NCAD West: Streamlined Medication Unit Brings Treatment to Rural Communities

In sprawling states where residents could be hours away from the nearest traditional opioid treatment program, innovative solutions are needed to deliver treatment to those who need it.

In a Friday morning session at the National Conference on Addiction Disorders West, Haley Horton, regional operations manager for Community Medical Services, shared with attendees how her organization has developed medication units to keep patients engaged in treatment, even if they live a great distance from their nearest OTP.

Not all rural areas are thrilled by the prospect of medication-assisted treatment, Horton said, and in the case of Safford, a southern Arizona city with a population of 9,500, CMS had to engage with key stakeholders for two years before getting the go-ahead to begin operations. CMS leaders met with local law enforcement and faith community leaders, and even joined a local softball league to build a relationship with the city.

“Little things like that go a long way,” Horton told NCAD West attendees. Horton added that it’s important to meet key stakeholders where they are, executing initiatives local officials are comfortable with first and patiently building trust before expanding services.

The medication unit model has proved to be an effective solution for CMS because it allows for a smaller scale OTP operation that provides access to all three medications for MAT while being staffed only by a nurse and medical assistant.

DEA does not recognize medical units as being different from traditional OTPs; they are part of, but separate from, the OTP. Medication units are, however, required to maintain separate inventories, records, reports and security in accordance with DEA regulations.

The medication unit is used exclusively for dosing, while intake, follow-up appointments, and support for behavioral health and co-occurring disorders is covered at CMS’s home OTP location, Horton said.

This is a challenge that can be addressed through the provision of transportation and collaborating with local medical providers for conducting physical exams, Horton said. For home OTP visits, CMS transports patients with Medicaid either by one of the company’s vehicles, billing for reimbursement, or by using Medicaid transportation. Horton said CMS prefers to use its own transportation, even if it means absorbing the cost in states where reimbursement for transportation is not an option, because it allows staff to engage with patients during the long drives.

Demand for services at the Safford medication unit, which opened in May 2018, became so great that a year later, the unit was converted into a full home OTP in collaboration with the Substance Abuse and Mental Health Services Administration, a first for the administration.

“We hit about 125 clients, and at that point, we realized we absolutely needed to have a counselor on site,” Horton said. “We needed to be able to bill for peer support. We did go through the process of conversion, and that is a conversion with SAMHSA. We notify all of our other regulatory bodies, but DEA doesn’t see it any differently, the state doesn’t see it differently from a licensing perspective, so it’s really SAMHSA’s [Center for Substance Abuse Treatment] division.”