Four-year, $2 million federal grant will more than double rural providers

Contact: Steven Lee, 210-450-3823, lees22@uthscsa.edu

SAN ANTONIO, Dec. 1, 2022 – UT Health San Antonio has received a four-year, $2 million federal grant to expand its substance use disorder response program, Be Well Texas, to the state’s 178 rural counties that have limited or no access to resources and support addressing opioid addiction.

With the Health Resources and Services Administration (HRSA) grant, Be Well Texas will lead and assist a consortium of 28 rural provider organizations in building a responsive behavioral health care delivery system with the capacity to reduce the morbidity and mortality of opioid use disorder, or OUD, among Texas’ rural residents.

That will more than double Be Well Texas’ current provider network of 12 rural providers. The growth coupled with Be Well Texas’ telehealth capacity will ensure the availability of opioid use disorder treatment services in all of the state’s rural counties.

Briseida “Bee” Courtois, MSW, LCDC

“Deaths from opioid-related overdose are one of the greatest health failures of our time, and partially attributable to unfairly distributed treatment resources,” said Briseida “Bee” Courtois, MSW, LCDC, Be Well Texas provider network program manager and director of this grant project. “These types of need disparities led UT Health San Antonio to launch the Be Well Texas network.”

A rural disparity

That disparity appears to be more pronounced in rural than in urban areas. More opioid prescriptions are dispensed to Texas’ rural residents per-capita than to urban residents, which likely has become a source of supply for illegal drug markets and contributor to increasing overdose rates.

For example, while opioid pills were distributed at a rate of 29.4 per person living in Bexar County each year from 2006 through 2014, the rate was 88.3 in Young County in North Texas, according to a Washington Post analysis of a database maintained by the U.S. Drug Enforcement Administration.

Other rural counties: Childress (76.2), Wilbarger (75.2), Brown (68.1), Palo Pinto (66.9).
Bexar County’s number was similar to other urban areas: Harris (35.6), Dallas (28.6), Travis (26.0), El Paso (16.3).

Opioid death rates in Texas might actually be higher than thought since the majority of the state’s rural counties do not report opioid-related mortality. This coupled with the fact that state data systems do not distinguish between urban and rural overdose deaths make it difficult to quantify the number of opioid-related deaths in Texas’ rural counties.

The new rural consortium will be a subset of the existing statewide Be Well Texas program, currently serving more than 10,000 adults annually and consisting of 76 contracted Medication-Assisted Treatment (MAT) and/or Office-Based Opioid Treatment (OBOT) providers delivering substance use treatment – for opioid use, alcohol use, stimulant use and other substance use disorders – as well as non-severe mental health treatment and peer recovery supports. Commonly used substances include prescription and synthetic opioids, including fentanyl, and heroin.

Aligning with HRSA goals

The consortium’s objective aligns with the goals of HRSA’s Rural Communities Opioid Response Program-Behavioral Health Care Support: to build capacity to deliver low-barrier, digital and/or in-person OUD treatment and recovery support services according to participant needs and preferences.

Key strategies are:

SAN ANTONIO (May 12, 2022) — Despite scientific evidence that the medication buprenorphine/naloxone (or Suboxone) effectively treats opioid use disorder (OUD), only one-sixth of Texas clinicians surveyed in 2019 and early 2020 said they were prescribing the lifesaving medication, according to a study from The University of Texas Health Science Center at San Antonio (UT Health San Antonio) published May 12 in JAMA Network Open.

“The U.S. Food and Drug Administration approved buprenorphine in 2002. It’s 2022 and we still see problems,” said Jennifer Sharpe Potter, PhD, MPH, the study senior author. Dr. Potter is professor of psychiatry and behavioral sciences, executive director of Be Well Texas, and vice president for research at UT Health San Antonio.

“Unfortunately, our data are consistent with reports using other methods that suggest lack of certified prescribers is a national problem,” Dr. Potter said.

Portrait of Jennifer Potter
Jennifer Sharpe Potter, PhD, MPH

The Drug Addiction Treatment Act (DATA) of 2000 made it possible for health care workers to obtain an “X-waiver” to prescribe buprenorphine. To be eligible, physicians needed to complete eight hours of qualified training before prescribing buprenorphine, and advanced practice providers including physician assistants, clinical nurse specialists and nurse practitioners needed to complete 24 hours of training.

UT Health San Antonio researchers sent surveys to more than 600 clinicians who attended X-waiver training courses offered statewide between March 2019 and February 2020. The team received responses from 126 clinicians, including 81 physicians, 37 nurse practitioners and eight physician assistants.

