Special Edition: The Opioid Epidemic

Digest Masthead

April 11, 2018                                                  SPECIAL EDITION: The Opioid Epidemic


Welcome to this Special Edition Digest focused entirely on the opioid epidemic. This edition provides culled and vetted resources listed in one place, to help you meet the challenges of providing substance use disorder (SUD) services in your communities, which are at the frontlines of the epidemic. We have also identified some (we know there are more) promising practices, to share across health centers. 

HRSA supports health centers to provide Patient-Centered Medical Homes (PCMHs) that integrate behavioral health and primary health care, through supplemental grant funding and technical assistance (TA) and training.

With the declaration of the opioid epidemic as a public health emergency, HRSA continues to support health centers to enhance access to primary care-based SUD services, including medication assisted treatment (MAT), as well as pain management and other prevention services. In addition, HRSA is collaborating across HHS and other government agencies to help address issues that affect health centers’ delivery of SUD services, such as reimbursement, policies, regulations and research.


This Health Center SUD Services diagram depicts HRSA’s approach to addressing the opioid epidemic. Please visit HRSA’s brand new opioid webpage that highlights the various ways in which the agency is addressing the opioid crisis.

We know it is challenging to provide SUD services in a primary care setting. To improve our understanding, HRSA held an addictions services listening session at the National Association of Community Health Centers (NACHC) Community Health Institute in August, 2017 and a health center clinicians listening session at the NACHC Policy and Issues Forum in March, 2018. Information from these listening sessions, as well as feedback from other health centers and stakeholders, informs the development of HRSA policies and programs. We want to better assist you with the real-life challenges of being at the frontlines of the opioid epidemic.


Thank you to the highlighted health centers for disseminating their promising practices and aiding in peer-to-peer learning. Please email me to share your promising practices and save this e-mail for easy reference in the future.

Health centers are an essential part of our nation’s health care system. On behalf of the entire staff of the Bureau of Primary Health Care, thank you for everything you do!

Judith Steinberg, MD, MPH
Chief Medical Officer
Bureau of Primary Health Care
Health Resources and Services Administration

Pivotal Reports and Guidelines

CDC Guideline for Prescribing Opioids for Chronic Pain. Related CDC resources include:

Medications for Opioid Use Disorder. SAMHSA TIP 63, February, 2018. Current, comprehensive review with practical information, tools and resources on screening, assessment of appropriate level of care, MAT with dosing guidelines, behavioral health therapy, and peer supports.

MATx Mobile App to Support Medication-Assisted Treatment of Opioid Use Disorder. SAMHSA. Mobile app to support health care professionals providing medication treatment for OUD.

The Surgeon General's Report on Alcohol, Drugs and Health. HHS, 2016. See especially Executive Summary and Chapter 6: Health Care Systems and Substance Use Disorders.

Models of Care

Medication-Assisted Treatment Models of Care for Opioid Use Disorder in Primary Care Settings. AHRQ Technical Brief No. 28, December, 2016. A go-to resource for MAT models of care delivery in primary care, including MA nurse care manager model, Vermont hub, and spoke model.

Primary Care: On the Front Lines of Addiction. A 2016 issue brief, providing an overview of primary care models of addiction services with links to references and evaluations.

Implementing Medication Assisted Treatment for Opioid Use Disorder in Rural Primary Care: Environmental Scan Volume 1. AHRQ, October, 2017. A summary of challenges and potential solutions of implementing MAT in primary care, with emphasis on rural settings, and summary of care models.

Technical Assistance and Training

Toolkits and Websites that Have Multiple Resources

HRSA Opioid Crisis Webpage. Resources, technical assistance, and training to support grantees integrating behavioral health care services into practice settings and communities.

Rural Prevention and Treatment of Substance Abuse Toolkit. Toolkit for implementation of SUD services in rural settings, located on the HRSA-sponsored Rural Health Information Hub; includes models of care and tools/resources for implementation, sustainability, and evaluation.  

Integration of Buprenorphine into HIV Primary Care Settings. Package of training and implementation tools to assist in the integration of SUD, HIV, and primary care; located on the HRSA-sponsored TARGET Center, a website for tools and resources to support the Ryan White Community and others providing HIV care.

SAMHSA-HRSA Center for Integrated Health Solutions (CIHS). National training and technical assistance resource center that promotes the development of integrated primary and behavioral health services.

