News & Updates

Thank you to all those who have joined us in previous webinars in our ongoing series “FORE’s COVID-19 National Emergency Response: Maintaining Access to MOUD.”

In our previous webinars, we have focused on the pandemic impact on access to treatment, including  federal and state emergency regulatory changes facilitating greater use of telemedicine, and how to best care for some of our most vulnerable patients during this extraordinary time. We also know that the isolation that comes from sheltering in place can negatively affect those in recovery, many of whom depend on group meetings and other recovery supports, increasing the risk of returning to substance use. Peer recovery coaches have been established as an important component of treatment and recovery programs. This week, we will focus on the challenges and concerns facing peer recovery coaches and substance use navigators during the pandemic.

Please join us on Thursday, May 28^th at 3pm EST as we welcome…

• Julia Felton, PhD, Assistant Professor, Division of Public Health, College of Human Medicine, Michigan State University
• Jessica Magidson, PhD, Assistant Professor, Department of Psychology, University of Maryland
  • NIDA- and FORE-funded researchers focused on the training of peer recovery coaches to improve retention in MOUD

• Karen Fortuna, MSW, PhD, Assistant Professor of Psychiatry, Dartmouth Geisel School of Medicine
  • Engaged in innovative research on the use of technology with peer specialists and peer-delivered mHealth services

• Sadie M. Smith, MSW, Chief Program Officer, Mosaic Group (Towson, MD)
• Dwayne Dean, ICPR, CPRS, RPS, Peer Recovery Advocate, University of Maryland
• Kristen Senters-Young, MA, Director, Women’s Specialty and Prevention Services, Flint Odyssey House
  • Panel of peer recovery coaches and behavioral health professionals that are “on the ground” helping people

… as they lead a discussion on how peer recovery coaches and navigators can effectively and safely help patients sustain their recovery, as well as care for themselves, during the COVID-19 pandemic. An open Q&A session will follow the presentation.

View the recorded webinar | Download webinar slides

We continue to invite you to look at our Resources page for the most up-to-date information and guidance. You can view a recording of our previous webinars below. As always, please reach out with questions and/or resources that you believe would benefits others.

During a time when we must be physically distant from each other to slow the spread of the coronavirus, many of us are finding new ways to stay connected with friends, family members, and colleagues.

Maintaining connections is especially important for people in recovery from substance use disorder, and many are tapping into virtual supports. The Substance Abuse and Mental Health Services Administration has put together a list of programs that have begun offering or have ramped up web-based group meetings, chat rooms, and message boards. Many national programs, including Narcotics Anonymous, are offering virtual meetings. Some are tailored to people recovering from particular types of addiction, and some are tailored to certain groups. For example, Young People in Recovery, a nonprofit that provides life skills training and support to teens and young adults recovering from substance use disorders, is offering several virtual recovery meetings a day as well as social events including group cooking and trivia competitions.

Some states have taken steps to ensure people in recovery can find help during the pandemic. For example, New York State’s Office of Addiction Services and Supports has expanded access via phone, chat, video visit, and safe in-person visits for people looking for treatment or recovery supports. Other states, including Ohio and New Hampshire, have compiled lists of virtual recovery resources.

There are also mobile apps that provide on-demand coaching, tracking tools, and other resources. Some of the best known, including Sober Grid and RTribe, offer free chats and other connections with peers as well as educational resources; access to coaches, counselors, and other professionals comes through subscriptions. The Addiction Policy Forum, an advocacy group created by patients and families, has created a hub for information about COVID-19 relevant to those coping with substance use disorder and offers the free Connections app to help people track their recovery and find support.

Most virtual supports require a connected device (e.g., a computer, tablet, or smartphone), and  many people have limited data plans that may curtail access to virtual recovery supports. California is encouraging stores like Walmart to make it easier for people to access free Wi-Fi while sitting in their cars in parking lots — clearly not ideal but a feasible short-term solution. While many online platforms, including Zoom and Google Meet, are free to use, it’s important for conveners to use password protections and other measures to preserve privacy on these platforms.

Even if people don’t have smartphones or other connected devices, they may be able to use text or phone-based supports. With all the focus on virtual platforms, experts say it’s important to remember that simple phone calls can still provide vital connections. Many other organizations operate free helplines.

States like California distributed laptops and HIPAA-compliant Zoom accounts to many behavioral health care providers so they could continue to offer counseling and other treatment during the pandemic. The recent CARES Act made $200 million in grants available through the Federal Communications Commission (FCC) to some addiction treatment providers, including community mental health centers, to purchase equipment needed for telehealth. The COVID-19 Telehealth Program grants can be used to pay for internet or voice services, remote patient monitoring tools, and tablets or phones to distribute to providers as well as patients. The FCC has also put into place the Connected Care Pilot Program, which targets $100 million in funding to support telehealth services for low-income and other vulnerable residents. If telehealth is here to stay beyond the pandemic, people in recovery will need support so they can stay connected and get help where and when they need it.

This is by no means a comprehensive list. But by providing this range of examples, FORE encourages all types of organizations engaged in treatment and recovery to share these resources and let us know of others; these recovery supports can be life-saving.

Hendrée Jones, Ph.D., Executive Director of UNC Horizons, a residential and outpatient treatment program for pregnant women and mothers experiencing substance use disorder in North Carolina, was recently given the American Society of Addiction Medicine’s R. Brinkley Smithers and Distinguished Scientist Award for her accomplishments in advancing the scientific understanding of addiction and its prevention and treatment. With support from the Foundation for Opioid Response Efforts (FORE), Jones is now preparing to launch Jenna’s Project, named after a patient who died from an opioid overdose shortly after being released from prison. We spoke to Jones about her work and how FORE’s grant funding will help fill an important gap in the continuum of treatment and support services for women.

What motivated you to specialize in this area?
Jones: I can trace it back to childhood. My mother taught children who had severe developmental disabilities and cognitive challenges. Three in particular changed my view of the world and set me on my path. One was a boy who had been affected by exposure to lead paint, another was a girl whose mother had been the victim of violent abuse while she was pregnant, and the third—a girl with my exact same birthday—had full-blown fetal alcohol syndrome. I remember looking at her and thinking, that could be me if my mother drank. My Ph.D. research focused on prenatal inhalant use. As part of that I got to meet women who had substance use disorders while they were pregnant or during the time they were new moms. I fell in love with the patients and their stories of survival. These women were so stigmatized and demonized, but talking to them it was clear they had amazing stories of resilience and survival. It just cemented that I wanted to be part of the solution.

