Online Training Enables Primary Care Providers in Rural New Mexico to Prescribe Medication for Opioid Use Disorders

Rural primary care practices in New Mexico have expanded on an AHRQ initiative to offer proven medication-assisted treatment to patients with opioid use disorder (MAT for OUD, or MOUD). With AHRQ funding, a program called MOUD ECHO was developed. It uses the Project ECHO format (also AHRQ-funded), which uses video-conferencing technology to train, advise, and support rural healthcare providers. MOUD ECHO works to ensure primary care staff all over the State are trained and supported to use medication in treating patients who have opioid use disorder. As of mid-August 2023, 1,059 primary care providers in rural New Mexico had attended a MOUD ECHO session.

Julie Griffin Salvador, Ph.D., Associate Professor, University of New Mexico Health Sciences Center, developed the program to expand medication-assisted treatment so that rural primary care practices could deliver this lifesaving care to patients. After the initial AHRQ research grant ended, the State of New Mexico stepped in to provide support so that these training efforts could continue.

As of August 2023, Dr. Salvador and her team have delivered a 12-session weekly curriculum remotely to primary care providers from 54 clinics in New Mexico, a largely rural State. Many of the clinics are part of Federally Qualified Health Center (FQHC) systems that treat Medicaid patients.

Primary care providers and clinic staff join the MOUD ECHO program to learn about opioid use disorder, treatment using medications (particularly buprenorphine), harm reduction strategies, stigma, therapies, and other topics. Participants meet key benchmarks along the way during their training, including getting a license to prescribe buprenorphine, beginning prescribing to patients, and increasing the overall number of patients receiving treatment. The hour-long weekly training sessions are held during lunchtime to avoid disrupting patient care appointments. The continuing and ongoing training allows participants to start at any time.

Virtually all (95%) of the participants said the training sessions were relevant and improved their confidence in treating patients with opioid use disorder. Some highlighted the value of the training’s collaborative discussions, commenting that they did not otherwise have the opportunity for such professional interaction in their rural areas. They also valued the video access, saying they would not have been able to get training if travel had been required.

Those who completed the training now are helping address the opioid epidemic in New Mexico, as Chris Alliman, M.D., has. After going through the training, he not only altered his care of patients, he changed his career. When he started the training, Dr. Alliman, a family medicine specialist, was a primary care physician at two FQHCs. He is now the physical medicine director at an Albuquerque substance abuse treatment center.

“Before joining the MOUD ECHO training program, I was not treating patients with opioid disorders. It had been too overwhelming to consider. But now that I’ve gone through the training, I love it and look forward to helping these patients,” Dr. Alliman said.

Mia Lozada, M.D., general internist at Gallup Indian Medical Center, said, “The MOUD ECHO program showed me how safe and truly lifesaving buprenorphine can be for an individual. To be surrounded [virtually] by other providers who were tackling the same clinical questions made this experience far less isolating. Low-barrier access to MOUD is the goal; placing more barriers for the Native American patients we care for would simply perpetuate generations of historical trauma.”

“Inspired by Project ECHO, we created an on-call system at our facility to connect a patient to MOUD care within 24 hours—a goal that didn’t exist before,” Dr. Lozada continued. “We now collaborate extensively with our Emergency Department providers, who are excited to prescribe buprenorphine upon discharge for patients who are at a pivotal moment of change, to be able to bridge them to primary care.”

Dr. Alliman noted, “It’s a wonderful thing to help people struggling with opioids. New Mexico has lost a lot of doctors, so widening primary care abilities has expanded the possibility of treatment to more people.”