Boston – Boston Medical Center has developed a first of its kind app to help providers deliver evidence-based addiction treatment. The app, BMC MAT, which can be downloaded free of charge now in the Apple iTunes store and Google play, provides guidelines and resources to treat opioid use disorder (OUD) with medication (buprenorphine or naltrexone) in office-based settings.
The interactive app includes clinical algorithms that help walk providers through each step of the decision-making process when caring for patients with OUD. The app also gives access to several tools, such as the Diagnostic and Statistical Manual of Mental Disorders (DSM–5®) diagnostic criteria for OUD, the Clinical Opioid Withdrawal Scale (COWS), and the Alcohol Use Disorders Identification Test (AUDIT-C). There is also a Quick Start tool that helps providers make decisions on how best to approach treating their patients with OUD, as well as managing chronic pain for someone with a history of substance use.
“Millions of Americans struggle with substance use disorders, yet a fraction of these individuals receive treatment for their condition,” said Colleen LaBelle, MSN, RN-BC, director of Boston Medical Center’s Office-Based Addiction Treatment (OBAT) program and the State Training and Technical Support+, who led the development of this app. “This app brings resources and guidance into the hands of providers to help expand access to medication to treat opioid use disorder.”
BMC’s OBAT program, developed under the leadership of LaBelle in 2003 following FDA approval of buprenorphine to treat OUD, brought treatment for substance use disorder into primary care. This nurse care manager-led model helped increase access to medication treatment for OUD and decrease the stigma around addiction, reinforcing the message that substance use disorder is a chronic condition that can be managed medically just like heart disease or diabetes. Now, LaBelle and her team oversee implementation of the OBAT model at federally qualified health centers in Massachusetts, and the model has been adopted at locations across the country. In 2020, LaBelle and team provided training on evidence-based addiction treatment to over 14,000 individuals.
The country is still in the middle of an addiction crisis. According to the Centers for Disease Control and Prevention, more than 81,000 drug overdose deaths – the highest on record – took place in the US during the 12 month period ending in May 2020. According to the 2019 National Survey on Drug Use and Health, approximately 1.6 million people aged 12 and older had OUD. Injection drug use is common among people with OUD, which increases the risk for other life-threatening complications such as HIV, hepatitis B, hepatitis C, and endocarditis.
Decades of research has demonstrated that life-saving medications for addiction, such as buprenorphine, greatly reduce the risk of all-cause mortality and overdose death in people with opioid use disorder (OUD). Buprenorphine administered in office-based settings has also been shown to reduce HIV-risk behaviors related to injection drug use. However, medications available to treat OUD and save lives, including buprenorphine and naltrexone, are consistently underutilized. A 2018 JAMA Pediatrics study showed that only 25 percent of commercially insured young adults with OUD between the ages of 13 and 22, and five percent of Medicaid insured young adults with OUD of the same age received life-saving medication for addiction. Results of another 2018 study published in Annals of Internal Medicine demonstrated that only three out of 10 opioid overdose survivors received buprenorphine or naltrexone.
“The data clearly shows that medication saves lives of those with opioid use disorder, and it’s our role to increase access to these medications. Using technology and innovative approaches, like this app, we can better equip providers with evidence-based guidelines and resources to treat patients with opioid use disorder,” added LaBelle, who is also with the Grayken Center for Addiction at BMC.
The app was funded in part by the Substance Abuse and Mental Health Services Administration through the Opioid Resource Network and the Massachusetts Department of Public Health.
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