Long-Acting MOUD Incentive Program

 Those with substance use disorders are often overlooked in the way treatment is designed, especially for the opioid crisis as the symptoms of street opioids continue to shift. Pathways to Housing PA is committed to including feedback directly from those affected in our program design. Our Center of Excellence (COE) staff are tasked with supporting individuals with OUD in seeking treatment or medication for opioid use disorder (MOUD) and breaking down barriers along the way, and we were thrilled to partner with Scattergood to expand our COE offerings.

A few years ago, we piloted an incentive program for long-acting injectable MOUD. Our team noticed that adherence to daily medication was a struggle, but participants showed little interest in a once-a-month option. When asked, participants cited concerns about income. That is what led to our incentive-based program; by providing a stipend, we are reducing the barrier to treatment that most got in the way. We consider that one of our biggest accomplishments: designing the parameters with input from those with OUD.

We are thrilled to partner with Scattergood to run the program again for a significantly larger number of individuals, while also working with Thomas Jefferson University to conduct data collection and research on the efficacy of the project. With the research to back up our success, we can share the model with our peers and hopefully help more people.

Our largest hurdle thus far has been applying for and receiving approval for the project through the City’s Internal Review Board (IRB). The IRB approval process is long, as the board only meets once per month to review submissions. It took some time for us to secure a partner at Jefferson to conduct the research, some additional time to write the project proposal, and then several months for the project to be approved by the IRB. We did expect this to take some time to get off the ground, but we were shocked that it took nearly a year to get from being awarded the grant to launching the program.

It’s a time-consuming process, but we knew that when we committed to conducting research on our results and we’re thrilled that we are, finally, on track to launch the project with full IRB approval. If we had a magic wand, this would be where we applied it: making this process of building evidence-based research less time-consuming. 

The longer the process takes, the longer participants are living without the opportunity to try long-acting MOUD. And that can mean the difference between life and death. Here’s a quote from James about his experience with Suboxone/Sublocade, a type of long-acting MOUD, which he tried as a result of our initial incentive program: 

“An issue I had with the street drugs was the volatility and the unpredictability. So I was always up and down with the withdrawal. Suboxone created a situation where that wasn’t an issue. It gave me this baseline of, you know, a legal drug that could keep me from having these real high highs and low lows. And it was effortless. It was one shot, and it was done [once] for a month, and then it worked. It worked so well that I was unaware of how well it was working until I stopped. When I stopped, I was just in awe of how much of the load that the Sublocade was carrying. It’s a wonderful thing.”

Talking with James highlights a few important things about this project. First, that long-acting MOUD works. It supports people with OUD In finding stability, which is impossible when they’re stuck in the cycle of addiction. Second, it highlights the reality of being in recovery: it isn’t linear. Participants start and stop MOUD; they use less, then more, then less. Starting MOUD isn’t a failsafe, but a tool to help folks start that journey of recovery. If we can break down barriers and encourage people to try, it is often the difference between taking that first step towards recovery and remaining in active addiction.

As we launch the project with full IRB approval, our biggest opportunity is the impact we can have on the broader community of people with OUD. We know we will be directly affecting those in the incentive program, but the research project will provide evidence-based data that supports the efficacy of the program. This data has an opportunity to influence other organizations providing MOUD and treating those with OUD to try using incentives, and potentially support thousands of people with OUD in their recovery. We are thrilled to be leading this charge for our community and look forward to keeping you up to date as we get further into the program.