Program development and implementation outcomes of a statewide addiction consultation service: Maryland Addiction Consultation Service (MACS)

Abstract

Background: As the opioid epidemic continues, there is a mounting sense of urgency to improve access to high-quality early identification and treatment services. However, the need is outpacing capacity in many states and effective solutions to support primary care and specialty prescribers to identify and treat more patients with opioid use disorders are still emerging. This paper describes one state’s approach to increase access to medication for opioid use disorders (MOUD) through development and implementation of a statewide addiction consultation service: Maryland Addiction Consultation Service (MACS). Methods: Program components include a warmline, outreach and training, and resource and referral linkages for prescribers based on related consultation service models and documented barriers to prescribing MOUDs. Results: Initial implementation outcomes indicate service components are being adopted as intended and by the target audience; many prescribers who engaged with the service have their buprenorphine waiver (44%) but do not have any additional formal addiction training (57%). Also, statewide penetration is promising with prescriber engagement in 100% of counites, however only 33% of counties in engaged in all four types of MACS services. Most calls (61%) originated from urban counties. Conclusions: The MACS program increases access to specialty addiction medicine consultation and training through use of technology. MACS can serve as a model for other states looking to bridge the gap in access to addiction treatment.

Keywords:

• Opioid use disorder
• buprenorphine
• medication-based treatment
• medication for opioid use disorders
• access to addiction treatment

Acknowledgements

MACS is funded by the Maryland Department of Health's Behavioral Health Administration and is available to prescribers across Maryland at no charge.

Author contributions

All authors were involved in the conception and implementation of the study and approved of the final manuscript. SS collected data, performed analysis, and drafted and revised the manuscript. KC drafted portions of the Methods section and revised the manuscript. EC oversaw analysis, drafted portions of the Methods section, and revised the manuscript. KRF reviewed and revised the manuscript. CW drafted portions of the Introduction and Discussion sections and revised the manuscript. EW drafted portions of the Introduction and Discussion sections and revised the manuscript.

Sources of support

NIMH 1K08MH116119-01A1.

Additional information

Funding

This work was supported by Maryland Department of Health, Behavioral Health Administration. The funding organization had no role in the design and conduct of the study; the collection, management, analysis, and interpretation of the data; or decision to submit the manuscript for publication. The funding organization contributed to the review and approval of the manuscript for publication.