Delaware has the second highest rate of drug overdose in the country; of those overdose deaths, 88% involved opioids. Further, in Delaware, 61 opioid prescriptions are written for every 100 residents. Delaware also ranks first in the country for high-dose and long acting-opioid prescriptions, both of which increase the risk of OUD and overdose. One of the most effective interventions to reduce opioid related mortality is the delivery of evidence-based treatment including medication for opioid use disorder. Like most states, Delaware does not have sufficient treatment capacity for opioid use disorder. Because there are too few addiction medicine specialists, it is critical that primary care, women's health, and infectious disease specialists who are seeing patients in the community increase their confidence and training to be able to identify and treat opioid use disorder. A variety of barriers have been identified as contributors to buprenorphine underutilization including: insufficient training, education and experience; lack of institutional and clinician peer support; poor care coordination; provider stigma; inadequate or burdensome reimbursement; and burdensome regulatory procedures. Increasing office based opioid treatment (OBOT) in Delaware will lead to an increase in access to opioid use disorder treatment. Delaware Medicaid has received a grant from the Center for Medicare and Medicaid Services to improve addiction treatment capacity.

The OBOT Fellowship clinical track is designed to educate clinicians on identification, diagnosis and treatment of opioid use disorder. Additionally, time will be spent working to reduce stigma against people who use drugs and to help clinicians increase their level of comfort in talking about drug use and working with people who use drugs. We are utilizing self-paced courses as the first component. In addition, the webinars that will be provided over the 6 month period are designed to foster a Delaware based learning collaborative. Specifically, the topics covered during self-paced modules will include: Introduction to Working with People Who Use Drugs, Addiction, and medications for opioid use disorder (MOUD); Intake Assessment and Buprenorphine Initiation; Follow-Up Visit Management and Prevention of Recurrence; Engaging Patients in Their Care; Toxicology Interpretation; Overdose Prevention Strategies; Stigma and Harm Reduction; Opioid Use Disorder and Mental Health Illnesses; Maternal Care and Opioid Use Disorder; Opioid Use Disorder and Peripartum Management; Opioid Use Disorder and HIV/HCV; and Using Telemedicine for Linkage and Continuity in OUD Treatment during the Coronavirus Pandemic.