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Medication First

A state initiative in Missouri to prioritize expanding access to medications for opioid use disorder with federal opioid response money

The Missouri Department of Mental Health and Opioid STR/SOR grant partners have developed and disseminated a “Medication First” treatment approach to opioid use disorder in the state. This initiative is similar to the Housing First model developed to address chronic homelessness. The overall goal is to expand low threshold access to medications for opioid use disorder (MOUD) to as many people as possible. Four principles guide implementation of this state policy:

  • Individuals have access to MOUD as quickly as possible and not contingent on lengthy assessments or trainings
  • There are no time limits or arbitrary tapering of MOUD
  • Additional psychosocial services are highly encouraged but not required for individuals to receive MOUD
  • MOUD are only discontinued if a person's condition worsens

Building on evidence that long-term retention in treatment with MOUD improves outcomes, Medication First provides a a crucial, stabilizing resource without conditions (i.e. low threshold). Individuals are able to self-determine their pathway of recovery and re-engage in normal life activities rather than their medication treatment be contingent on group therapy and educational classes. 

More detail on the initiative can be found in this presentation and the linked academic papers below.

A helpful Medication First implementation guide for providers can be found here. 

This initiative led to statewide increases in MOUD utilization, retention in treatment, and timeliness of receiving MOUD treatment.

Continuum of Care
Treatment
Type of Evidence
Peer-reviewed
Response Approach
Medications for Opioid Use Disorder
Peer-reviewed Article
The case for a medication first approach to the treatment of opioid use disorder
Implementation and evaluation of Missouri's Medication First treatment approach for opioid use disorder in publicly-funded substance use treatment programs
Related Resources
Medications for Opioid Use Disorder Save Lives
Opioid Use Disorder: Barriers to Medicaid Beneficiaries’ Access to Treatment Medications
Advancing Access to Addiction Medications: Implications for Opioid Addiction Treatment
Adult Drug Courts and Medication-Assisted Treatment for Opioid Dependence
Routes of Non-Traditional Entry into Buprenorphine Treatment Programs
Medication-Assisted Treatment With Buprenorphine: Assessing the Evidence
Medication-Assisted Treatment With Methadone: Assessing the Evidence
Medication-Assisted Treatment Models of Care for Opioid Use Disorder in Primary Care Settings
Guidelines for Medication for Addiction Treatment for Opioid Use Disorder within the Emergency Department
The Role of Community Health Centers in Addressing the Opioid Epidemic
The Fentanyl Epidemic: State Initiatives to Reduce Overdose Deaths
Medication First.pdf

Evidence of Program Effectiveness

This state initiative has been successful in expanding access to MOUD:

"MOUD utilization increased (44.8% to 85.3%), timeliness of MOUD receipt improved (Median of 8 days vs. 0 days), there were fewer psychosocial services delivered, treatment retention improved at one, three, and six month time frames, and the median cost per month was 21% lower than in the year prior to STR. All differences were driven by increased utilization of buprenorphine." (Winograd et al., 2020)