Over the last few decades, addiction medicine and treatment have evolved with our understanding of how substances, as well as adverse childhood experiences and trauma, change brain chemistry. What are some of the most important takeaways for you—particularly as they relate to women?
Jones: I think the big takeaway is that two licit substances—alcohol and tobacco—pose the greatest risk of having long-term negative outcomes on children, far more than illicit drugs. Despite this, there continues to be a misunderstanding that because a substance is illegal, it must mean it’s worse or the outcome should be worse. I don’t think we have effective enough interventions for alcohol and tobacco before, during, and after pregnancy. There is also an over-attribution of problems to prenatal exposure to substances; they are often presented as the only explanation for a poor birth outcome or poor longitudinal outcomes. But we know from the literature that the postnatal environment is equally if not more important. That’s why I am excited that many states are expanding Medicaid for at least one year postpartum. It really should be three years because those are the most critical for child development.

The program you run, UNC Horizons, provides residential and outpatient treatment for pregnant women and new moms with substance use disorder. In what ways is Horizons different from other substance use disorder treatment programs for women?
Jones: Many programs are focused on moms while others focus more on the child or the fetus. We treat the mom, the child, and the relationship. It’s that dyadic work that really sets us apart. We’re helping children understand what moms are trying to say, helping moms understand what the child is trying to say, and helping them communicate with one another. We also focus on praising women for all the positive things they do because we want to model verbal reinforcement that they can use as parents. Many of the women we serve grew up in the foster care system and have been bounced around, often in the care of someone with an active addiction. We want to build on their strengths and help them understand the importance of celebrating milestones in their children’s lives.

How do you assess whether women have experienced trauma?
Jones: We know that 85 percent of women coming into our program have experienced physical, sexual, or emotional abuse if not as children then certainly in adulthood, so we act as though everyone has been exposed. We also know that people who have been traumatized often see the world as unpredictable and unsafe, so women aren’t going to walk in and trust us. So saying very openly and explicitly, here’s what we do, and here’s what we don’t do is important. We are, supervising with some guardrails, but they control their treatment experience. We say here’s a menu of 25 things. Tell us what resonates for you.

How have your operations changed as a result of COVID-19?
Jones: Fortunately, we have had no positive cases across any of our programs, but I am worried about it because we work with a marginalized population—many are women of color who fit the risk factors for contracting COVID-19. To protect patients and staff we moved all of our residential and outpatient groups to the HIPAA-compliant version of Zoom, which means people are still isolated. I’m worried about that because in my view addiction is isolation and the opposite is connection. I’m also worried because across the country we are seeing increased rates of child abuse and neglect. To lessen the risk, our day care workers have pivoted to having Zoom calls with kids, sending them notes, and developing little activity packets for them as well as increasing the support women and children are receiving from a maternal-child therapist team.

What other changes have you made to the residential program to protect women from exposure?
Jones: While we continue to stay open and admit new women and their children, we do this slowly with a move-in protocol that includes a two-week quarantine where we bring the family, their medicine, food, and other needed home items using social distancing. The biggest change is not having visitors and no outings other than to the grocery store, which means more trips so there is social distancing in the vehicles.

What can you tell us about your outcomes? How do you measure them?
Jones: Only about 5 percent of children have low birth weight or are born prematurely, which is better than the state average and certainly better than the national average. More than three-quarters of the women are employed when they complete our program and for women involved with child protective services, 95 percent have their cases closed. It’s fantastic to be listening to our women share when they get their children back.

What are you hoping to accomplish through Jenna’s project?
Jones: We know that people leaving jails and prisons are 40 times more likely to die of a drug overdose in the first two weeks after release. To help them through this dangerous period, we plan to engage women before they are released and meet them at the door to make sure they get treatment for their opioid use disorder. We will also help them get housing, or a job, or reunify them with their children. That’s the whole objective: to help women not just avoid death but thrive.

What challenges do women face with parenting after time spent in prison?
Jones: A lot of times women have an idealistic view that they’re going to walk back into their child’s life and just be welcomed with open arms. Sometimes that happens and sometimes it doesn’t. The child may not know how to respond or doesn’t want to be with them and that just brings up more guilt and shame and can create an opportunity for abuse and neglect. It’s a matter of carefully navigating those relationship dynamics to make sure that everyone feels safe and they are getting the support that is going to be most helpful for everyone.

How will the grant from FORE help?
Jones: It will allow us to have the staff we need for case management and to hire peers to help with recovery. We hope the results of the pilot will demonstrate to our state and others that is a model that works. I’m really thankful that FORE is so innovative and forward-thinking to be willing to invest in Jenna’s Project.

(Picture: Hendrée Jones, Ph.D., center)

Thank you to all those who have joined us in previous webinars in our ongoing series “FORE’s COVID-19 National Emergency Response: Maintaining Access to MOUD.”

In our previous webinars, we have focused on the pandemic impact on access to treatment, including  federal and state emergency regulatory changes facilitating greater use of telemedicine, and how to best care for some of our most vulnerable patients during this extraordinary time. Many of the low barrier access points important for OUD treatment expansion have been disrupted or stressed during the COVID-19 emergency. Last week, our webinar focused on the current emergency department experience. This week, we will focus on the challenges and concerns facing primary care sites treating OUD, with a particular focus on Federally Qualified Health Centers (FQHCs) within the primary care safety net during the pandemic.

Please join us on Thursday, May 7^th at 3pm EST as we welcome…

• Shuchin Shukla, MD, MPH, Faculty Physician and Opioid Crisis Educator, Mountain Area Health Education Center (MAHEC)
• Vaty Poitevien, MD, Chief Medical Officer, Housing Works
• Sue Lin, PhD, MS, Director, Quality Division, Office of Quality Improvement, Bureau of Primary Health Care (BPHC), Health Resources and Services Administration (HRSA)

… as they lead a discussion on the challenges and concerns that Community Health Centers are facing while tackling both the opioid and COVID-19 public health emergencies. An open Q&A session will follow the presentation.

View the recorded webinar | Download webinar slides

We continue to invite you to look at our Resources page for the most up-to-date information and guidance. You can view a recording of our previous webinars below. As always, please reach out with questions and/or resources that you believe would benefits others.