Among the 126 respondents, less than half (61) had received an X-waiver after attending the waiver training. Of those, almost two dozen were prescribing buprenorphine. Only 17% of survey respondents (22 of 126) were prescribing the lifesaving medication after attending the X-waiver training. This study contributes new evidence that X-waiver training is only part of the puzzle when it comes to understanding the barriers that clinicians must overcome to begin prescribing buprenorphine.

Policy change last year

During the COVID-19 pandemic, in April 2021, the U.S. Department of Health and Human Services published new practice guidelines to reduce the training burden for treating opioid use disorder with buprenorphine. According to the U.S. Substance Abuse and Mental Health Services Administration website, the revised guidelines “exempt eligible practitioners from certification requirements related to training and the provision of psychosocial services, which were previously necessary when dispensing or prescribing buprenorphine for the treatment of OUD to 30 or fewer patients.”

More than relief of training burden is needed

Dr. Potter and the team believe more than this exemption is needed to expand access to best practices in OUD care. Obstacles to adoption cited by survey respondents included, “Complexity of the X-waiver process,” “Perceived lack of professional support and referral network,” and “Getting started with prescribing buprenorphine.”

“The failure to treat OUD is part of the reason that we have the current rate of overdose deaths,” Dr. Potter said. “At a time of unprecedented opioid-related overdose deaths, there is now relief from the training burden of obtaining the X-waiver to prescribe buprenorphine, a medication that reduces the risk of overdose by 50%.”

A demonstrated need

Nearly 1,900 opioid overdose deaths were documented in Texas in 2020, according to the National Center for Health Statistics. In the JAMA Network Open paper, the authors cited sources that stated:

“If we are going to address the epidemic levels of overdose from drugs in the United States, we need to implement a comprehensive approach that includes making it easier for clinicians to treat OUD and reduce the burdens on providing this level of care,” Dr. Potter said.

“We can’t just provide relief from the waiver,” she added. “We must provide support so that clinicians know how to incorporate this into their practices in a way that is feasible for them.”


Survey of Barriers and Facilitators to Prescribing Buprenorphine and Clinician Perceptions on the Drug Addiction Treatment Act of 2000 Waiver

Holly J. Lanham, PhD, MBA; Jennifer Papac, MD; Daniela I. Olmos, BA; Emily L. Heydemann, MSW; Nathalia Simonetti, BS; Susanne Schmidt, PhD; Jennifer S. Potter, PhD, MPH

First published: May 12, 2022, JAMA Network Open

https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2792215


The University of Texas Health Science Center at San Antonio (UT Health San Antonio) is a primary driver for San Antonio’s $42.4 billion health care and biosciences sector, the city’s largest economic generator. Driving substantial economic impact with its five professional schools, a diverse workforce of 7,200, an annual operating budget of more than $1 billion and a clinical practice that provides more than 2 million patient visits each year, UT Health San Antonio plans to add more than 1,500 higher-wage jobs over the next five years to serve San Antonio, Bexar County and South Texas. UT Health San Antonio is the largest research university in South Texas with an annual research portfolio of approximately $350 million. To learn about the many ways “We make lives better®,” visit http://www.uthscsa.edu.

Stay connected with The University of Texas Health Science Center at San Antonio on FacebookTwitterLinkedInInstagram and YouTube.

SAN ANTONIO, Nov. 17, 2021 — In partnership with UT Health San Antonio, Be Well Texas, a new statewide addiction medicine treatment option, has launched virtual services for those seeking recovery from substance use disorders (SUDs) and mental health challenges.

Through telehealth and in-person visits, services are delivered under the supervision of board-certified physicians in addiction medicine and psychiatry, and include SUD assessment, psychiatric evaluation, evidence-based counseling, medication management, peer recovery support, case management, and pharmacy and lab services throughout Texas.

Be Well Texas is the first addiction medicine virtual clinic established by UT Health San Antonio and is the first of its kind in Texas with a no-pay option.

Portrait of Jennifer Potter
Jennifer Sharpe Potter, PhD, MPH

Be Well Texas founder Jennifer Potter, PhD, MPH, vice president for research (interim) and professor of psychiatry at UT Health San Antonio, sees the clinic as a first stop on the road to recovery, regardless of ability to pay. “Be Well Texas removes the barrier of cost, the physical barrier of distance and the social barrier of negativity surrounding addiction. Our specialists deeply understand the challenges of addiction and are eager to listen,” Dr. Potter said. “Some of them have gone through it themselves and can relate directly to their patients.”

