disorder treatment services. In addition to measuring aspects of recovery, the survey also measures patient perception of telehealth services. Developing and sharing this survey is our small way to help. You can see a preview of the survey by clicking here. 

If you are interested in utilizing the survey with your patients, please sign up here and OMNI  will send you an unique link that you can distribute directly to your patients. OMNI will then share the data back with you. There is no cost to you to participate in this effort. Please know that all survey responses will be confidential and we will not be sharing any individual responses.

[1] https://www.drugabuse.gov/publications/effective-treatments-opioid-addiction/effective-treatments-opioid-addiction