1. Prestera Center The MAT recipe for continuation *MAT in 6 of 8 counties *827 active clients *Agency employs physicians that prescribe *Med Reviews done in group setting *LPN assistance Key Ingredients  Scripted programCommunity Education  Set practice standardsPhysician buy in  Program specific policiesMeds on Medicaid formulary  Strong LPNClinic set-up  MARS MeetingsAccountability The Wild and Wonderful WV experience Genise Lalos, MA, LSW, AADC-S 2013 Ohio NIATx Buprenorphine Study Kick Off Meeting

2. WV MAT Partners Prestera Center Valley Healthcare System Seneca Health Services Westbrook Health Services WV DHHR

3. Financing of the MAT program State of WV put Bup and Vivitrol on Medicaid formulary Clients self pay Some insurance companies (not many and not much) Drug companies offer indigent care programs Family members of clients Some care coordination programs to prevent re- hospitalization

4. Primary Barrier People don’t know what they don’t know General Community ( and our own staff) were against MAT. The 12- step community was against MAT. At times WV’s regulatory licensing bureau was against MAT. The answer was education, education, education AND having clients speak about their personal experiences. Created MARS meetings.

5. Challenges Diversion was the #1 concern of physicians in prescribing office based Buprenorphine Prescribe 1 week at a time Hold clients accountable for attending required programming and 12 step meetings. Hold staff accountable for holding clients accountable UDS for the presence of Bup in the urine Random pill/film counts

6.  Results * Clients got better*MARS Mtgs successful *Agency made $$$*Physician incentive *More $ available for meds *General Community and staff support MAT because they see the results MAT is a standard practice at the agency now. New staff/clients take it for granted. They did not see the strife that paved the way. They only see their lives being changed. That is exactly how it should be.