Tackling the opioid crisis during COVID

Solutions like the Be Well Texas virtual clinic are urgently needed as the COVID-19 pandemic exacerbates the opioid crisis. Many suffering from addiction remain in isolation and have been cut off from traditional support networks. According to Centers for Disease Control and Prevention estimates, more than 4,000 people died of drug overdoses in 2020 in Texas, a 33% increase from the year before.

Be Well Texas’ innovative solutions are made possible through a contract with Texas Health and Human Services.

The University of Texas Health Science Center at San Antonio, also known as UT Health San Antonio, is a premier academic research center that makes lives better through excellence in education, research, health care and community engagement. Be Well Texas is partnering with UT Health Physicians, the medical practice of the Joe R. and Teresa Lozano Long School of Medicine.

Contact Be Well Texas at 1-833-778-2571 or https://BeWellTexasClinic.org.


The University of Texas Health Science Center at San Antonio, also referred to as UT Health San Antonio, is one of the country’s leading health sciences universities and is designated as a Hispanic-Serving Institution by the U.S. Department of Education. With missions of teaching, research, patient care and community engagement, its schools of medicine, nursing, dentistry, health professions and graduate biomedical sciences have graduated 39,700 alumni who are leading change, advancing their fields, and renewing hope for patients and their families throughout South Texas and the world. To learn about the many ways “We make lives better®,” visit www.uthscsa.edu.

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Survey of 126 clinicians helps pinpoint barriers to obtaining waivers, prescribing buprenorphine

FRIDAY, May 13, 2022 (HealthDay News) -- The growth in the number of clinicians with waivers to prescribe buprenorphine slowed during the pandemic, and support and mentorship are needed to facilitate obtaining a waiver, according to two studies published online May 12 in JAMA Network Open.

Joanne Spetz, Ph.D., from the University of California in San Francisco, and colleagues examined the number of clinicians with waivers to prescribe buprenorphine for opioid use disorder before and during the COVID-19 pandemic. The researchers found that 47,912 clinicians had waivers to prescribe buprenorphine in quarter (Q)2 of 2018 (84.3 percent physicians) compared with 99,481 clinicians in Q4 of 2021 (69.4 percent physicians). The number of waivers grew at a mean of 4,234 per quarter before the pandemic compared with 3,133 per quarter during the pandemic.

Holly J. Lanham, Ph.D., from the University of Texas Health Science Center San Antonio, and colleagues examined barriers and facilitators of obtaining an X-waiver and prescribing buprenorphine in a survey study conducted between September and December 2020. The researchers found that 48.4 percent of the 126 clinicians who responded had received an X-waiver; of these, 36 and 64 percent were and were not prescribing buprenorphine, respectively. Significantly different barriers among waivered and nonwaivered clinicians included the complexity of the X-waiver process, perceived lack of professional support and a referral network, and getting started. Significantly different barriers experienced by prescribers and nonprescribers were getting started and accessing reimbursement for treatment. Facilitators mentioned most frequently were changes to the waiver training and the need for networks connecting experienced clinicians with those starting out.

"Clinicians need ongoing support and mentorship from experienced and knowledgeable clinicians throughout the X-waiver and prescribing processes," Lanham and colleagues write.

Abstract/Full Text - Spetz

Abstract/Full Text - Lanham

Editorial

SAN ANTONIO - The opioid crisis has been front and center in recent years, but methamphetamine addictions - and overdoses - may be an even more pressing and overlooked problem in Texas.

"By the end of this year, over 4,000 Texans will have lost their lives to a drug overdose," says Dr. Jennifer Potter, vice president for research at UT Health San Antonio. "I would estimate based on the data that we’re seeing that about 30 percent of those involve methamphetamine."

Doctors at UT Health San Antonio have launched two clinical trials in an effort to come up with treatment options for meth addicts.

"Methamphetamine really doesn’t have a lot of solid, reliable evidence-based treatments," Dr. Potter says.

The first study began in March. Treatment as part of a clinical study for methamphetamine addicts includes up to five sessions a week for two months.

"It uses magnetic stimulation to actually provide the treatment," says Dr. Tara Karns-Wright, UT Health San Antonio assistant professor.

Sessions last just 18 minutes.

"We’re looking to see if this treatment will help people who struggle with methamphetamine or cocaine use, reduce their urge to use," says research assistant Kierstyn Gallegos.

The goal is to provide scientifically approved options beyond incentives like cash or prizes to entice addicts to change their behavior.

"Doctors and counselors want a lot of options in the tool bag," Dr. Potter says. "If you only pull out a wrench, all you’re going to have is a wrench and wrenches don’t always work for every problem."

The second study, also a multi-year effort, will begin in July and involve medications.

