Resources and Programs
UR Medicine Recovery Center of Excellence addresses morbidity, mortality, and other harmful effects of the substance use disorder (SUD) crisis in rural communities, with special attention to synthetic opioids. We identify and adapt evidence-based and emerging best practices to be successful in rural communities, and we develop programs and disseminate resources that facilitate their implementation.
To Address a Fundamental Challenge
Community Conversations to Reduce Stigma
- An innovative program that combines artwork—portraits of rural residents who have been affected by substance use disorder—with workshops. The goal is to inspire conversations that break down stigma associated with SUD. We offer workshops for the community at large and for medical staff. We are currently adapting the workshop in partnership with Indigenous communities.
Taking Action: National Rural SUD Health Equity and Stigma Summit
- Held in May 2022, the summit convened leaders from across the country who are dedicated to reducing stigma and promoting health equity for people with SUD. Presentations, articles, and other materials are available on our website.
Resources to Address Not-In-My-Backyard (NIMBY) Responses
- Presentations and fact sheets that provide communities with information about the opioid crisis, addiction as a chronic disease, and evidence-based treatments that support people in recovery. We will also provide information on the benefits of treatment centers and community recovery supports. (To be released in 2023.)
Emergency Department Stigma Campaign
- This 12-month campaign provides 12 posters of individuals in recovery and ED physicians that counter potentially stigmatizing views toward patients with substance use problems and disorders who present to rural EDs. The posters provide QR codes that link to information about treatment resources and brief videos with positive messages about recovery and substance use treatment from the individuals featured in the posters. (To be released in 2023.)
- An approach we have used in rural New York State to create broader access to and community-wide support for mental health and SUD treatment. An Ecosystem of Recovery is a network of individuals and organizations across the rural community, working together and using best practices to ensure effective treatment, care transitions, ongoing support, and sustained long-term recovery for people with SUD. Several practices listed here are part of an Ecosystem of Recovery, which may serve as a helpful framework for other rural communities.
- We offer workshops to help communities identify gaps in SUD treatment infrastructure and build a system of care that supports recovery, along with regular online “office hours” where participants can check in to navigate challenges.
SUD Treatment Clearinghouse
- An online storehouse combining resources from the three RCORP Rural Centers of Excellence—the Fletcher Group, the University of Vermont Center on Rural Addiction, and our center—to offer a wide range of support for organizations addressing the SUD crisis in rural communities.
To Prevent Harm and Save Lives
Naloxone Delivery in Rural Communities
- Resources to develop naloxone distribution programs.
- Strategies to raise awareness about polysubstance use and prevent overdose from combined substances.
Promoting 988 Suicide and Crisis Lifeline
- Materials and a social media campaign to help rural health care teams raise awareness about the new 988 Suicide and Crisis Lifeline.
Developing Community Safe Spaces
- We are conducting a needs and feasibility assessment in Tennessee that will assist rural communities interested in establishing pop-up Safe Spaces—staffed by peers with clinical support available via telehealth—in order to rapidly engage patients in crisis. These are small-scale, lower-cost alternatives to an ED or crisis center, and they are generally more feasible in lower-population-density rural areas. (Assessment results will be available in 2023.)
- We have partnered with SafeSide Prevention to provide suicide-prevention workshops adapted to the needs of service providers and organizations in rural communities, along with ongoing support.
Suicide Prevention and Families
- We are developing a family-focused training on substance use and suicide prevention. The training will be informed by a rapid evidence assessment and interviews with family members in local communities. (To be released in 2023.)
Guidance on Post-Operative Pain Management
- Adaptation of a medical center program that has reduced the use of opioids after elective surgery by helping patients set expectations; providing educational resources to surgeons about post-operative pain, SUD, and diversion; and providing regular feedback about outcomes. The project includes disseminating best practices and tools and supporting communities with implementation. (To be released in 2023.)
To Make It Easier to Access Treatment
In Primary Care:
Telehealth as a Bridge to MOUD in Primary Care
- Telehealth partnership with a remote provider to prescribe maintenance medication for opioid use disorder (MOUD) as a “bridge” until a patient’s primary care provider is ready to provide MOUD locally.
Treatment of Opioid Use Disorder (OUD) in Primary Care Practices
- Training for primary care providers and staff so they can provide more comprehensive care for their patients with OUD or SUD.
Behavioral Health Care Manager (BHCM)
- A clinical staff member in a primary care practice who manages care for people with SUD or mental health concerns and coordinates with other providers to ensure uninterrupted transitions to treatment and support.
Engagement in Care upon Release from Incarceration
- Facilitating partnerships between rural primary care practices and the Transitions Clinic Network (TCN) to increase formerly incarcerated people’s access to care for chronic health conditions, including SUD, and help them navigate services in the community. TCN provides implementation assistance and support to practices.
Primary Care Pain Management
- A white paper about the response of a rural community to the dissolution of two pain-management clinics, which left hundreds of patients with chronic pain without established relationships with primary care, mental health, or other necessary services. The lessons learned may be helpful to other communities. (Coming soon.)
- A pilot program that assists rural primary care practices treating patients with chronic pain, including patients who may have lost access to a pain-management clinic. The pilot model uses a case-discussion format within the practice to guide common treatment challenges. This is supplemented by advice from a pain-management provider and pharmacist, who discuss complex cases with a dedicated physician and nursing leader from the practice. (Results of the pilot will be available in 2023.)
In the Emergency Department (ED):
Behavioral Health Assessment Officer (BHAO)
- A licensed behavioral health provider in a rural hospital ED manages care during the ED visit for patients identified at screening to have SUD or mental health concerns, including coordinating referrals and ensuring smooth transitions to a treatment program as appropriate.
ED-Initiated Buprenorphine Packet
- Comprehensive guide for rural hospitals on the process of establishing an ED-Initiated Buprenorphine program. (Coming soon.)
In Other Nearby Locations:
- Comprehensive guidance on shifting group therapy for SUD to a telehealth format to increase engagement of patients. Joining groups via telehealth can offset barriers around travel and transportation and offer anonymity for individuals in a small community.
Methadone Maintenance Treatment Closer to Home
- The Rural Opioid and Direct Support Services (ROADSS) program establishes auxiliary medication sites in rural communities that are connected via telehealth to an opioid treatment program (OTP) outside the immediate area, enabling patients to receive methadone pharmacotherapy and services locally. Methadone is a medication that controls cravings for opioids and improves retention in treatment programs.
- Development of a mobile methadone unit that will serve rural Upstate New York communities as an extension of Strong Recovery, a certified OTP located in Rochester, New York. This program is being carried out in partnership with SAMHSA, HRSA, and the New York State Office of Addiction Services and Supports.
- A program to identify and assist clinics interested in delivering Cognitive Behavioral Therapy for Treatment Seeking—a low burden, but effective way to expand patient engagement with treatment. The program provides resources, training, and support to clinic staff.