Recovery Support Services Research Articles

Retention and Overdose Risk among Patients Receiving Substance Use Disorder Treatment, Mental Health Care and Peer Recovery Support: A Longitudinal Analysis.

Drug overdose remains a major crisis in the United States. Expanding substance use disorder (SUD) treatment and recovery support services is critical for reducing overdose risk during disasters such as the severe acute respiratory syndrome coronavirus 2 (SARS-CoV2) pandemic. We evaluated the outcomes of an innovative multicomponent service, inclusive of medications for SUD, and peer support, colocated in an outpatient infectious disease clinic in Baltimore City. Our goal was to examine whether a multicomponent SUD program can support patients in recovery during a pandemic. One hundred five patients in the RESTORE service between 2019-2020 completed baseline, 3-month, and 6-month surveys. Telemedicine and phone-based support groups were implemented in March 2020 after statewide restrictions on face-to-face services due to SARS-CoV2. Data from surveys and electronic medical records were integrated and analyzed using mixed-effects regression models. At baseline, most patients (88%) reported using drugs/alcohol in the preceding 30 days; 48% of patients reported a history of drug overdose, as well anxiety (23%) and depression (28%) symptoms. Despite pandemic-related disruptions and procedural changes, retention in RESTORE was high (83% after 3 months, 76% after 6 months). Mixed-effects regression models indicated decreased anxiety, alcohol use, heroin use, and nonfatal overdose after 6 months of enrollment (all P < 0.05). Multicomponent SUD services that are colocated within infectious disease specialty services could help patients to successfully manage their overdose risk and mental health even during future disasters. This model of care could be implemented in other specialty settings that see high rates of SUD.

Associations between prescription stimulant use as prescribed, nonmedical use, and illicit stimulant use among adults evaluated for substance use treatment, 2017-2021

BackgroundLimited data exist on risk factors for illicit stimulant use, including associations between prescription stimulant use/nonmedical use (NMU) and illicit stimulant use. MethodsWe used 2017–2021 data from adults assessed for substance use disorder (SUD) treatment using the National Addictions Vigilance Intervention and Prevention Program Addiction Severity Index-Multimedia Version® tool. Multivariable Poisson regression models analyzed associations between past 30-day prescription stimulant use as prescribed or NMU and past 30-day illicit stimulant use. Separate models examined past 30-day illicit stimulant, methamphetamine, and cocaine use. We explored problem severity across seven biopsychosocial domains (e.g., drug, psychiatric, family) by past 30-day prescription stimulant use/NMU and illicit stimulant use. ResultsAmong 218,981 assessments, 1.8% reported prescription stimulant NMU; 1.6% reported use as prescribed. Past 30-day prescription stimulant NMU (vs. no use) was associated with past 30-day illicit stimulant use (adjusted prevalence ratio [aPR] [95% CI]: 2.67 [2.59, 2.75]), methamphetamine use (aPR: 2.81 [2.71, 2.92]), and cocaine use (aPR: 3.53 [3.33, 3.74]). Prescription stimulant use as prescribed (vs. no use) was associated with lower prevalence of past 30-day illicit stimulant use. Assessments reporting prescription stimulant NMU (vs. no use, or use as prescribed) appeared more likely to have moderate-to-extreme problem scores across biopsychosocial domains, indicating greater need for treatment or assistance. Assessments reporting prescription stimulant use as prescribed or NMU frequently reported opioids, alcohol, or other substances as their primary substance problem. ConclusionsAdults using illicit stimulants/nonmedically using prescription stimulants may benefit from care addressing polysubstance use, mental health, social, and recovery support services.

알코올 중독 회복경험에 대한 질적 메타요약

The purpose of this study is to identify key experiences found in domestic qualitative studies on recovery from alcoholism and to derive recovery support measures based on them. To achieve this research purpose, this study applied a qualitative meta-summary. Qualitative meta-summary is a method that summarizes the results of various qualitative studies into abbreviated statements and calculates the size of the frequency effect for each abbreviated statement to identify more core experiences in the research area. As a result of examining the abbreviated statements with a large frequency effect, the core recovery experience was the experience of deciding to abstain from drinking through repeated relapse experiences, self-understanding and acceptance. When comparing the new concept of recovery with the core experiences found in this study, it was confirmed that the recovery experiences found in Korea do not show respect for the diversity of recovery experiences and promote a positive outlook on recovery. Based on the results of this analysis, this study discussed the importance of the expansion of recovery support services and advocacy movements.

