California Residency Program Collaborative

Education | Outreach | Treatment

Improving care for patients with substance use disorders

Sponsored by California Academy of Family Physicians and CAFP Foundation

The overall goal of this project is to improve education, outreach and treatment for patients with substance use disorder disease, including stimulants and opioids, with a focus on medication assisted treatment options.  Our goal is to enhance training for primary care and emergency medicine physicians while encouraging creative and innovative approaches to meet program and community needs. Projects will identify methods to improve or advance the standard of care for patients, demonstrate how best to implement those methods, and evaluate the outcomes of these efforts.

Our programs’ projects will:

  1. Advance the training of primary care and emergency medicine residents and physicians in the field of substance use disorder disease treatment;
  2. Improve the patient experience of care (including quality and satisfaction);
  3. Promote care that is patient-centric, engaging the community in the overall management of substance use disorder.

Our expectation is that program have an identified need(s), a methodology to both implement the action plan and measure the project’s impact, and a timeline for spread and plan for sustainability. Collaboration and communication with other stakeholders, including community members, are also encouraged and should be outlined in the proposal.

Our 16 residency programs will work for one a little over a year on their projects and during that year also work as a collaborative – meeting to share resources, wins, challenges and results. They will participate in face-to-face meetings, webinars and check-in calls, and will present a final report in June 2022.

CAFP and the CAFP Foundation are very pleased to announce this year’s residency programs that will participate in our Collaborative. Congratulations to our 2021-2022 Grantees!

  • Adventist Health Hanford Family Medicine Residency Program
  • Adventist Health Tulare Family Medicine Residency Program
  • Adventist Health Ukiah Valley Family Medicine Residency Program
  • Eisenhower Health GME Emergency Medicine Residency Program
  • Eisenhower Health GME Family Medicine Residency Program
  • Harbor-UCLA Family Medicine Residency Program
  • Harbor-UCLA Emergency Medicine Residency Program
  • Kaiser Central Valley Emergency Medicine Residency Program
  • LAC+USC Emergency Medicine Residency Program
  • LAC+USC Psychiatry Residency Program
  • Olive View-UCLA Medical Center, Primary Care
  • Pomona Valley Hospital Medical Center’s Family Medicine Residency Program
  • Shasta Community Health Center Family Medicine Residency
  • Stanford Pediatrics Residency Program
  • Sutter Health Family Medicine Residency Program
  • Sutter Health Family Medicine Residency Program, Davis Track

Education and Resources

DHCS Alert (5.27.21): Closure of 29 Lags Pain Clinics
On May 25, 2021, DHCS learned that Lags Medical Centers voluntarily closed 29 California locations this month, even though DHCS only suspended seven National Provider Identifier numbers associated with up to 17 locations, potentially impacting about 20,000 beneficiaries access to pain management care. Read More

New Requirements for Buprenorphine X-Waiver (as of April 28, 2021) US Department of Health and Human Services (HHS) has released new practice guidelines for treatment of opioid use disorder. HHS has officially removed the X-waiver training requirement to treat patients with buprenorphine." Download PDF:  xWaiver Training HHS ruling   


New HHS Practice Guidelines FAQs
Prescribers no longer need to complete the MAT training for the 30-patient limit.


How do I apply for an X waiver?

Go to the SAMHSA website to apply for the X waiver through the notification of intent (NOI). You will need your state license and DEA registration. When the system asks for Certification Qualification Criteria check “Other” and write in “Practice Guidelines.” (Please note, there have been reports of an error message regarding a form showing completed CME, which will hopefully be fixed. (SAMHSA buprenorphine info center can confirm submission via infobuprenorphine@samhsa.hhs.gov).  

How long will it take to get my X waiver once I apply? 

SAMHSA will review applications within 45 days of receipt. Once the application is complete and the application is approved, SAMHSA will email an approval letter. The DEA will follow up with an updated DEA license showing X waiver. The whole process can take two months – a good reason to start the process now.

How do I write a prescription using my X waiver?

Once you have received your X waiver, you write a prescription for buprenorphine for opioid use disorder by indicating your X waiver license number on the prescription. The pharmacist will have no indication if the X waiver license was obtained after 8 hours of training or not. You can e-prescribe buprenorphine for opioid use disorder by indicating your X waiver license number in the “notes to pharmacy” section or NADEAN: x-license number section in the EHR.

How does the 30 patient limit work? 

