The MOUD Plus Pilot: Counseling and Peer Support to Support Retention for Medically Complex Patients With Opioid Use Disorder Seen In Primary Care

This is a pilot randomized controlled trial (N=70) comparing the refined team-based collaborative care model ("MOUD Plus") to treatment as usual. The hypothesis is that this team-based intervention, called "MOUD-Plus", consisting of prescribers along with integrated substance use counselor, and referral to community based peer recovery support, can improve care engagement and retention on MOUD by increasing engagement, building trust, and offering patient directed therapeutic and peer-enhanced support for their treatment on MOUD. Main existing components of MOUD: ("Treatment as Usual") 1. Scheduled or Walk in clinic M-F 8-5 pm 2. Visits with buprenorphine waivered prescriber 3. Prescribers are trained to initiate and continue treatment same day ("low threshold" prescribing) 4. Connection to usual primary care services 5. On-site lab, pharmacy, and screening for HIV, hep C with referral to treatment "MOUD Plus": New Components to support OUD and medical complexity 1. Engagement with an Integrated Substance Use Disorders (SUDS) Counselor for medical complexity to aid in rapport building, brief counseling interventions (e.g., motivational interviewing, harm reduction counseling), and care coordination. 2. Referral and coordination with outside peer organizations that work with the program to assist medically complex clients to support self-efficacy and treatment goals. 3. Enhanced care coordination and panel management to address continuity of care and medication management for those enrolled. Outcomes: 1. Retention on medication for opioid use disorder (MOUD) at 2, 3-months (primary), and 6-months 2. Engagement with care teams at 2, 3, and 6-months (secondary, mechanism of action) 3. Change in trust in care team, and recovery capital at 2 months, 3, and 6-months (secondary outcomes) 4. Assess feasibility, acceptability, and potential scalability of the program using the RE-AIM-QuEST framework