Promoting the Use of Injectable Naltrexone (Vivitrol) in Colorado Staff Training, Patient Screening, Medication Administration, and Payor Source Development Addiction Research and Treatment Services (ARTS)

AIM (Plan) Baseline use of Vivitrol is 0; started screening & dosing in February targets to enhance adoption & utilization: Train and motivate staff Methadone dispensing nurses able to do injections rather than just physicians Promote better screening of potential patients by counselors Reduce no-shows for injection appointments Increase the number of payor sources

Change (Do) Schedule and reinforce multiple trainings: injection procedure (separate nurse training), effectiveness of this new pharmacological treatment, patient selection Devise new Assessment and Screening form to better target potential patients, track counselor behavior for incentives, and reinforce staff training Institute reminder calls for injection appts. tested at primary site to increase show rate and compliance, thus improving outcomes Work with Medicaid and others to increase payor sources and build sustainability beyond life of donated supply

RESULTS (study) Reminder Calls Overall Utilization Patients on naltrexone (Vivitrol)

NEXT STEPS (Act) No additional training needed at this time. Staff are on board. Screenings are increasing: Continue to encourage more widespread screening at our 6 clinics Reminder calls worked: continue, expand to other sites Payor sources are still limited: we have been successful with donations, sample program and Signal “mini-grant”, but need to move beyond this for sustainability. Medicaid billing is in the works (need new provider number, correct taxonomy code and separate NPI). Plan to work with child welfare agencies and probation offices.

IMPACT (Business Case, Lessons Learned) Potential problem with physician slots Program Medical Director requires 1 hour history & physical visit with each client → Physician time is expensive and is prioritized for methadone/buprenorphine intakes. Program cannot afford to purchase additional physician time. Payor source development needs to address cost of physician time. Much better utilization and compliance with injectable form vs. oral form (historical data) ARTS model of methadone dispensing nurses providing the injections at our 3 OTP sites is working quite well Addiction Research and Treatment Services (ARTS)