Evolution of the assertive community engagement model for peer recovery coaching informed by the assertive community treatment model

Peer recovery support services for Substance Use Disorder (SUD) are becoming increasingly more prevalent to support individuals in initiating and maintaining recovery. However, models that operationalize service delivery are lacking. Here we describe the Assertive Community Engagement (ACE) model, a new model that emphasizes personalization and peer recovery support with a social determinants of health focus. This article defines the tenets of the ACE model, provides evidence to support the model, and addresses applications of this model to different settings. We review literature on Assertive Community Treatment (ACT) programs and research using peer recovery coaching interventions to develop the ACE model tenets, implementation guidelines, and evidence in support of the model. The ACE model has ten core tenets for service delivery: (1) the target population is individuals with SUD; (2) peer recovery coach services as a single touchpoint; (3) service delivery relies on assertive engagement techniques; (4) comprehensive support services are provided; (5) services include long-term care; (6) community-based care is provided; (7) services have 24/7 crisis availability; (8) outcomes focus on both substance use reduction and quality of life improvements; (9) direct social support is provided; (10) services are personalized and flexible. Empirical evidence for the model includes evidence for increase engagement in treatment and other recovery support services, reduced substance use frequency, and decreased hospital utilization. The ACE model is a promising model of peer recovery support that deserves further investigation for improving substance use and quality of life outcomes.

Post-overdose follow-up in the community with peer recovery specialists: The Lake Superior Diversion and Substance Use Response Team

BackgroundAs the overdose epidemic continues to worsen, nonfatal overdose calls for service represent a critical touchpoint for intervention. While most studies have focused on law enforcement led post-overdose follow-up, the current study describes the programmatic characteristics and outcomes of a non-law enforcement post overdose program comprised of peer specialists embedded within a local police department. MethodsWe examined information on 341 follow-up responses occurring over a 16-month study period using administrative data. We assessed programmatic characteristics including demographic information on clients, referral source, engagement type, and goal completion. ResultsThe results indicate that over 60% of client referrals ended in the goal of in-person contact. Of those, about 80% went on to complete an engagement goal with the peer specialist. We found no significant variation in client demographics and referral source or follow-up engagement (in-person or not); however, client referrals from law enforcement first responders, the most common source, are significantly less likely to result in an in-person contact, though, if contact is made, similarly likely to complete an engagement goal. ConclusionsPost overdose response programs that do not involve law enforcement are exceedingly rare. Given that some research has shown that police involvement in post overdose response can have unexpected, associated harms, it is important to assess the effectiveness of post overdose programs that do not involve the police. Findings here suggest that this type of program is successful at locating and engaging community members into recovery support services who have experienced an overdose.

Drug Overdose Deaths Among Non-Hispanic Black Men in the U.S.: Age-Specific Projections Through 2025

Fatal drug overdoses have risen sharply in the U.S. since 2015, reaching their highest levels during the pandemic. Non-Hispanic Black men have been disproportionately harmed by this latest surge; overdose mortality per 100,000 has increased fourfold since 2015. Whether the mortality rate will continue to climb is unknown. In this study, we addressed the narrower question of which age groups are likely to experience a significant increase or decrease in the burden of drug overdose deaths through 2025, based on foreseeable changes in the age structure of the Black male population. We used the 2020 and provisional 2021 age-specific mortality rates from the Centers for Disease Control WONDER (Wide-Ranging Online Data for Epidemiologic Research) database and the standard population balancing equation to project overdose deaths in 2025. Overdose deaths were identified by ICD-10 codes. We bracketed the projections between 2 plausible alternatives: a pessimistic forecast based on time series extrapolations and an optimistic forecast that assumes success nationally in lowering overdose deaths through prevention, treatment, and harm reduction initiatives. Among Black men aged 31-47 years, overdose deaths in 2025 are expected to increase by 440 or 11% (95% CI=8%, 14%) relative to 2020. By contrast, overdose deaths among younger Black men aged 19-30 years are expected to decline by 160 or -9% (95% CI= -15%, -5%). Among older Black men aged 48-64 years, overdose deaths are also expected to decline by 330 or -7% (95% CI= -10%, -4%). Similar results were found using 2021 provisional mortality rates. Overdose deaths are predicted to increase significantly over current levels among Black men in their 30s and 40s. Local policy makers should direct harm reduction resources, such as naloxone kits, syringes, and fentanyl test strips, to places frequented by Black men in this age group. Outreach messaging should be tailored to resonate with men of middle age. Equally urgent is the scaling up of nonstigmatizing, evidence-based drug treatment and recovery support services in Black neighborhoods.