"Recovery is possible. That’s something that a lot of times people who use drugs, and their families, think is impossible," Dr. Potter says.

Since the pandemic began, addiction - and overdose deaths - have skyrocketed in Texas.

"We’ve seen a 22 percent rise in the number of overdose deaths related to opioids and methamphetamine," Dr. Potter says. "That should be alarming every community in Texas."

If you want to reduce or stop your meth use and are not currently in formal substance use treatment, you can join UT Health San Antonio's program by contacting the research team at 1-210-450-3760 or via email at stimulus@uthscsa.edu.,

Find out more about the Be Well, Texas Clinic by clicking here.

AUSTIN — As Texas officials continue to pursue compensation from opioid manufacturers and distributors, boots-on-the-ground advocacy groups are cautiously optimistic about what settlement money could mean in ending, or at least combatting, the opioid epidemic.

In 2021, Texas reached several settlements with opioid drug makers and distributors including Johnson & Johnson, AmerisourceBergen and most recently Endo Pharmaceuticals for their role in perpetuating the opioid epidemic which in 2018 killed more than 1,400 Texans, according to the National Institute on Drug Abuse.

That same year, Texas providers wrote 47.2 opioid prescriptions for every 100 state residents, data shows.

“Many Texans suffer from addiction and need significant support and treatment to avoid becoming another statistic,” Texas Attorney General Ken Paxton said. “My office will continue to hold the companies that contributed to this crisis accountable and ensure that sufficient funds flow to Texas to provide much needed relief to our citizens.”

With these settlements, the state is expected to bring in an estimated $2 billion in settlement cash, much of which will go to the Texas Opioid Abatement Fund, established in the 87th legislature to manage payments received by the state from opioid manufacturers and distributors. The established fund will ensure settlement money is allocated fairly and spent to remediate the opioid crisis using efficient, cost-effective methods, according to the state’s website.

Records show at least 70% of the awarded money will be sent to the fund.

As of a Jan. 2 deadline, more than 480 Texas counties and cities had signed on to receive some kind of assistance from the fund, as part of the multi-state effort to hold companies accountable. The Texas Opioid Council has been tasked with deciding how and where that money will be spent.

“It’s time for us to come together again as only Texans can, maximize our recovery, and take care of our citizens so that we can serve as an example for the rest of the country,” Paxton said.

Jennifer Sharpe Potter, a professor of psychiatry at UT Health San Antonio, said she hopes the money will help push the state forward in how it perceives and treats opioid addiction.

Potter, who runs Recovery Texas — a website that offers access to immediate, peer-to-peer support services — and Be Well Texas Clinic — which hosts several recovery programs including a 24-hour visual clinic, said she believes the money could be transformative in how the state address substance use disorders by removing some of the many barriers.

One of the biggest barriers, she said, is access to affordable, effective treatment, which her programs look to address.

According to the National Institute of Health, methadone treatment, used to treat narcotic drug addiction, costs about $4,700 per year. This assumes daily visits and includes medication as well as integrated psychosocial and medical support services. Buprenorphine, given to stable patients in certified opioid treatment programs, can cost nearly $6,000 per year, including medication and twice weekly visits, it said. 

“We know how to treat opioid use disorder. What we don't do well is how to get that treatment out into communities,” Potter said.

Harris County, the state’s most populous county, suffered the greatest number of opioid-related deaths in 2019 at 564, according to Texas Department of State Health Services data. This was followed by Dallas, Bexar, Tarrant and Travis counties, respectively.

Suzanne Jarvis, director of Data and Program Analytics at the Houston Recovery Center, said another big obstacle facing opioid use disorder is the stigma attached to drug use.

Jarvis said since there are few health conditions that have negative ripple effects into one’s life like loss of housing or a job equal to opioid use disorder, it can be difficult for society to see it as a treatable disorder and not a moral failing.

“It is a chronic health condition that can be managed over time, [but] it needs to be seen and treated that way,” she said. “We don’t punish diabetics when their sugars are off.”

Jarvis said that she hopes the state funding is used to align policies and programs in political, social and medical structures in a way that produces better health outcomes for people.

This, she said, starts with education as opioid use disorder is a preventable health condition often formed due to genetic and social factors. Then, should someone need treatment, ensure that it is timely and affordable.

“I just think the more open and educated we get, the better the solutions that will come for all of us,” she said.

Jarvis added that with the funding, she hopes the council will appropriate money based on greatest need. In doing this, she said she hopes the council directly works with advocates and communities to evaluate what their needs are and best approaches for their communities, as they vary greatly.

