IMPLEMENTING A STANDARDIZED OPIOID USE DISORDER SCREENING AND REFERRAL CARE MODEL IN A NORTH CAROLINA ADULT PRIMARY CARE OFFICE

Purpose: North Carolina has experienced significant impacts of the opioid epidemic, with rates of use disorder and unintentional overdose on the rise annually. Despite this, screening and referral for opioid use disorder (OUD) is typically not part of routine primary care. Methods: This pilot implements a standardized OUD screening and referral pathway in an adult primary care office aiming to increase identification of OUD and access to treatment in the patient population. The process was standardized as a clinical pathway, directing screening to be conducted for all adult patients in the practice annually, and offering contact information for local treatment resources and a prescription for Narcan for those who screened positive. Results: The screening portion of the pathway had a 77.86% success rate, indicated by 292 patients receiving the screening of the total 375 patients seen by the NP during the pilot period. Screening rates for OUD increased by roughly 22.6% in comparison to pre-intervention rates for the NP's full patient panel, with the rate at a pre-intervention of 3.4%, and a post-intervention of 26%. There were no patients who screened positive for OUD in this pilot; therefore, the treatment resource portion of the pathway was not administered to any patients. Conclusions: Findings demonstrate that implementation of a standardized OUD screening and referral pathway is highly effective at increasing the rate of screening in the patient population but has consistently low yield. Future research is needed to address potential causative factors of low yield and assess methods to overcome them. Still, increasing rates of OUD screening more adequately assesses the holistic needs of the adult primary care patient population, and better addresses a stigma and shame-carrying condition that is undoubtedly present in the community. Implementation of the standardized pathway starts the conversation about OUD for those who otherwise would not seek help from their primary care, allowing them to feel safe in their disclosure. Medical professionals have an opportunity to further ensure the health and safety of their patients and provide harm reduction interventions, ultimately contributing to a healthier population.