Thank you to all those who have joined us in previous webinars in our ongoing series “FORE’s COVID-19 National Emergency Response: Maintaining Access to MOUD.”

In our previous webinars, we have focused on the federal and state emergency regulatory changes facilitating greater use of telemedicine, how hospitals and clinicians are implementing telemedicine in compliance with new temporary regulatory requirements, and how to best care for some of our most vulnerable patients during this extraordinary time. This week, we will focus on what Emergency Departments are experiencing during the pandemic, the implications for access to OUD treatment through the ED, and the impact on other parts of the delivery system continuum.

Please join us as we welcome Gail D’Onofrio, MD, MS, Chair of the Department of Emergency Medicine at the Yale School of Medicine, Emily Kauffman, DO, Assistant Clinical Professor and Emergency Medicine Physician at the Ohio State University Wexner Medical Center, and Sandra Schneider, MD, FACEP, Associate Executive Director of Clinical Affairs and Past President of the American College of Emergency Physicians, on Thursday, April 30 at 3pm EST, to lead a discussion on the challenges and concerns that Emergency Departments are facing while tackling both the opioid and COVID-19 public health emergencies. The presenters will be joined by Alister Martin, MD, MPP, Emergency Medicine Specialist and Founder of ‘Get Waivered’ at Massachusetts General Hospital, for an open Q&A session following the presentation.

View the recorded webinar | Download webinar slides

We continue to invite you to look at our Resources page for the most up-to-date information and guidance. You can view a recording of our previous webinars below. As always, please reach out with questions and/or resources that you believe would benefits others.

Thank you to all those who have joined us in previous webinars in our ongoing series “FORE’s COVID-19 National Emergency Response: Maintaining Access to MOUD.”

In our previous webinars, we have focused on the federal and state emergency regulatory changes facilitating greater use of telemedicine, how hospitals and clinicians are implementing telemedicine in compliance with new temporary regulatory requirements, and how to create a clinical telehealth environment to keep patients engaged in care. This week, we will focus on what is needed to continue to effectively care for pregnant and parenting women with OUD during the pandemic.

Please join us as we welcome Hendrée Jones, PhD, Professor and Executive Director at the University of North Carolina at Chapel Hill’s Horizons Program, Maridee Shogren, DNP, CNM, Clinical Associate Professor of Nursing at the University of North Dakota, and Mishka Terplan, MD, MPH, Senior Physician Research Scientist at Friends Research Institute, on Thursday, April 23 at 3pm EST, to lead a discussion on the unique challenges and concerns for keeping women with OUD safe and in care through pregnancy and the postpartum period in the midst of the COVID-19 national emergency. An open Q&A session will follow the presentation.

View the recorded webinar | Download webinar slides

We continue to invite you to look at our Resources page for the most up-to-date information and guidance. You can view a recording of our previous webinars below. As always, please reach out with questions and/or resources that you believe would benefits others.

As the nation grapples with the coronavirus outbreak, our work at FORE has not stopped. After awarding our first round of grants in March to 19 organizations that are expanding access to treatment for opioid use disorder (OUD), we’ve been reaching out to grantees and others on the frontlines to hear how the pandemic has been affecting their efforts and how best we can support them.

We have heard about pressing challenges in maintaining access to OUD treatment and recovery services, particularly for people at high risk for complications of COVID-19. Not only can opioid use have negative effects on respiratory and pulmonary health, but many of those coping with OUD are incarcerated and are thus vulnerable to the high transmission rates seen in some jails and prisons. Many others with OUD are low income and/or unstably housed, and thus may not have access to safe shelters, nor to the telehealth tools now being widely used to provide routine care. We also know that the isolation that comes from sheltering in place can negatively affect those in OUD treatment, many of whom depend on group meetings and other recovery supports and can increase the risk that those in recovery will return to substance use. The National Institute on Drug Abuse (NIDA) and many others are already highlighting these critical factors on how the COVID-19 pandemic impacts the work to prevent and treat OUD.

First, FORE is using its capacity as a convener and resource to assist those on the front lines of the challenges at the intersection of the COVID-19 pandemic and the nation’s opioid crisis. Thus far, we have assembled several resources to shine light on strategies that health care organizations, government agencies, and community-based organizations are using to confront these challenges as well as provide a place for up-to-date regulatory and policy guidance under the national and public health emergencies. In response to what we are hearing, FORE launched a weekly webinar series in mid-March and, so far, have conducted webinars on:

• regulatory changes and guidance related to medications for OUD during the COVID-19 pandemic;
• actions taken by state and federal governments to assist those with OUD during the pandemic and outline further steps policymakers could take;
• the impact of COVID-19 on treatment of OUD among people who are incarcerated and ways of ensuring continuous care after release; and
• creating patient-centered telehealth experiences for medication-based OUD treatment.

Each week our panelists include grantees as well as other experts. We are gratified to see the high level of interest in these webinars, which draw several hundred attendees for each session.  In case you’ve missed them, recordings are freely available on our website along with downloadable presentations. Additional resources are being developed around each webinar topic, including a document with answers to questions raised during the webinar and materials such as policy briefs and tools for use in practice.

To promote access to treatment, FORE is also sharing bulletins from the Substance Abuse and Mental Health Services Administration (SAMHSA) and the Drug Enforcement Administration (DEA) that offer guidance on providing medication-based treatment during a public health emergency. And we have commissioned legal advice on the permissibility of four hypothetical scenarios for prescribing buprenorphine during the pandemic under the federal Controlled Substances Act.

We invite you to explore these and other tools for how to sustain access to OUD treatment during the pandemic on our Resources page.

I want to add that this is just the beginning of our response. In the coming days and weeks, we will continue to identify contributions we can make to support patients and providers as they make temporary changes and anticipate future needs. The impact of the pandemic is likely to be felt for a significant amount of time, especially among those with OUD and those working to maintain connection to and treatment for them. We want to ensure that the innovative solutions that emerge from this pandemic are identified and spread to produce long-lasting improvements in access.

FORE wants to hear from those working on the frontlines of the nation’s OUD crisis about your greatest needs and how you may be changing the way you work in response to the coronavirus pandemic. We also hope to hear from patients about how you are experiencing the necessary changes in the health care treatment system at this time. Please write to us at info@forefdn.org.