Program, Policy and Social Support Characteristics Associated With Rural vs. Urban Recovery Housing, 2018–2020

Study objectives were to survey rural and urban recovery house owners/operators on their existing National Alliance for Recovery Residences-like (NARR-like) house programs/policies, and delineate rural–urban differences to raise awareness of NARR standards that align with current recovery house policies/programs and to inform new/enhance existing NARR standards. An electronic survey was developed and disseminated to 112 identified recovery houses in Kentucky. There was a 77% survey response rate. Rural recovery houses were more likely to have provisions in place for persons with disabilities, require clinical services participation, and have a stricter return-to-use policy. Work and/or school requirements in recovery houses were associated with resident stability and house expectations for community integration. Understanding differences in existing NARR-like rural versus urban recovery house policies and programs is necessary to raise state-led NARR affiliate awareness of differential recovery house training and support service needs that can best ready recovery houses for NARR certification.

Hard to succeed: A call for social change from mothers with substance use in the child welfare system

This qualitative participatory action research applies photovoice methodology to engage, understand, and prioritize the voice of mothers involved with the child welfare system and recovery support services. Thirteen mothers were given digital cameras to create photographs that represented their experiences with the child welfare agencies, courts, and systems of care involved in their lives. They then participated in sessions of critical dialogue to reflect on their experiences, identify community needs, and discuss and codify themes and shared priorities as co-researchers in the study. Findings reveal that mothers depict a child welfare system in which it is easy to fail and hard to succeed. Three key subthemes include: (a) disempowerment, (b) incongruent system design, and (c) the need for relational support with emphasis on empathetic and equipped caseworkers. Implications focus on strategies to achieve empowerment and improve programmatic and system practices to better align with the needs and experiences of mothers in recovery. The role of caseworkers as central influencers, creating networks of support with strengths-based, simplified, and coordinated care, as well as opportunities for destigmatized and accessible early intervention are recommended areas of improved focus. Collectively, findings inform how community stakeholders can support women across the multiple systems they interact with and include a social action statement from mothers about what they want stakeholders to understand about their experiences and how they define the need for social change.

Gender differences in lifetime and current use of online support for recovery from alcohol use disorder.

BackgroundDigital recovery support services (D‐RSS) use technology to engage individuals seeking recovery from alcohol use disorder (AUD). Given sparse data on use of these emergent services as well as longstanding and stark gender disparities in use of traditional alcohol treatment services, we sought to quantify lifetime and current D‐RSS use and to test associations with several recovery outcomes, with particular attention to gender differences.MethodsWe analyzed data obtained in fall 2020 in a national survey of adults with a resolved alcohol problem (n = 1487). We estimated lifetime and current D‐RSS use, prevalence of various types of D‐RSS, and related outcomes (e.g., recovery stability, relapse events, quality of life). Stratified logistic regression models identified correlates of D‐RSS use for women and men, controlling for demographic and AUD characteristics.ResultsOverall, an estimated 14.9% of the population of adults with a resolved alcohol problem reported lifetime use of D‐RSS, with no difference by gender. Current use was lower and was reported by more men than women (9.9% vs. 5.8%, respectively). Men had higher odds of D‐RSS use if they had <1 year of recovery (adjusted odds ratio [aOR] 7.84), 1 to 5 years of recovery (aOR 2.17), and if never married (aOR 3.29). Among women, higher odds of D‐RSS were associated with AUD symptom count (aOR 1.30), being unemployed (aOR 9.85), and having minor children in the household (aOR 3.58). Among women, there was no association between D‐RSS use and recovery stability, relapse events, and quality of life. However, among men D‐RSS use was associated with reporting that the COVID‐19 pandemic had made it more difficult to resist alcohol or drugs and with lower self‐reported quality of life.ConclusionsD‐RSS are a promising technological approach to support recovery. There is room to increase their use, and gender‐specific approaches may be needed given different correlates of use for women and men. In addition, further research is needed to explore whether D‐RSS may confer benefits through similar mechanisms as in‐person recovery services.

