Over the past two years. CODAC Health Recovery & Wellness Inc. in Tucson, Ariz., has converted one of its facilities from a traditional opioid treatment program (OTP) to a multi-service setting with 24-hour access. At the Rx Drug Abuse & Heroin Summit in Nashville this April, leaders with the organization will discuss the components critical to bringing about a fully integrated health home to address a community's opioid-related problems.
Addiction Professional spoke with CODAC vice president of clinical services Daniel Barden, MS, and medical director for MAT Larry Onate, MD, who will co-present a conference breakout session on April 13.
Editor's note: This interview has been edited for length and clarity.
What was the motivation for establishing the 24/7 program?
Barden: Up until Jan. 1, 2018 we had operated as a traditional MAT clinic. The state had talked to us about creating something with a 24-hour access point. We talked with our members, with people in the community, with our local police department, and one of the things we found out was that there were services scattered throughout Tucson, but when people came to our clinic, we couldn't get them to go to other places also. They would say, “I come here every day,” and to them there was a sense of burden to have to go to other locations. So we started to talk to them about, “What do you need? What would help you?”
What were the initial steps in creating an integrated care site?
Barden: First we brought medical services into the building. We hired a nurse practitioner and a physician. We also added an IOP, and we started doing gender-specific treatment. Our message was, “Whatever you need, you can get here.” We moved some functions over from our other locations. Now this is the only location where we have OB-GYN services. We're also going to be adding yoga.
What were some of the initial challenges in implementing this initiative?
Barden: Working with our neighbors. While we're on a main street, there's a neighborhood association behind us. When we were first coming in there were some concerns about crime and loitering, but we've worked really closely with the neighborhood, and that hasn't happened.
Onate: We've tried to set this up differently from other clinics. We've focused a lot on safety. Our facility still looks pretty new. The patients really take pride in the treatment setting here—that was by design. We've looked really hard at addressing certain behaviors and minimizing them. For every interaction we have, we try to make it therapeutic.
Describe the cooperative nature of the clinical staff's work at this facility.
Barden: We have a “huddle” around each individual member. The psychiatric and medical staff, the recovery coaches, the nurses, they will all be together to talk about what's happening to the person. Then there is a regular one-hour interdisciplinary team meeting each week, where they come together and review the people who are struggling the most. It's a beautiful thing to see input from every person who's treating the patient.
What variables are you using to evaluate the initiative's impact?
Barden: We're looking at folks' recovery in terms of how many are employed, how many who have been homeless are now living in a stable environment, and arrests and rearrests. That's what recovery is really all about. We of course are also looking at substance use data, length of time in treatment, and admissions and readmissions.
Onate: Once you get a good handle on the addiction piece, you see people becoming more interested in their overall health. You see them more engaged in what they will do with their day.
What will be the main takeaways you will share in your session with the Rx Summit audience?
Barden: I want to convey the importance of looking at all of the actions you can take to build an environment that decreases the stigma around accessing services.
Onate: For me, it's the understanding that all of the professionals in the addiction field should have one common goal, involving keeping patients alive and moving them along in treatment. This is a long process. The integration of all providers to be coordinated in these efforts—that's one of the things we're missing.