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Background: Medications for opioid use disorder (MOUD) are shown to improve quality of life while reducing risk for overdose and death among people with OUD. The Veterans Health Administration has supported numerous efforts to increase MOUD availability, but a treatment gap persists: among Veterans with OUD, half do not receive MOUD, and over 5000 died from overdose between 2016 and 2021. To improve MOUD adoption in a large VA health system, we developed a care model to identify and proactively engage Veterans with untreated OUD. Methods: The Virtual Outreach Low-Threshold MOUD care initiative (VOLT), a multi-faceted implementation bundle to support MOUD adoption, had 3 core elements: (1) an electronic health record-powered case-finder to identify individuals with untreated OUD and recent OUD-related clinical events (new OUD diagnosis, nonfatal opioid-involved overdose, acute care encounter for OUD, or referral to residential treatment for OUD), (2) case-finder result reconciliation by a physician champion, and (3) proactive tele-outreach to validated cases of untreated OUD by an MOUD prescriber. Results: The Case-Finder identified 526 encounters over a 2-year evaluation period. Most were either flagged for an inaccurate OUD diagnosis corrected by the physician champion (163, 31%), or validated as appropriate for tele-outreach (107, 20%). Of tele-outreach cases, 67 (63%) were contacted, and 37 (55%) were deemed MOUD-eligible. Of these, 28 (76%) initiated MOUD, all opting for buprenorphine. Retention on MOUD was 71% at 3 months and 57% at 6 months. The proportion of health system Veterans with OUD receiving MOUD increased from 44% pre- to 54% post-implementation. Conclusion: VOLT engaged Veterans with untreated OUD and recent OUD-related clinical events in buprenorphine care with high 3- and 6-month retention and was associated with a 10-percentage point increase in system-wide MOUD adoption. This novel care model may complement existing efforts to close the MOUD treatment gap.

Background Amidst the worsening United States drug overdose crisis, the Accreditation Council for Graduate Medical Education (ACGME) instituted requirements for internal medicine (IM) residency programs to provide trainees with core substance use disorder (SUD) instruction and clinical experiences. Negative provider attitudes towards patients with SUDs, however, are a significant barrier to learning and providing standard-of-care treatment. We designed an addiction medicine curriculum for IM residents combining transformative learning methods and core competencies in SUD care with stigma-disrupting learning objectives and messaging strategies. The curriculum was implemented as a five-day core rotation for second year IM residents at a large, urban academic program. Here we report the curriculum’s association with self-reported attitudes towards and preparedness to diagnose and treat patients with SUDs. Methods All participating residents received voluntary pre- and post-experience surveys evaluating self-reported preparedness to diagnose and treat SUDs on a 4-point Likert scale and attitudes towards patients with opioid and alcohol use disorder on the Medical Condition Regard Scale (MCRS). Responses were linked by anonymous unique identifier and analyzed with McNemar’s and paired t-test. The evaluation was approved by the program’s Institutional Review Board. Results Of residents completing the curriculum, 18 of 46 (39%) also completed both the pre- and post- survey. Of those, preparedness to diagnose SUDs increased over the course of the curriculum from 39–100% (p < 0.05) and preparedness to treat increased from 22–89% (p < 0.05). Average MCRS scores also demonstrated large significant increases for both opioid (41.9 to 47.2, p = 0.003) and alcohol use disorders (core pre = 41.3, post = 47.1, p < 0.001), indicating increased regard for patients with these conditions at curriculum completion. Conclusions Our findings build on previous work associating stigma-reducing educational strategies with increased preparedness to diagnose and treat SUDs conditions in a non-self-selected core rotation learner cohort. Medical educators should consider incorporating these strategies when developing ACGME-mandated addiction medicine curricula for IM residents. Clinical trial number: not applicable