Implementing medication assisted treatment: The Advancing Recovery program

The Robert Wood Johnson Foundation's Advancing Recovery program is testing strategies to promote adoption of medication assisted treatment and behavioral therapies. State (or local) agencies partner with three or more community treatment programs to modify state (e.g., regulations, contracts) and provider (e.g., intake, physician linkages) systems and promote pharmacological or behavioral evidence-based practices for addiction treatment. Advancing Recovery combines systems thinking (analysis of barriers, financing, purchasing and inter-organizational linkages) with process improvement Plan-Do-Study-Act (PDSA) change strategies. Eight of twelve sites addressed medication assisted treatment – Maine, Maryland (Baltimore), Texas (Dallas), and West Virginia increased access to buprenorphine; Missouri and Rhode Island promoted oral alcohol medications and Colorado and Florida worked with injectable long-acting naltrexone. A mixed method evaluation assessed change over time and identified implementation strategies and challenges.

Maine, Maryland and Missouri enhanced linkages with physicians, provided access to medications, and trained clinicians; they made substantial gains in the use of medications. Gains were more incremental in Colorado, Florida, Rhode Island, Texas and West Virginia. Common implementation barriers included a) mechanisms to purchase and pay for medication, b) contract language that constrained provider options, d) contracts and regulations that did not require systems for patient referral to prescribers, e) counselor and physician training, and f) patient education and choice. Initial changes were small to encourage action. State policy interventions evolved through trial and error. Successful states constructed linkages with prescribers and gained access to state pharmacy purchases. Provider and consumer education were essential facets of implementation.