Thank you to all those who have joined us in previous webinars in our ongoing series “FORE’s COVID-19 National Emergency Response: Maintaining Access to MOUD.”

The abrupt transition to telemedicine to maintain MOUD treatment during the COVID-19 pandemic holds significant impact for providers and patients alike. In our previous webinars, we have focused on the federal and state emergency regulatory changes facilitating greater use of telemedicine and provided guidance for hospitals and clinicians on how to implement telemedicine in compliance with new temporary regulatory requirements. This week’s webinar will focus on the patient experience, specifically how to create a clinical telehealth environment and prepare patients so that there is effective engagement.

Please join us as we welcome Tanya Lord, PhD, MPH, Director of Patient & Family Engagement at the Foundation for Healthy Communities in New Hampshire, Lara Weinstein, MD, MPH, DrPH, Associate Professor of Family and Community Medicine at Thomas Jefferson University in Philadelphia, and Joshua Carter, PsyD, Director of MAT and Addiction Services at Cabin Creek Health Systems in West Virginia, on Thursday, April 9 at 3pm EST, to lead a discussion on the impact of the COVID-19 national emergency on the patient care experience and the importance of preparing patients to adapt to the use of telehealth for effective MOUD treatment. The panelists will provide tools and tips from their own clinical work, as well as review the latest federal and state policies related to this issue. An open Q&A session will follow the presentation.

View the recorded webinar | Download webinar slides

We continue to invite you to look at our Resources page for the most up-to-date information, guidance, and recordings of our previous webinars. As always, please reach out with questions and/or resources that you believe would benefits others.

Thank you to all those who have joined us in previous webinars in our ongoing series “FORE’s COVID-19 National Emergency Response: Maintaining Access to MOUD.”

Building off last week’s webinar, and in response to several questions we have received, we will focus this week’s webinar on the implications of COVID-19 emergency measures for those with opioid use disorder (OUD) in correctional facilities. Please join us as we welcome Nickolas Zaller, PhD, Professor at the University of Arkansas for Medical Sciences Fay W. Boozman College of Public Health, Nicolas Terry, Executive Director of the Hall Center for Law and Health at Indiana University Robert H. McKinney School of Law, and Jodi Manz, MSW, Project Director for Chronic and Vulnerable Populations at the National Academy for State Health Policy (NASHP), on Thursday, April 2 at 3pm EST, to lead a discussion on the impact of the COVID-19 national emergency on the current treatment of OUD for those who are incarcerated and the importance of ensuring a safe release to optimize continuity of care. The panelists will review the latest federal and state policies related to this vulnerable population. An open Q&A session will follow the presentation.

View the recorded webinar | Download webinar slides

We continue to invite you to look at our Resources page for the most up-to-date information, guidance, and recordings of previous webinars. As always, please reach out with questions and/or resources that you believe would benefits others.

Due to the tremendous response to our webinar last Thursday, FORE is developing a weekly webinar series to continue to provide information and board support to those on the frontlines maintaining access to opioid use disorder (OUD) treatment and recovery services during the COVID-19 pandemic.

Building off of last week’s successful webinar, please join us as we welcome Jocelyn Guyer, MPA, Managing Director at Manatt Health, and Jodi Manz, MSW, Project Director for Chronic and Vulnerable Populations at the National Academy for State Health Policy (NASHP) for a discussion on emerging federal and state actions and opportunities to assist those with OUD through the COVID-19 pandemic this Thursday, March 26 at 3pm EST. They will review the latest federal and state guidance focused on what can be done to support people with OUD during the response to the pandemic. The presenters will include case studies and concrete examples from states and localities around the country. An open Q&A session will follow the presentation.

View the recorded webinar | Download webinar slides

We continue to invite you to look at our Resources page for the most up-to-date information and guidance. As always, please reach out with questions and/or resources that you believe would benefits others.

Update, 3/19/2020: FORE has posted an Opinion Letter with a legal analysis of four hypothetical scenarios for prescribing buprenorphine for OUD during the COVID-19 public health emergency. You can find it in our Resources section with other updated guidance from Federal agencies. The recorded webinar and slides are also now available for download below.

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As the nation rapidly evolves its efforts to contain the coronavirus outbreak, FORE has been in contact with our grantees and others on the frontlines in an effort to identify the most pressing challenges in maintaining access to opioid use disorder (OUD) treatment and recovery services. We hope that by generating this information, and helping to identify solutions, we can provide some broad assistance during a time of such uncertainty.

We will be using our website and LinkedIn page to draw attention to unmet needs and the strategies that health care organizations, government agencies, and community-based organizations are using to confront them.

We invite you to look at our Resources page for valuable information — including recently produced guidance from our California Bridge grantee at the Public Health Institute. This guidance outlines strategies for serving OUD patients who face serious risks pursuing face-to-face care during this pandemic.

Working with FORE, Dr. Hannah Snyder, Co-Principal Investigator of CA Bridge, will conduct a national webinar this Thursday, March 19 at 3pm EST. The webinar will highlight their guidance on how we can think creatively about using telemedicine and other tools to reduce barriers to access and ensure support is available to those in recovery as in-person meetings are temporarily limited. In addition, we will be joined by Jodi Manz, MSW, Project Director for Chronic and Vulnerable Populations at the National Academy for State Health Policy (NASHP) and Daniel McClughen, Esq., Associate at DCBA Law & Policy, to answer your questions concerning evolving regulations and newly issued guidance around MOUD during the pandemic.

View the recorded webinar | Download webinar slides

If you have not seen it already, we also highly recommend a recent post on the blog of Nora Volkow, M.D., Director of the National Institute on Drug Abuse, which highlights the added risks populations with substance use disorder face. Additionally, new SAMHSA guidance for opioid treatment programs was released yesterday.

We will be working with partners to continue to develop and share information in response to pressing questions related to maintaining access to treatment during this time. Please reach out with questions and/or resources that would benefit others so we can share them.

Today, FORE announced its first round of grant awards. We are proud to support 19 organizations that are working to increase access to opioid use disorder treatment in diverse and innovative ways. They demonstrate an array of models of working on the frontlines to end the opioid crisis.

These 19 projects were selected from a highly competitive field of more than 400 applicants; the selection process was informed by reviews from 50 independent experts. Our grantees will be working to expand access to treatment for vulnerable populations, including pregnant women, the homeless, and those just released from jails or prisons who are at high risk of relapse and overdose deaths. From remote areas of Alaska and Alabama to New Hampshire and New York City, they are working to engage and educate health care providers and fielding peer support workers and doulas to forge relationships that lead to lasting recovery.

