Getting started with medication-assisted treatment (MAT) for opioid use disorder can be an intimidating prospect, especially for clinicians with no prior experience or training in addiction medicine. UNC Project ECHO was established to help expand access to MAT by ensuring that prescribers have the guidance and support they need to overcome common obstacles.

The program is supported by the federal Agency for Healthcare Research and Quality (AHRQ) and the NC Department of Health and Human Services (NC DHHS). Practice coaching and one-on-one mentoring services are available at no cost to prescribers in all 100 NC counties. UNC Project ECHO also offers regular free virtual Grand Rounds clinics with MAT content appropriate for established and new MAT prescribers, who call in from around the state to participate.

Dr. Robyn Jordan, medical director for UNC Project ECHO and a clinical assistant professor in the UNC School of Medicine’s Department of Psychiatry, said demand for these services has risen in recent months as awareness of MAT has increased. She said the program is generally able to schedule practice coaching sessions or assign mentors within six weeks of receiving a request. Prescribers or practices at any stage of readiness to provide MAT to patients can benefit from consultation. For example, a practice that does not have authorized MAT prescribers or is simply not ready to begin offering treatment could receive coaching on how to implement effective screening and referral for opioid use disorder.

Project ECHO is not unique to UNC. Project ECHO is an established education model in which experts in a specific clinical area educate and train community clinicians, typically using videoconferencing and other information technology. Mountain Area Health Education Center (MAHEC) in Asheville has its own Project ECHO for MAT, which is currently offering a free 5-part videoconference series on office-based MAT.

Having experienced prescribers to consult with on questions and dilemmas can be invaluable to newer MAT providers, many of whom are unused to working with patients with addiction, Jordan said. For example, the first instinct of a new MAT prescriber faced with a patient in relapse may be to cease treatment with MAT medications. Current standards in addiction medicine are much less “all or nothing” and more oriented towards harm reduction, including reduced mortality and decreased use of illicit drugs, Jordan said. Surveys of physicians and patients conducted by the federal Substance Abuse and Mental Health Services Administration (SAMHSA) have found that continued treatment with buprenorphine, for instance, is associated with an 80 percent reduction in illicit opioid use, compared to patients who quit taking buprenorphine.

The harm reduction approach is reflective of the gradual evolution of thinking about addiction as a chronic illness, not unlike heart disease or diabetes. “Patients will have A-1Cs that you don’t like because people are going to eat their doughnuts,” Jordan said. No one would consider it appropriate or ethical to exclude diabetes patients from treatment following “bad” test results, she noted. Instead, patients are counseled, encouraged to make better choices and provided with support. That’s just what quality MAT programs try to do for patients with opioid use disorder, Jordan said.

Learn more about UNC Project ECHO at https://echo.unc.edu/. Contact the program by email at echo@unc.edu or by phone at (919) 966-7104.

Join UNC Project ECHO for virtual Grand Rounds

UNC ECHO offers two main types of call-in MAT clinics. Both are free and provide one hour of CME credit.

General MAT clinics are typically held weekly. Clinics present case-based didactic sessions given by addiction medicine specialists, followed by discussion, recommendations and Q & A.

ABCs for MAT clinics are typically held biweekly and are intended for beginners, including individuals who are not currently providing MAT.

UNC Project ECHO posts its clinic schedule here. Note: the program is currently scheduling clinics for the fall. Be sure to check the site regularly for the most up-to-date information. Find additional training opportunities on NCMB's MAT page.