How a Low Barrier Care Model Can Benefit OTP Patients

We know that both medication and counseling are effective tools for treating substance use disorder (SUD), and yet less than 10% of the people who need them have access to these treatments.

These access issues stem from a variety of factors, including systemic barriers to healthcare, stigma around SUD, and policies that make it harder for patients to stay in treatment.

To help combat these challenges, the Substance Abuse and Mental Health Services Administration (SAMHSA) issued an advisory discussing the benefits of low barrier care for SUD. In this article, we’ll summarize the key takeaways from this advisory and explain how opioid treatment programs (OTPs) can begin to implement a low barrier care model.

What is Low Barrier Care? 

Low barrier care focuses on making services as available and accessible as possible, while also minimizing the burdens placed on patients in treatment.

Low barrier care looks for ways to offer patients additional flexibilities and options for receiving treatment, but it’s about more than just physical and regulatory factors. This model also focuses on creating an environment where everyone can feel comfortable receiving care, with a patient-first approach to treatment and an emphasis on removing stigma and addressing internal biases.

Here's what SAMHSA had to say about the benefits of this approach:

“In this way, low barrier models of care meet people where they are, providing culturally responsive and trauma informed care that is tailored to the unique circumstances and challenges that each person faces.”

Implementing Low Barrier Care at Opioid Treatment Programs

1. Increase treatment availability 

One of the largest barriers for many SUD patients — especially those in methadone treatment programs — is the travel time required for daily, in-person clinic visits.

 To help mitigate this, look for opportunities to make SUD treatment available across the healthcare system. This could include harm reduction efforts like syringe access and naloxone distribution throughout the community, or it could mean setting up medication units in an FQHC/RHC, CCBHC, or CMHC. 

OTPs can also find creative ways to make treatment within the clinic more readily available. SAMHSA recommends allowing walk-in appointments, extending clinic hours, and making telehealth services available.

2. Reduce barriers to Medications for Opioid Use Disorder (MOUD)

Too often, patients are unable to access MOUD because of policies that don’t prioritize the patient’s wellbeing.

SAMHSA recommends that MOUD providers avoid placing preconditions on a patient, such as the requirement to receive multiple services simultaneously or complete multiple visits before receiving medication.

OTPs should also consider the ways in which take-home methadone can help improve a patient’s outcomes. Research shows that take-home doses are effective and increase treatment engagement, but many providers hesitate to issue them because of safety concerns. 

Employing a remote dosing solution like Sonara Health allows OTPs to safely and confidently issue take-homes to patients who then record their doses for the care team to review. This reduces the burden of daily, in-person visits on the patient, and it builds trust between individuals and their care teams.

3. Collaborate with patients to build personalized treatment plans

Every individual has unique needs, preferences, and concerns, and an effective low barrier treatment model will take that uniqueness into account. For OTPs, this can look like:

• Basing visit frequency on the patient’s clinical stability, not on a standardized schedule

• Not restricting treatment based on self-reported drug use or toxicology results

• Considering comorbidities when building a treatment plan

• Working with patients to determine recovery goals and treatment next steps

• Connecting patients to services that support recovery outside of the clinic, such as housing and employment opportunities

• Accepting that reduced substance use and harm mitigation are worthwhile goals

By implementing these changes, providers can help patients feel seen and supported, which in turn leads to improved treatment engagement and better outcomes.

4. Commit to continuous learning

If healthcare leaders want to see a successful implementation of low barrier care, they need to equip their employees and providers with ongoing opportunities for growth and education.

These may include training on the latest evidence-based intervention, trauma informed care, education about harm reduction, cultural competence training, and continuing education opportunities for both clinic staff and providers. 

OTPs should also stay committed to organizational improvement, implementing opportunities for feedback from both patients and employees. Providing the opportunity for anonymous feedback can help patients feel more comfortable giving honest opinions without fear of retribution.

Partner with Sonara to Make Low Barrier Care a Reality

At Sonara, we believe every patient deserves access to individualized, quality treatment for SUD. And we’re thrilled to see SAMHSA aligning with these ideals.

We also understand that restrictive regulations, funding challenges, and high patient volume can make it difficult for OTPs to implement these concepts, and we want to help change that.

To learn more about how Sonara can partner with you to make take-home methadone more accessible and support your providers in their treatment efforts, contact us today.