Others are helping to develop and spread new care models that leverage telemedicine to reach patients in remote, underserved areas or build capacity in emergency departments, which can play a vital role in initiating treatment and routing patients to ongoing care. Still others are doing the important work of identifying what’s most effective and why, generating insights for policymakers and payers.

As a group they are promoting access to opioid use disorder treatment across the U.S., with a particular focus on urban, rural, minority, tribal, and low-income communities that lack resources to meet patients and families’ needs. Visit Our Grantees page to learn more about these organizations and their plans for spreading innovative, evidence-based solutions to the crisis.

As we support our grantees in achieving their goals, we will be looking to fund additional work as part of a comprehensive approach that includes educating professionals about opioid use disorder prevention and treatment; developing sustainable payment approaches; informing state and federal policies to ensure access to care; and raising public awareness of effective strategies to end the crisis.

Download: Full Press Release | Media Kit

The leadership of the Foundation for Opioid Response Efforts (FORE) is dedicated to deploying our resources in the most impactful way. To do so, we convened four advisory meetings over the past several months, with the aim of understanding the range of existing approaches to opioid use disorder (OUD) prevention and treatment and how we might contribute through grantmaking, convenings, partnerships, and information dissemination.

The program advisory meetings were also an opportunity to seek guidance on areas of work FORE should avoid — either because they duplicate other efforts, have too narrow a focus, or are unlikely to have an impact. Engaging experts in state and federal policy, addiction medicine and primary care, pharmacy, criminal justice, health insurance, rural health, veterans’ health, women’s health, and other fields informed our first request for proposals on access to treatment, as well as the selection of our inaugural grants, which will be announced shortly.

In the meantime, we wanted to share summaries of the discussions and recommendations of our experts. The following three summaries are now available in our new Resources section of our website:

• Access to Treatment: Vulnerable Populations
• Medical Education and Training
• Access to Treatment: Delivery System and Payment Models

A fourth summary, on Improving Clinical Practice of Pain Management, will be available soon.

Our first advisory meeting, which focused on access to treatment, offered a sobering account of the challenge: only one of nine people coping with a substance use disorder receives treatment. As with other parts of our health care system, there are racial, economic, and geographic disparities in who gets treatment, with certain groups — including minorities and those involved in the criminal justice system — at particular risk. Poor access to effective treatment equates to higher mortality. Participants also noted that many people coping with OUD need more than medical treatment to rebuild their lives, including counseling and wraparound supports.

In June, we heard from experts about ways to train and equip the next generation of clinicians to help prevent, identify, and treat opioid addiction. Experts emphasized the importance of giving medical students and residents opportunities to see the effectiveness of OUD treatment firsthand in hopes of reducing bias against what some may see as “difficult” patients. They also called for development of new models that bring clinical specialties together and foster interdisciplinary training so that students of the health professions — including physicians, nurses, social workers, pharmacists, dentists, and others — learn to work as a team to provide care.

During our July advisory meeting, we explored health care delivery and payment reforms that may help expand access to OUD treatment. The group considered innovative models such as Vermont’s hub-and-spoke approach, in which specialized drug treatment centers treat the most clinically complex patients are connected with  primary care practices who are supported to be able to treat those with less complex needs. Others pointed to the health home model, which has been used to offer coordinated physical and behavioral health care for people with multiple chronic conditions, including mental health and substance use disorders. Participants suggested that peer support coaches and telehealth tools could help engage more people in treatment. Expansion of the clinical workforce, better performance metrics, and new payment policies would be needed to help spread and scale effective treatment models.

Our sincere thanks to the many leaders who contributed their time and expertise to these discussions. We will continue to draw on their suggestions and hold additional advisory meetings as we move forward.

(Picture: Participants in our first advisory meeting on ‘Access to Treatment’ included (from left to right) Mary Wakefield, Ph.D., R.N. (Chair), Elizabeth Connolly, Mishka Terplan, M.D., M.P.H., Kelly J. Clark, M.D., M.B.A., Judge Peggy Fulton Hora (retired), Loretta Finnegan, M.D., Douglas Olson, M.D., Hendree Jones, Ph.D., and Mark Levine, M.D.)

We are pleased to welcome H. Westley Clark, M.D., M.P.H., J.D., Dean’s Executive Professor of Public Health at Santa Clara University, to FORE’s board. Clark is a psychiatrist, lawyer, and expert on substance use disorder and treatment, pain management, and psychopharmacology. He also brings a wealth of knowledge about the legal, ethical, and policy issues associated with addiction and behavioral health.

“Dr. Clark knows firsthand what works to help people diagnosed with substance use disorder — and how our policies and regulations can impede or catalyze access to treatment,” says Andrea Barthwell, M.D., FORE’s board chair. “We’re thrilled to have his leadership”.

As director of the Center for Substance Abuse Treatment at the federal Substance Abuse and Mental Health Services Administration (SAMHSA) from 1998 to 2014, Clark led the nation’s effort to make evidence-based addiction treatment more accessible to all Americans. That work informed his contributions to Facing Addiction in America: The Surgeon General’s Report on Alcohol, Drugs, and Health, for which he served as the section editor for treatment in 2016.

He also spent more than a decade providing clinical care to our nation’s veterans, first as the chief of the Substance Abuse Inpatient Unit and later as chief of the Associated Substance Abuse Programs at the Department of Veterans Affairs Medical Center in San Francisco, Calif.

Dr. Clark has been a strong advocate for preserving the privacy protections that prevent the unauthorized disclosure of a patient’s treatment for substance use disorder, which is vital to encouraging people to seek care. “No other medical condition evokes the same societal prejudice or sanctions as addiction,” Dr. Clark wrote in an editorial for STAT. He has also written about the role of trauma in substance use disorder and the importance of integrating other medical services, including hepatitis treatment, into addiction care.

Clark has received several awards, including: the 2015 Lisa Mojer-Torres Award from Faces &Voices of Recovery, the 2015 James Ralph Memorial Award for Outstanding Public Service from the Black Psychiatrists of America, the 2015 Annual Award from the American Society of Addiction Medicine, and the 2008 John P. McGovern Award from the American Society of Addiction Medicine.