NIDAMED for Medical and Health Professionals. National Institute on Drug Abuse webpage for resources, CMEs, tools, and trainings.  

SAMHSA Knowledge Network. Training and TA resources accessible at one site.

Medication-Assisted Treatment TA and Training

Opioid Addiction Treatment ECHO. HRSA-sponsored, national technical assistance that supports primary care teams to enhance health center capacity to treat OUD. Bi-weekly virtual sessions with didactic training and the opportunity to present patient cases to receive interdisciplinary clinical expert input. Continuing education credits are offered after attendance at each teleECHO clinic.  

Providers Clinical Support System. A SAMHSA-sponsored, comprehensive set of resources, trainings, and tools on opioid treatment, including pain management. Access to coaching. Provides buprenorphine waiver training for clinicians (physicians, NPs, and PAs).

Addiction Treatment Transfer Centers Network. A SAMHSA-sponsored, nationwide network of regional centers. A multidisciplinary resource for professionals in the addiction treatment and recovery services fields.

Opioid Overdose Prevention Toolkit. SAMHSA, 2016. A guide for health care professionals, communities, patients, and families to prevent and manage opioid overdoses. 

Pregnant Women and Neonatal Abstinence Syndrome TA and Training

Patient Safety Bundles: Obstetric Care for Women with Opioid Use Disorder. A HRSA-sponsored resource providing steps in obstetrics care for women with OUD, with links to resources.

Clinical Guidance for Treating Pregnant and Parenting Women with Opioid Use Disorder (OUD) and their Infants. SAMHSA, January, 2018. Comprehensive and up-to-date resource with practical information and tools.

Pain Management TA and Training

Implementing Medication Assisted Treatment for Opioid Use Disorder in Rural Primary Care: Tools and Resources Volume 2. AHRQ, October, 2017. See Table 1: Tools for the Prevention of Opioid Use Disorder.

Safe and Effective Opioid Prescribing for Chronic PainIncludes vignettes of complicated provider-patient interactions around prescribing opioids for chronic pain. See also:

Six Building Blocks: A Team-Based Approach to Improving Opioid Management in Primary Care. Provides a structured system-based approach for improving management of patients on chronic opioid therapy; includes implementation guide, tools and resources. 

PainNET. Online learning community with tools, discussion forums, blog, and other resources for chronic pain management and safe opioid prescribing. 

Mentoring for MAT providers

Opioid Addiction Treatment ECHO. Also listed in Medication-Assisted Treatment TA and Training section above. Includes virtual mentoring through case consultation by SUD experts.  

Substance Abuse Warmline: University of California, San Francisco’s Clinician Consultation Center. HRSA-sponsored, free, expert clinical advice on substance use disorder treatment for clinicians managing complex patients with addiction, chronic pain, and behavioral health issues. Both online and phone consultations are available. Warmline is accessible by phone toll free at 855-300-3595 and operates from 9:00 a.m.-8:00 p.m. ET, Monday-Friday. Providers can also upload cases online.

PCSS Coaching/Mentoring Program. A SAMHSA-sponsored service that gives providers guidance on prescribing OUD medications. This national network of experienced providers is available at no cost. Mentors provide support by telephone, email, or in person if possible.


Confidentiality of Substance Use Disorder Patient Records – 42 CFR. SAMHSA. Includes a summary of the federal law governing confidentiality for people seeking treatment from federally assisted programs, links to rule-making webinars, and listening session transcripts.  


Telehealth Resource Centers (TRCs). HRSA-sponsored, provides assistance, education, and information to organizations and individuals who are actively providing or interested in providing health care at a distance, website with TA and Training, and access to 12 regional and two national TRCs.

Center for Connected Health Policy. Resource for telehealth state laws and policy, including coverage/reimbursement.

Workforce: Recruitment and Retention, Education Health Centers

HRSA Health Professions Education Grants. Health centers can be eligible applicants or can partner with applicants on health professions education grants and programs, including for behavioral health integration workforce.  

Health Workforce Connector. A HRSA-sponsored recruitment tool. An online site for connecting National Health Service Corps and Nurse Corps candidates with job openings.

