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Equipping Rural Providers to Fight North Carolina’s Opioid Epidemic

Practicing medicine today often means coming face-to-face with the opioid crisis. Opioid abuse disorders can be complicated to treat, and the human toll is enormous. In the United States, the number of opioid deaths in 2016 was five times higher than in 1999.

North Carolina is no exception. From 2015 to 2016, the state’s opioid death rate increased by 24.7 percent. But a new UNC initiative is trying to change that.

The UNC Extension for Community Healthcare Outcomes for Rural Primary Care Medication Assisted Treatment (UNC ECHO for MAT) aims to help eliminate opioid abuse and overdose deaths through a new workforce development model.

Medication-assisted treatment (MAT) includes combining medication with counseling and behavioral therapies to treat substance abuse disorders. While effective, MAT also requires physicians to undergo additional training to prescribe the drugs involved in treatment. For providers in rural communities, access to specialists and others who have prescribed MAT is not always possible.

“The goal of the overall project is to reduce the barriers for primary care providers providing treatment for opioid abuse disorders,” says Marisa Domino, PhD, professor in the Department of Health Policy and Management in the Gillings School of Global Public Health. She is co-investigator of the project along with principal investigator Sherri Green, PhD.

“We know that one of the barriers is the additional training that’s required in order to prescribe MAT, and that includes the eight hours of training for physicians and the 24 hours that’s required for advanced practitioners,” Dr. Domino says. “But also there’s the whole process of starting up prescribing and getting everyone at the practice, including the front-office staff, on board. This was an effort to directly address those barriers.”

How UNC ECHO for MAT Works

The UNC ECHO for MAT project is a three-year, $2.9 million project funded by the Agency for Healthcare Research and Quality to offer training and education to providers who otherwise might not have access.

MAT is one of the best ways to combat opioid abuse disorders—and therefore help prevent opioid-related overdoses—but there’s a shortage of MAT providers in North Carolina, especially in rural communities. With that in mind, providers from rural areas were invited to participate, particularly those from areas where the opioid overdose death rate was above the national average.

“We are able to focus on 22 of North Carolina’s 100 counties,” Dr. Domino says.

The ECHO model of training started at the University of New Mexico and is a web-based, video-learning collaborative. “It has been described as a ‘hub and spokes’ model,” Dr. Domino says. “The hub are the experts we have at UNC and around North Carolina who have already undergone training to prescribe MAT and have started prescribing to their patients. The spokes are the providers, and they can log in from wherever they are and participate in these sessions.”

Although part of the sessions involves didactic training, including topic-focused lectures, the training mostly focuses on real-life case studies. “They’ll go through a particular patient, and providers can share any difficulties or challenges he or she is experiencing, and the group can help with diagnosis, treatment and follow-up,” Dr. Domino says.

Planning for the initiative began in 2016, and the ECHO model was implemented in 2017. Dr. Domino says the project is looking for ways to make it more sustainable and carry on beyond the three-year mark. “We’ve since gotten funding from the state in order to allow us to work with providers in all 100 counties,” Dr. Domino says.

Growing the ECHO Education Model

Although the initiative was born out of and still partners with the University of New Mexico Project ECHO, UNC’s version has expanded to meet local needs.

“Our particular model goes beyond the ECHO model,” Dr. Domino says. Instead of keeping the program contained online, UNC also offers hands-on training. “We send practice coaches who are familiar with MAT to practices to implement a whole variety of technical assistance and support as they get ready to implement MAT.”

Whether online or in person, the program gives providers valuable access to information. “I think that’s especially important in rural communities, where they might not have access to the specialists,” Dr. Domino says. “The common goal is improving treatments in those areas together by discussing all sorts of outcomes and any difficulties they might encounter.”

While data are still being collected on how the additional training from UNC ECHO for MAT has improved opioid abuse, Dr. Domino says the impact seems promising.

“We hear from the providers that they really value this as a resource to help them along the way,” she says. “I think by encouraging providers to do the training that’s required and helping them while they’re implementing MAT, it’s not only about prescribing, it’s about creating the connections with behavioral health and social services specialists to improve health and opioid abuse in the state.”


For more information and to enroll in this no-cost program, email echo@unc.edu or call (919) 966-7104.