“It's very hard to do, but it does create an opportunity to direct the funds to the biggest bang for the bucks,” Jarvis said.

Texas Comptroller Glenn Hegar will be executive director of the council. His office was not immediately available to confirm when the council will convene or when money will be made available.

There’s a new, low-cost resource for Texans to find a path to recovery from substance use and mental health issues.

It’s called Recovery Texas, and while based at The University of Texas Health Science Center at San Antonio, the help, resources and treatment provided are available to all of Texas, with funding to cover the cost of those who are unable to pay.

The website, RecoveryTexas.org, is at the heart of the initiative. Here, Texans can chat with peer recovery support specialists, take advantage of a self-screening tool, or schedule an appointment for treatment at the Be Well Texas Clinic. This is a new, telehealth clinic that provides the same, high-quality experience as an outpatient program.

Recovery Texas has secured funding to cover the cost of both the treatment and medication, if that’s deemed appropriate.

The path to recovery can begin by calling or texting 1-833-922-2557, or chatting online at recoverytexas.org. The staff is ready to help Texans weekdays, 9:00 AM – 9:00PM, Central Time. The project launched in October, and is already expanding. The hotline and web chat will be staffed 24-hour a day in the coming weeks.

A new, statewide initiative called Recovery Texas is now available to help individuals struggling with substance use find access to free care. The project, led by Jennifer Sharpe Potter, PhD, MPH, of UT Health San Antonio, was instituted to reach those impacted by the isolation of COVID-19 and the impacts of natural disasters.

The project centers around RecoveryTexas.org, a website that offers access to immediate help via phone or text, as well as online substance use and mental health self-assessments and access to non-traditional therapies like yoga and peer recovery support. The site also serves as a resource hub to help those with more severe cases to easily access medication-assisted treatment and referrals to counseling within a statewide network of providers who can treat them, regardless of the individual’s ability to pay.

“We have needed a program like Recovery Texas for a long time to overcome stigma and make it easy for individuals and families to access compassionate care for substance use exactly when they need it. Everything offered on Recovery Texas is evidence-based, meaning that all the programs are proven to be the best treatments available. This is all available to anyone, whether they have insurance or not,” said Dr. Potter, professor of psychiatry and behavioral sciences, who directs Texas Medication for Opioid Use Disorder (TxMOUD), a center within the Department of Psychiatry and Behavioral Sciences created to eliminate barriers to evidence-based treatment for those with substance use disorder (SUD).

Dr. Potter also serves as vice dean for research in the Joe R. and Teresa Lozano Long School of Medicine and associate vice president for South Texas Public Health Initiatives at UT Health San Antonio.

Recovery Texas comes at a crucial time, as COVID-19 ramps up again across the country. Since the pandemic began, there has been a 29.4% increase in overdose deaths nationally and a 31.9% increase in Texas, according to the U.S. Centers for Disease Control and Prevention. The Texas Department of State Health Services reports 20,000 emergency room visits due to opioid poisonings, with over 1,500 of those occurring in Bexar County.

“It’s really been a perfect storm for this,” said Karla Ramirez, LCSW, MSSW, MSHA, associate director of TxMOUD and a specialist in the Department of Psychiatry and Behavioral Sciences. “There has been a significant increase of overdoses, especially during the pandemic because there was such a lack of connection and we were all so isolated. People clearly are struggling.”

RecoveryTexas.org is designed for anyone who feels they are or may be struggling with substance use, no matter the substance or severity. The site provides immediate access to help by phone or text, including access to a certified peer support counselor — an individual who has lived through the recovery process and has special training to accompany others on this journey.

“Substance use and substance use disorder, it’s a big continuum,” Ramirez said. “Someone using a substance in an inappropriate way, like using prescription medicine in a way other than prescribed, or someone who is drinking a little too much — that can turn into a substance use disorder, especially when they start engaging in activities that are bad for them or going to extreme lengths just to obtain the substance. And it’s important to remember that it is considered a chronic disease,” Ramirez said.

RecoveryTexas.org also includes a portal to the referral network and the UT Health Physicians Be Well Texas Clinic regardless of ability to pay. Among the UT Health San Antonio mental health providers are Van King, MD, professor, and Jennifer Papac, MD, clinical assistant professor, in the Department of Psychiatry and Behavioral Sciences.

The project is supported by a number of funding streams, including grants from the Substance Abuse and Mental Health Services Administration (SAMHSA) and Texas Health and Human Services (THHS), together funding approximately $25 million for this project. The project partners with harm reduction programs across the state and local mental health authorities, and is a collaboration with Unity Recovery, a recovery community organization.