HRSA National Cooperative Agreements

Community Health Center, Inc. (CHC Inc./Weitzman Institute). TA and training to expand health centers’ strategies to recruit, develop, and retain clinical workforce. Webinars and learning collaboratives on implementing post-graduate nurse practitioner and clinical psychology residencies at health centers and advancing the team-based care model. Request TA from CHC, Inc.

Association of Clinicians for the Underserved (ACU). Provides training, tools, individual technical assistance, and other resources on clinical workforce recruitment and retention for health centers.Request TA from ACU.

Health Center Promising Practices

Community Care of WV

Onsite integrated pain management clinic, staffed by family medicine clinicians who were trained in pain management by contracted anesthesiologist/pain management specialist. Integrated with behavioral health and primary care; protocols, tools, and forms available; reduces provider burnout and improves performance on pain management measures and other chronic conditions measures.

For more information and resources contact Sarah Chouinard, MD; Chief Medical Officer

Community Health Center Inc., CT

Health center-wide action plan, involving entire health center operations, to: (1) prevent abuse and addiction, (2) improve access to treatment for addiction, (3) reduce contributing factors to abuse and addiction, (4) reduce the number of deaths by opioid overdose, and (5) support and care for individuals and families affected by opioid addiction.

For more information and resources contact Margaret Flinter, Senior Vice President and Clinical Director

Cornell Scott-Hill Health Center, CT
Multi-level addiction services, bidirectional behavioral health and primary care integration, HIV and hepatitis C care integration; coordination with emergency department post-opioid overdose reversal and MAT induction

For more information, contact Dr. Douglas Bruce, Chief of Medicine, Dr. Ece Tek, Chief of Behavioral Health

DotHouse Health, MA

Example of the implementation of the MA nurse care management model: nurse serves as coordinator/care manager of primary care MAT program.

See this article for description of model.  

For more information, contact Rachel King, MD; Director, Primary Care Integration 

El Rio Health, AZ

Pain management SWAT team: clinical pharmacist, LICSW and NP co-manage chronic pain patients with primary care team for 3-4 visits, develop care plan; on-site sports medicine specialist, physical therapy and acupuncture; onsite MAT; pain management dashboard.

For more information, contact Dr. Doug Spegman, Chief Clinical Officer

Family Care Health Centers, MO

Developing multidisciplinary MAT program with peer support specialist, community health worker, social worker care manager; trauma-informed care and health center-wide staff training; includes family medicine residency MAT training.

For more information, contact Dr. Jared Asher, Chief Behavioral Health Officer

Family Health Centers of San Diego, CA

Embedded behavioral health clinicians and certified alcohol and drug counselors in primary care; universal Screening, Brief Intervention and Referral to Treatment (SBIRT) and depression screening with warm hand-offs or referral to behavioral health; three co-located rehabilitation medicine services with sports medicine, physical therapy, and chiropractic care; concentrated mental health program for patients with serious mental illness, MAT program with induction by addictions specialists, and maintenance by primary care.

For more information, contact Fran Butler-Cohen, President and CEO

Oregon Health & Science University (OHSU) Family Medicine at Richmond, OR

Behavioral health-focused model for MAT built on concepts of harm reduction. Multidisciplinary team with masters and doctoral level mental health clinicians, nurse care manager and DATA waivered providers; behavioral health clinicians address underlying mental health conditions, coping skills and relapse prevention; structured workflow for hand-offs and frequency of visits; and embedded in family medicine residency training.

See this article for description of model.

For more information, contact Dr. Nick Gideonse, Medical Director, MAT Program

PCC Community Wellness Center, IL

Behavioral health clinicians embedded in primary care with universal SBIRT and mental health screening; psychiatric NPs with access on-site or via telemedicine; chemical dependency clinic for MAT is hub for assessment, intensive behavioral health, MAT induction and stabilization; primary care continuity clinics are spokes for maintenance MAT; high-risk chemical dependency clinic for combined prenatal care and substance use treatment for pregnant women.

For more information, contact Amanda Brooks, Chief Population Health Officer

Watts Health, CA

Integrated behavioral health in primary care, obstetrics, and SUD treatment facility; universal SBIRT and mental health screening, facilitated by EHR enhancements and warm-handoffs to behavioral health clinicians; EHR interoperability across disciplines; operates multi-level SUD treatment facility; on-site physical therapy; most prevalent substance used: methamphetamine.

For more information, contact Jorge Reyes, Director, Behavioral & Social Services