Clark earned a B.A. in chemistry from Wayne State University. He earned his M.D. and M.P.H. from the University of Michigan and completed a psychiatric residency at its University Hospital Neuropsychiatric Institute. He also completed a fellowship in addiction psychiatry at San Francisco Veterans Affairs Medical Center. He is board certified in psychiatry with a specialty certification in addiction medicine from the American Board of Preventive Medicine. Dr. Clark earned his J.D. from Harvard University Law School and is a member of the Washington DC Bar.

“I’m honored to be part of FORE’s efforts to increase access to treatment for opioid use disorder and promote innovative solutions to a pressing public health crisis,” Clark says “It’s an opportunity to bring my experience to bear on an issue I care deeply about.”

As the year comes to a close, and before we usher in a new one, we at FORE wanted to express our gratitude to every person who has advised us, worked with us, and responded to our inaugural request for proposal.

Our first year as an organization has been filled with many positive and inspiring experiences as we worked to build FORE’s infrastructure and programming, and we thank each and every one of you who has helped to fulfill our objectives. We have enjoyed each and every partnership we have had the pleasure of making and look forward to many more.

The team at FORE wishes you happy holidays, and best wishes for a wonderful new year!

We are pleased to welcome Richard Schottenfeld, M.D., professor and chair of the Department of Psychiatry and Behavioral Sciences at Howard University College of Medicine, to FORE’s Board of Directors. Schottenfeld is an innovator in the field of addiction medicine and the integration of treatment for substance use and other psychiatric disorders in primary care settings.

“Dr. Schottenfeld brings a unique combination of academic rigor and hands-on experience,” says Andrea Barthwell, M.D., FORE’s board chair, the founder and CEO of Two Dreams, and medical director at Encounter Medical Group. “From his early experience as a general practitioner in rural Wyoming to his current efforts to bring treatment and recovery services into urban, community-based settings, he has consistently responded to the needs of patients and found practical ways to help. The urban primary care clinic he directed served as a model for integrating substance use treatment to primary care.”

Schottenfeld also led some of the early studies of medication-assisted treatments for opioid use disorder in primary care clinics and physicians’ offices. His studies of buprenorphine helped lead to approval in the U.S. of buprenorphine for treatment of opioid use disorder outside of specialized narcotic treatment programs.

“The thrust of my career has been to make substance use disorder treatment more readily available to more people,” says Schottenfeld. “I am thrilled to be joining FORE’s efforts to identify what’s working and spread innovative models around the nation.”

As a leading clinical researcher and educator, Schottenfeld has authored more than 125 peer-reviewed publications, directed training programs in addiction psychiatry, and led post-doctoral drug abuse clinical research. He also created an interdisciplinary faculty development program that has produced a cadre of faculty in internal medicine, obstetrics and gynecology, pediatrics, and psychiatry leading to the development of substance use disorders training, clinical services, and research in their departments.

Schottenfeld earned a B.A. from Yale College, graduating Phi Beta Kappa, magna cum laude, and with distinction in English literature. After earning an M.D. degree from Yale, he completed an internship in internal medicine at the Mt. Sinai Hospital in New York City before working for a year as a general practitioner in Hanna and Green River, Wyoming. He returned to Yale to complete psychiatry residency training and a Robert Wood Johnson Clinical Scholars Program clinical research fellowship.

In this season of giving thanks, I wanted to express my sincere appreciation to the many of you who submitted proposals during FORE’s first-ever request-for-proposal (RFP) process. We received more than 440 responses from organizations in 46 states, representing those working in academia, nonprofits, public charities, government agencies, health systems, and federally qualified health centers. As we hoped, the proposed projects further FORE’s four overarching goals:

• Educating providers about opioid use disorder (OUD) prevention and treatment
• Expanding and sustaining evidence-based treatment and payment approaches
• Informing state and federal policies
• Raising public awareness of effective strategies to curtail the opioid epidemic

The volume of proposals vastly exceeded our expectations and has made the process highly competitive. In this initial round, we invited full grant proposals from about 20 percent of the organizations that submitted letters of intent. We will announce our first grant awards by the end of January. In the meantime, I want to share a few of our observations so far.

Even with public dollars and other resources, there is still substantial room for a small foundation to help. We were heartened to hear about the incredible work taking place in communities around the country and have gained a clearer understanding of how we might help. At the same time, we realized some applicants may be unaware of the availability of state and federal funding for their efforts. It seems clear that government leaders can do more to raise awareness when there are state and federal grants for certain direct services, such as telehealth-based treatment or naloxone supplies. It may also help if we share information with other funders about unmet needs identified during the RFP process.

There is a pressing need to build the nation’s behavioral health infrastructure. The proposals laid bare the fact that behavioral health services were few and far between in many parts of the country well before the opioid crisis increased demand. Today, psychiatrists, primary care providers, and other prescribers as well as counselors, coaches, and other professionals are struggling to deliver OUD treatment to all in need. These professionals need training opportunities and ongoing support.

Several efforts target vulnerable populations. We received proposals from people working in rural, urban, Native American, and other communities where people may be particularly vulnerable because they have low incomes, poor health, and/or limited access to care. The populations they serve are diverse, from pregnant women and mothers trying to juggle treatment with parenting to people just released from jails and prisons who are at high risk of relapse, overdose, and death. Our goal is to ensure that all those in need are served.

More clarity on FORE’s funding priorities is needed. We received nearly 200 responses to our survey asking for feedback on the RFP process. The most common suggestion was to offer more details about what we do and do not fund. Our first round of grants will do just that by enabling us to share concrete examples.

We are thankful to all those who have taken the time to submit proposals. In early 2020, we will continue to fund new opportunities and we hope you remain part of our network. The work of each and every one of you is vital to ending the opioid crisis.

(Picture: FORE’s inaugural RFP elicited proposals from over 440 organization from 46 states.)

Earlier this month, my staff and I visited Huntington, W.V., a city that made headlines in 2016 after 26 residents overdosed in a four-hour period. Leaders of this small Appalachian city bordering Kentucky and Ohio have strived to understand the problem by working with researchers to identify the rates and types of injection drug use, the demographics of those affected, and the problems they face. Now the city is emerging as a leader in finding and implementing solutions. During our visit, we saw how city leaders and their community partners have rallied around residents suffering from opioid use disorder by promoting harm reduction and increasing access to treatment.