Recovery 101: A Community Psychoeducation Program on Mental Health Recovery and Peer Support Services Created by an Academic Psychiatrist and Delivered by Peers.

Despite the ongoing growing interest and established benefits of mental health recovery and peer support services, little is known about the effects of mental health recovery and peer support services specifically in community education programs. Seeking to further expand this scope, this article details the development, implementation, and evaluation of a recovery and peer services community psychoeducation program created by an academic psychiatrist and delivered by trained mental health peers. A community psychoeducation intervention on recovery and peer services was provided in 2 different series: 5-session and 1-session series. Participants in the intervention were recruited from 2 local nonprofit recovery-oriented organizations and a public mental health service agency. Surveys were administered before and after each presentation session and analyzed both quantitatively and qualitatively. Quantitative survey items covering knowledge, awareness, interest, and likelihood of involvement in peer services for recovery all showed statistically significant gains from before to after the sessions. The qualitative data provided information about the participants' interests in the program in terms of knowledge of recovery, self-improvement, advocacy, resources, support, and nonspecific positive comments. An essential contribution of the program was to introduce participants to recovery and peer services. It also provided them with foundational knowledge that placed participants in a position to begin to practice the concepts of recovery. According to the participants' comments in the surveys, the program imbued a sense of hope and motivation; support and fellowship; and, importantly, role modeling and wisdom from the presenters.

SAMHSA announces almost $1.5 billion in new SOR grants

On May 19, the Substance Abuse and Mental Health Services Administration (SAMHSA), Center for Substance Abuse Treatment (CSAT), announced that it is accepting applications for the fiscal year (FY) 2022 cohort of the State Opioid Response (SOR). Only single state agencies (NASADAD members) and territories can apply. From the funding opportunity announcement: “The purpose of this program is to address the opioid overdose crisis by providing resources to states and territories for increasing access to FDA‐approved medications for the treatment of opioid use disorder (MOUD), and for supporting the continuum of prevention, harm reduction, treatment, and recovery support services for opioid use disorder (OUD) and other concurrent substance use disorders. The SOR program also supports the continuum of care for stimulant misuse and use disorders, including for cocaine and methamphetamine. The SOR program aims to help reduce unmet treatment needs and opioid‐related overdose deaths across America.” There will be 59 awards for the grants, which are for up to 2 years. No cost sharing is required. Applications are due July 18. For more on the grant, go to https://www.samhsa.gov/grants/grant‐announcements/ti‐22‐005.

SAMHSA announces $55 million for most recent Tribal Opioid Response grant program

The Substance Abuse and Mental Health Services Administration (SAMHSA) has announced $55 million in funding for its Tribal Opioid Response (TOR) grant program. “Every five minutes, someone in the U.S. dies from a drug overdose,” said U.S. Department of Health and Human Services Secretary Xavier Becerra in announcing the funding opportunity May 4. “The TOR program ensures this country's Native American communities get connected to effective, culturally relevant treatment and recovery support services, which is critical to our work to advance health equity and address addiction and overdose.” And from Miriam E. Delphin‐Rittmon, leader of SAMHSA and assistant secretary for mental health and substance use for the U.S. Department of Health and Human Services (HHS): “The TOR grant program recognizes the full continuum of integrated care and services that are needed to help prevent substance use, expand quality treatment, and sustain recovery for people battling substance misuse.” The TOR grant program is increasing access to FDA‐approved medications for the treatment of opioid misuse, and supporting prevention, harm reduction, treatment and recovery support services for opioid and stimulant misuse and co‐occurring mental and substance use conditions. Funding will be provided each year for up to 150 grantees over a two‐year project period, beginning late FY 2022. According to the Centers for Disease Control and Prevention, the rate of drug overdose deaths among American Indians and Alaska Natives is above the national average. TOR supports the American Indian and Alaska Native Cultural Wisdom Declaration, which elevates the importance of tribal identities, culture, spiritual beliefs and practices for improving well‐being. Tribal entities are encouraged to include the following elements into grant applications as appropriate: ancestral cultural knowledge, wisdom, ceremony and practices of American Indian and Alaska Native tribes. To apply, see TOR Notice of Funding Opportunity.