The removal of the training requirement allows you to apply for an X waiver for up to 30 patients. The limit of 30 patients applies only to active patients and is not an annual limit. A patient counts for this limit for the duration of the prescription. For example, an ED physician can write 30 one-week prescriptions weekly and up to 120 one-week prescriptions in a month and still be within the 30 patient limit. 

Additional Resources

Education: Access the Content Here

Treating SUD - Linking with Community Services – This activity is a recording of virtual session offered in March, 2021 through the Primary Care Residency Program Collaborative (PCRPC) around improving Substance Use Disorder (SUD) services and includes a list of additional resources and a robust Q&A section.  Treating SUD - Linking with Community Services offers information, tools and resources to clinicians considering the addition of Medication Assisted Treatment (MAT) services for their patients. Hosted at Homeroom: Access the Content Here

Incorporating MAT into Practice – A Community Conversation  – This activity is a recording of virtual session offered in March, 2021 through the Primary Care Residency Program Collaborative (PCRPC) around improving Substance Use Disorder (SUD) services and includes a list of additional resources and a robust Q&A section.  Incorporating MAT into Practice – A Community Conversation offers learners an opportunity to listen in while more experienced MAT providers provide tips and tricks and discuss lessons learned throughout their career providing MAT services.  Hosted at Homeroom: Access the Content Here

MAT waivered Prescriber Support (https://stanford.cloud-cme.com/course/courseoverview?P=0&EID=35466) - This online activity is sponsored by Stanford University School of Medicine and will update members of the healthcare team about different strategies for treating patients with chronic pain and provide strategies to reduce reliance on opioids for pain relief.

AAFP EveryOne Project - The EveryONE Project is an initiative, which is part of the American Academy of Family Physicians’ Center for Diversity and Health Equity, offers education and resources to help you advocate for health equity, promote workforce diversity, and collaborate with other disciplines and organizations to reduce harmful health disparities.

Free SAMSHA Training

For those providers who wish to treat more than 30 patients after their first year of certification, SAMHSA funds the Providers’ Clinical Support System (PCSS) to provide practitioner training in the evidence-based prevention and treatment of OUD and offers the required trainings needed to apply for buprenorphine waiver notifications. Learn more about practitioner buprenorphine training requirements.

SAMHSA offers tools, training, and technical assistance to practitioners in the fields of mental and substance use disorders. Find information on SAMHSA training and resources. SAMHSA has developed a Buprenorphine Quick Start Guide (PDF | 1.5 MB) and pocket guide (PDF | 231 KB) for all practitioners seeking to prescribe buprenorphine.

Learn more about buprenorphine.

Useful Links:

Questions

If you have questions, please direct them in writing to Jerri Davis, jdavis@familydocs.org.

Expert Advisory Panel members:

Name Specialty/Constituency
Carol Havens, MD, FAAFP, FASAM, EAP Chair Family Medicine and Addiction Medicine Chair, CAFP’s Committee on Continuing Professional Development
Thomas C. Bent, MD, FAAFP Family Medicine, CAFP Foundation Board of Trustees
Toni Brayer, MD Internal Medicine, Large systems
Condessa Curley, MD, MPH, FAAFP Family Medicine, Public Health
Tipu V. Khan, MD, FAAFP, FASAM Family Medicine and Addiction Medicine with emphasis in Obstetrics
Keith Loring, MD Emergency Medicine and Addiction Medicine
Aimee Moulin, MD Emergency Medicine and Addiction Medicine
Heyman Oo, MD Pediatrics
Michael Potter, MD, FAAFP Family Medicine, Practice based research
Lee Ralph, MD Family Medicine and Sports Medicine
Melanie Thompson, DO Family Medicine
David Tran, MD, MPH Family Medicine and Palliative-Hospice Medicine
Staff and Consultants
Jerri L. Davis, CHCP CAFP VP of Education
Pamela Mann, MPH CAFP Foundation Executive Director
Mary Ales, MBA, FACEHP Mosaica Solutions
Shelly Rodrigues, CAE Mosaica Solutions
Pam Kittleson, RPh IPMA, Director of Quality
Debra Levinthal, DPM IPMA Executive Director
Heidi Ness IPMA Director of Education and Accreditation
Cheri Olson, MD IPMA Medical Director

2019-2020 CA Primary Care Residency Program Collaborative Final Reports

Narrative - Final ReportFull Final Report

This website will be continually updated with information to assist these and other residency programs that strive to make improvements in order to better serve their patients with SUD. Please check back as we post education, tools and resources on this website throughout the collaboration.

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