For example, in December 2017, the city established a Quick Response Team (QRT) through their Cabell County Emergency Medical Services. The QRT includes a paramedic, a peer recovery coach, a clergy member, and a police officer. Team members reach out within 72 hours and often sooner to residents whose opioid overdoses were reversed when paramedics administered naloxone. They encourage people to seek treatment or promote harm-reduction strategies for those who are not yet ready to do so—visiting multiple times in efforts to persuade people they care about their recovery. The approach is modeled on a program in Colerain Township, a suburb of Cincinnati, Ohio, and was launched with $1.35 million in federal grants. Team members’ persistence and resourcefulness have been remarkable. Not only will they search for available beds in treatment facilities and help people enroll in Medicaid coverage, they’ve even driven some to other states for care. Their knowledge of and presence in the local community contributes to their success: they’ve reached about half of those identified through the emergency medical response system or referrals from concerned family and friends and connected roughly a third of those with treatment.

We also visited PROACT (Provider Response Organization for Addiction Care and Treatment), a nonprofit organization offering medication-based treatment, therapy, education, job training, and other support services within the Valley Health federally qualified health center. It also includes a pharmacy and play space for children whose parents are receiving services and offers group and spiritual counseling. PROACT was developed by local health care providers who came together to fill gaps in local services and collectively finance them.

Community leaders are also thinking about the supports people need during the vulnerable period following initial treatment. Last year, Huntington City Mission, Marshall University Joan C. Edwards School of Medicine, and Marshall Health launched Project Hope for Women and Children, a transitional living facility for new and expectant mothers that provides peer and residential support, life skills training, and mental health services. It can house women and their children for up to six months, allowing them to continue in treatment and receive counseling and job training services.

Finally, we had the opportunity to meet with local foundations, including our host organization, The Pallottine Foundation, that have supported these and other efforts and are now working to spread lessons across West Virginia and beyond. They are also focusing on what Huntington needs to sustain current initiatives and build a healthier community for the future. One strategy for doing so is placing social workers in elementary schools, where they offer support to children living with parents or other adults struggling with addiction.

The visit to Huntington serves as an important reminder of why we do this work and suggests that a having a vision for a better future, collaboration, commitment, and compassion are key ingredients in efforts to curtail the opioid crisis. We also witnessed the value of projects that are embedded in the community and reflect local values, culture, and leadership. The city has seen a 25 percent decline in overdose death rates since this work got underway.

(Picture: The Quick Response Team—which includes Larrecsa Cox, a paramedic with Cabell County Emergency Medical Services; Virgil Johnson, a faith leader; and Sue Howland, a peer recovery coach with Prestera Center—has been known to make as many as eight attempts to reach someone.)

Over the past few months, my colleagues and I have visited several states that have been hard hit by the opioid epidemic — among them Maine, North Carolina, Ohio, and Pennsylvania — so we could hear from those developing innovative solutions. We learned a lot and wanted to share some of our insights.

We can leverage the strengths of people with lived experience.

In Maine, where I attended Governor Janet Mills’ Opioid Response Summit, I saw how important it is to engage people directly affected by the opioid epidemic. Each session was launched by a person in recovery or a family member. One of the most memorable sessions was led by a young man who spoke about the obstacles he overcame to find treatment—not just for his addiction, but also for other serious health problems. His story illustrates the value of models that integrate primary care, behavioral health care, and addiction treatment. Understanding patient experiences is essential to refining our treatment approaches and tailoring services to the needs of different groups.

Those who have successfully navigated treatment for opioid use disorder (OUD) can also engage others. In Ohio, we met peer recovery coaches at Ohio State University’s (OSU) Wexner Medical Center. The coaches forge relationships with people arriving in the ED after an overdose in an attempt to engage them in treatment. This itself is a sign of progress: ED physicians told us a year ago they mostly revived people from overdoses; with the spread of naloxone, physicians are now more likely to see people who’ve already been revived and may be ready for longer-term help. Peer coaches are key to establishing trust, OSU’s physicians and nurses told us, because their lived experience demonstrates recovery is possible, even if people aren’t yet ready to accept help.

We must take a holistic approach to OUD treatment.

We also observed two programs for pregnant women coping with OUD. OSU’s medical center hosts a comprehensive program for pregnant women with OUD. In addition to taking part in group prenatal sessions, women receive medication-based treatment (MBT) and counseling from a team that includes a maternal/fetal medicine specialist, an addiction medicine fellow, and peer recovery coaches.

The Horizons program at the University of North Carolina (UNC) offers a similarly holistic package. The residential and outpatient program for pregnant women offers prenatal care, MBT, counseling, and supportive services. Some women stay for as long as a year, receiving well-child care as well as job and parenting training.

Programs that offer holistic treatment and wraparound supports help women deliver healthy babies and rebuild their lives. Horizons also provides a model for other health care programs on how to leverage diverse funding streams to support women for up to a year.

We need to support people during vulnerable transitions.

Our visits demonstrated how important it is to offer support over time — especially during moments when people may be most vulnerable. At OSU’s medical center, leaders try to connect women with other sources of treatment after the six-week postpartum period, but they worry they will struggle without having integrated medical, behavioral health, and social supports.

At the University of Pittsburgh Medical Center (UPMC) and elsewhere, teams are working to create strong guardrails to steer people from the ED to ongoing treatment. UPMC’s addiction consults team comes to the ED to assess overdose patients and recommend treatment plans.

Thank you to our hosts who so generously shared their experiences. We need to learn from organizations like these about how best to support people making transitions from one treatment setting to another, or through different stages of recovery.

In future President’s Updates, I’ll share lessons from our upcoming visits to West Virginia and other states.

(Picture: FORE president Karen A. Scott, M.D., M.P.H., meets the thriving two-month-old son of a Horizons participant, who is benefiting from the program’s array of addiction treatment and social supports.)

After receiving an overwhelming response to the RFP, we are asking for your feedback!

We had a tremendous response to FORE’s inaugural Request for Proposal (RFP) and are looking forward to developing a strong network of grantees, partners, and collaborators. Applicants who submitted a Letter of Intent by the deadline can expect a confirmation of receipt email by the end of the week.

Over the next few weeks, we will be reviewing all the submissions. In the meantime, we would love to get some feedback on your experience with the process so far. You can help us improve, whether or not you submitted an application, by completing our brief anonymous survey.

Click here to complete the survey.