First responders‐Comprehensive addiction, recovery support services grants (SAMHSA)

Federal Grants & ContractsVolume 46, Issue 7 p. 7-8 Grant Alerts First responders-Comprehensive addiction, recovery support services grants (SAMHSA) First published: 01 March 2022 https://doi.org/10.1002/fgc.32256Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat No abstract is available for this article. Volume46, Issue73 March 2022Pages 7-8 RelatedInformation

The complexities of substance use disorder and people with disabilities: Current perspectives

This Supplement of the Disability and Health Journal presents research at the intersection of disability and substance use disorders (SUD). A better understanding of their complex relationship is needed to (1) inform the development of culturally relevant, accessible, and inclusive prevention and intervention efforts aimed at eliminating disparities in SUD prevalence among people with disabilities; and (2) improve access, quality and outcomes of SUD treatment and other recovery support services for people with disabilities. These eleven articles include themes around prevalence and identification of disability-related disparities, perspectives of people with lived experience of disability, and adaptations to substance use measures and interventions. They highlight the importance of a public health focus on the unique needs of people with disabilities and development of accessible and person-centered interventions. Integrative and holistic SUD prevention and treatment efforts, including pain management, are essential to address the complex needs of people with both disability and SUD.

Realizing Recovery: the U.S. Substance Abuse and Mental Health Services Administration’s Efforts to Foster Social Inclusion

For nearly 20 years, the U.S. Substance Abuse and Mental Health Services Administration (SAMHSA) has fostered social inclusion for Americans with mental and/or substance use disorders. SAMHSA has done this by promoting the recovery paradigm, an approach predicated on a positive, strength-based, and person-centered view of those with behavioral health conditions. SAMHSA has provided leadership by promoting policies, programs, practices, and public awareness initiatives that advance recovery, recovery support services, and recovery-oriented service delivery systems. SAMHSA’s approach has been participatory, engaging a variety of stakeholders, and comprehensive, focusing on multiple strategies in targeted priority areas.

$10 million from SAMHSA for pregnant women, family, children

The Substance Abuse and Mental Health Services Administration (SAMHSA) on Feb. 3 announced that it is accepting applications for a $10 million grant program to provide women and their children with substance use treatment and recovery support services across residential and outpatient settings. Applications are due April 4.

Stigmatization of Pregnant Individuals with Opioid Use Disorder.

Objective: The purpose of this study was to critically analyze the role of stigma in the care of pregnant and parenting individuals with opioid use disorder (OUD) through the theoretical lens of the Reproductive Justice (RJ) framework.Background: Overdose related maternal mortality, often involving opioids, is a national growing public health concern. OUD is a highly stigmatized condition that may negatively influence the well-being of pregnant/parenting individual's reproductive and human rights.Study Design: Secondary qualitative data analysis.Methods: A secondary data analysis was conducted using individual interviews (N = 23) from a larger study aimed at examining contextual factors surrounding pregnant/parenting individual's experiences with opioid use return to use and/or overdose. The RJ framework was used as a framework to examine the influence of OUD-related stigma and a person's right to bodily autonomy, their right to parent, and their right to parent the children they have in safe and sustainable environments.Results: The RJ framework supported the examination of factors that perpetuate stigma in this population. Individuals described stigmatizing experiences in the health care setting. Verbal and nonverbal interactions with health care providers and fear of child welfare involvement were counterproductive to recovery and potentially triggered OUD recurrence and/or overdose.Conclusions: Due to existing stigma, pregnant and parenting individuals with OUD often avoided health care and recovery support services; therefore, there should be the removal of barriers that prevent this population from accessing life-saving services. Future efforts should focus on health policy-related research to support structural changes within institutions.