We thank you for all your efforts of furthering our collective goal of bringing an end to the opioid crisis.

Dr. Karen Scott speaks about FORE’s unique opportunity as a private foundation

On August 6th, 2019, the Foundation for Opioid Response Efforts (FORE) President Dr. Karen Scott spoke with Gary A. Enos, Editor at Addiction Professional. Dr. Scott outlined her journey since joining FORE and how she approached building the Foundation’s infrastructure. With a focus on the FORE’s first Request for Proposal (RFP), Dr. Scott expressed the Foundation’s goal of supporting organizations that can connect underserved and vulnerable populations to evidence-based opioid use treatment and recovery services.

You can find the full article at Addiction Professional.

In conjunction with the release of the inaugural RFP, FORE held an open webinar to introduce the Foundation and provide information and respond to questions regarding the inaugural ‘Access to Treatment’ RFP.

On August 1, 2019, the Foundation for Opioid Response Efforts (FORE) held a webinar to provide information regarding the Foundation and to respond to questions related to the recently released “Improving Access to Opioid Use Disorder Treatment and Recovery Services for Underserved Populations and Communities” Request for Proposal (RFP).

FORE President Dr. Karen Scott began by giving an introduction about the Foundation’s origins and vision: To inspire and accelerate action to end the opioid epidemic. Dr. Scott also discussed what FORE’s approach to developing programs, partnerships, and grantmaking will be as the Foundation continues to grow. FORE Senior Program Officer Dr. Ken Shatzkes then spent time going over how the Foundation developed the inaugural ‘Access to Treatment’ RFP. The RFP was heavily informed by expert Program Advisory meetings that FORE convened in early 2019. Dr. Shatzkes covered many topics related to the RFP, including target projects the Foundation is interested in, eligibility guidelines, as well as FORE’s grant selection process. The second part of the webinar included a 30-minute Q&A session where participants were able to ask a wide variety of questions.

There was an overwhelming response to the webinar, as registration reached maximum capacity. Of 520 registered participants, over 430 people representing 45 different States attended the webinar. The slide deck, recorded webinar, and an FAQ are now available online for viewing.

The Foundation’s first RFP is focused on improving access to appropriate opioid use disorder treatment and recovery services for underserved and vulnerable populations.

The Foundation for Opioid Response Efforts (FORE) is proud to release the Foundation’s inaugural request for proposal (RFP): “Improving Access to Opioid Use Disorder Treatment and Recovery Services for Underserved Populations and Communities.” The purpose of this RFP is to help providers and communities develop ways to treat their most vulnerable and underserved populations with OUD by creating and/or evaluating innovative programs and policy proposals that improve access to a continuum of care of appropriate addiction treatment, including wraparound and recovery supportive services, or that expand upon existing promising models.

As a national foundation, FORE is committed to funding a diverse cohort of projects across the United States. Competitive applications will demonstrate innovative and creative ways to remove barriers to OUD treatment and recovery services for underserved populations that could credibly demonstrate the potential to be scaled to a national level to reach the largest number of patients and have the greatest impact.

Applicants may request up to $300,000 annually for up to two years. All applications must be submitted by email to AccessRFP@ForeFdn.org by 11:59 PM EST on August 25, 2019.

For more information, please download the RFP documents here.

Dr. Karen Scott joined other prominent experts in the field on a panel to discuss rural lessons learned from the opioid crisis. Dr. Scott introduced the foundation and discussed the importance of collaboration to support best practices making an impact in these communities.

On May 30, 2019, Foundation for Opioid Response Efforts (FORE) President Dr. Karen Scott participated on a panel focused on “Early Lessons Learned from the Opioid Epidemic” at the 7th annual Public-Private Collaborations in Rural Health Meeting, co-hosted by the Federal Office of Rural Health Policy at the Health Resources and Services Administration (HRSA), Grantmakers in Health (GIH), and the National Rural Health Association. Along with co-panelists from two federal agencies – HRSA and the White House Office of National Drug Control Policy (ONDCP) – and a regional foundation funding projects in West Virginia, – the Claude Worthington Benedum Foundation – Dr. Scott had the opportunity to introduce FORE, provide some background on issues of importance to the foundation, and describe the foundation’s early activities responding to challenges facing rural communities across the country.

The impact of the opioid crisis on rural communities is well documented. Disparities in access to healthcare, along with social and economic depression, is reflected in data which show both the high mortality rates from opioid overdoses and low rates of treatment. Federal agencies are working to target funding to these much-needed areas. In addition, the panel discussed ways in which private foundations have and can contribute to addressing local challenges – through support for specific projects, as well as partnering with public agencies and other foundations. This was an important opportunity for FORE to introduce our planned Request for Proposal on ‘Access to Treatment’ and connect with many local funders and federal agency leads.

FORE Board Chair Dr. Andrea Barthwell’s webinar focused on the need to identify new approaches and enhance and expand existing policies and programs proven to reduce opioid use disorder, addiction, and overdose.

The fast-evolving nature of the U.S. prescription opioid, heroin, and illicit fentanyl crisis can make it difficult to stay on top of timely issues and opportunities to make a greater impact. During the webinar, FORE Board Chair Dr. Andrea Barthwell, former President of the American Society of Addiction Medicine (ASAM) and Deputy Director for Demand Reduction in the White House Office of National Drug Control Policy (ONDCP) under President George W. Bush, introduced the Foundation of Opioid Response Efforts (FORE). She provided a concise overview of the opioid crisis based on her thirty years of experience in addiction medicine and shared how FORE plans to take action to address this public health challenge.

Dr. Barthwell shared FORE’s mission: To convene and support partners advancing patient-centered, evidence-based solutions addressing the opioid crisis. She described FORE’s intention to inspire and advance activities to address this public health emergency. With patients at the center, FORE’s areas of focus include provider education, payer strategies, policy Initiatives, and public awareness. Dr. Barthwell also announced that FORE will be convening advisory meeting panels with leading experts and stakeholders to advise Foundation staff on what is currently being done and where the greatest needs are. The panels will heavily inform a Request for Proposal (RFP) that FORE will be releasing later in the year.

(Picture: FORE Board of Directors Chair Andrea Barthwell, M.D., DFASAM, with U.S. Congressman Hal Rogers (R-KY, 5th District) and Michael Barnes, Esq., Managing Partner and Founder of DCBA Law & Policy.)