Examining Internalizing Mental Health Correlates of Addiction Severity in Patients Hospitalized With Medical Complications From Substance Use Disorder

Background:Comorbidities between Substance Use Disorder (SUD) and mental health disorders are highly prevalent, yet there remains a lack of information regarding how mental health conditions may affect addiction severity. Consequently, this study sought to investigate the relationship between internalizing disorders (anxiety and mood disorders) and addiction severity in patients hospitalized for SUD-related medical complications. Individual difference predictors and history of prior treatment for SUD were also examined.Methods:Participants (N = 200) were hospitalized patients who consented to receive peer-based recovery support services for their SUD. To be eligible for the study, participants needed to have a SUD diagnosis due to alcohol, opioids, methamphetamine, cocaine, or a combination of these substances (polysubstance use). Participants completed self-report questionnaires regarding demographics, mental health history, prior SUD treatment, and addiction severity (Drug and Alcohol Screening Test; DAST-10) during their hospitalization.Results:Results showed that patients with Generalized Anxiety Disorder (GAD) (M = 6.68, SD = 2.97) had greater addiction severity compared to those without GAD (M = 5.41, SD = 3.34), P = .016. Addiction severity results stratified by SUD type showed that the relationship was significant among patients with Alcohol Use Disorder (P = .014), but not among those with other SUD types (Ps > .27). Major Depressive Disorder (MDD) and Post-Traumatic Stress Disorder (PTSD) were not linked to addiction severity. Among those with GAD, 81.4% had previously been to treatment compared to only 53.1% of those without GAD, P = .010. The only participant characteristic linked with addiction severity was insurance status.Conclusions:GAD may represent a risk factor for advanced alcohol addiction trajectories, including greater addiction severity and severe health complications requiring inpatient hospitalization.

Patients with substance use disorders receiving continued care in skilled nursing facilities following hospitalization

Background: As hospitals in the US face pressures to reduce lengths of stay, healthcare systems are increasingly utilizing skilled nursing facilities (SNFs) to continue treating patients stable enough to leave the hospital, but not to return home. Substance use disorder (SUD) can complicate care of patients transferred to SNFs. The objective of this paper is to understand SNF experiences for this population of patients with comorbid SUD transferred to SNFs and examine care experiences in these facilities. Methods: This secondary mixed-methods analysis focuses on SNF experiences from a clinical trial of patient navigation services for medically-hospitalized adults with comorbid opioid, cocaine, and/or alcohol use disorder. This study compared baseline assessments and medical record review for participants (N = 400) with vs. without SNF transfer, and analyzed semi-structured qualitative interviews with a subsample of 15 participants purposively selected based on their transfer to a SNF. Results: Over 1 in 4 participants had a planned discharged to a SNF (26.8% sub-acute, 3.3% acute). Compared to participants with other types of discharge, participants discharged to a SNF had longer initial hospitalizations (4.9 vs. 11.8 days, p < 0.001), and were more likely to be White (38.6 vs. 50.8%; p = 0.02), female (38.9 vs. 52.5%; p = 0.01), have opioid use disorder (75.7 vs. 85.0%, p = 0.03), and be hospitalized for infection (43.6 vs. 58.3%; p = 0.007), and less likely to have worked prior to hospitalization (24.3 vs. 12.5%; p = 0.006). Qualitative narratives identified several themes from the SNF experience, including opioid analgesic dosing issues, challenges to the use of opioid agonist treatment of OUD, illicit opioid dealing/use, and limited access to addiction recovery support services during and following the SNF stay. Conclusions: SNFs are a common disposition for patients in need of subacute services following hospitalization but may be ill-equipped to properly manage patients in need of new or continuing SUD treatment.

Reducing Emergency Department Visits and Opioid-Related Deaths in Maryland

The state of Maryland has consistently ranked among the top states by opioid-involved overdose deaths. Emergency rooms in Maryland have been overrun with patients struggling with opioid use disorder (OUD). While hospitals are heavily burdened, it has become clear that they serve as a critical entry point for OUD prevention programs. Despite this, when section 19-310 of the Maryland Heroin and Opioid Prevention Effort (HOPE) and Treatment Act of 2017 passed, it included vague language requiring hospitals to create their own discharge protocols for such patients rather than putting into place statewide mandates. We propose two alternative solutions. First, the Maryland General Assembly can amend the HOPE and Treatment Act of 2017 to mandate that peer recovery services be made available during inpatient care, within the emergency department, and post-discharge for patients presenting with OUD. Second, we recommend the addition of a subtitle to describe how to establish and operate mobile clinic treatment programs. The former amendment would offer a prompt solution that could reduce opioid-related hospitalizations and deaths in the state. It will also help reach underrepresented populations who are the least likely to access peer recovery support and other health services in response to OUD.