Published: 12/24/2025 | Author: Terri

Since 2007, Massachusetts has provided a national model for its integrated approach to opioid treatment in the primary care setting.

Using a nurse care model (NCM), healthcare providers receive funds to improve access and coordinate care. This is done through a dedicated nursing staff. The NCM model means physician assistants, nurse practitioners and doctors can serve more patients. 

Nurse Care Model Expands Opioid Treatment Access

The NCM model provides office-based addiction treatment (OBAT) as an alternative to specialty substance use disorder (SUD) clinics, which expands access to treatment. Policymakers are recognizing the benefits of implementing this alternative more widely. 

In Massachusetts from June 2021 to July 2022, the majority of substance-related deaths were from alcohol and opioids. Concurrently, more than 50% of all opioid related deaths from overdose involved the stimulant, cocaine. 

In 2022, the model was expanded by the Massachusetts Bureau of Substance Addiction Services to include those with both stimulant and alcohol use disorders. 

The approach is promising and demonstrates that the Massachusetts approach can be a model for other states looking expand services and help individuals with a variety of SUDs, particularly those who are on Medicaid. 

The national median for Medicaid enrollees with OUD to receive medication is 60%. In 2023, 79% of clients enrolled in Massachusetts Medicaid received medication as a direct result of the NCM programs. 

Nurses Expanding Access to Opioid Addiction Treatment

NCM relies on specially trained nurses. Approaching OBAT care this way requires NCMs to screen for SUD. After confirming the diagnosis, an authorized prescriber or physician prescribes buprenorphine as appropriate. 

After initiating medication and management, NCMs educate clients, develop treatment plans, document treatment compliance, and coordinate care among healthcare providers. This frees up prescribers to see more individuals, expanding care access. 

Rethinking Public Policy and Funding Protocols

For the NCM model to succeed, clinicians need incentives to provide this type of care. This makes policymakers a critical component of implementation. The payment approach must provide adequate compensation for the expanded services. 

Massachusetts funds the model through a melange of federal money, state general funds, and Medicaid reimbursement. This includes the State Opioid Response Grant and the Substance Use Prevention, Treatment, and Recovery Services Block Grant. 

The grants provide coverage for services left uncovered by Medicaid. 

Another way providers reach out to those who may need care is by opting to receive funds that go toward wraparound services. 

These services may include partnering with a soup kitchen, providing transportation to appointments, and visiting homeless encampments. Nicole Schmitt, director of the Office of Strategy and Innovation, noted that this type of outreach engaged more people in treatment. 

Nurse Care Managers Aiding Individuals with OUD

The numbers are telling. Three years after the Boston Medical Center developed the new model and expanded it to 14 federally funded health centers (qualified health centers that provide primary healthcare to clients unable to pay), the healthcare providers prescribing buprenorphine from these locations expanded from 24 to 114. 

Patients who remained in treatment for more than a year went from 32% in 2010 to 67% in 2013. Due to the financial stability of the program, half of the locations expanded their programs beyond the initial grant size requirements. 

Studies conducted in five states revealed that NCMs not only increase the amount of OUD treatment provided, but also that individuals participated longer. Individuals in the programs noted that they were motivated to stay in treatment and that the care was non-stigmatizing and nonjudgmental. 

Expanding Office-Based SUD Treatment

The Massachusetts Bureau of Substance Addiction Services enlarged the program in August 2022 to include treatment for those with stimulant and alcohol use disorders. As of 2025, more than 40 locations across Massachusetts offered contracted OBAT treatment services through the bureau. This is a significant increase in treatment services from 2007. 

The bureau provides technical assistance and training to make these OBAT services possible. One example includes grant funding to provide training for managing outpatient alcohol withdrawal so providers feel confident offering the services. 

Jen Miller, director of grants and innovation at the bureau, remarked, “Training can ensure that the person who is given outpatient withdrawal management has the right supports at home or in their community, because outpatient withdrawal management is doable. Not everyone needs an inpatient level of care.” 

The bureau provides a free videoconference training and support program. This 12-session program is offered by Boston Medical Center. According to Ms. Miller, this assistance program is “run and developed by a program that implements OBAT services, so they’re keenly aware of some of the challenges and successes.” 

Reducing Stigma in Opioid Addiction Treatment

Massachusetts officials and clinicians evolved their treatment approaches to deal with the changing nature of substance use. Additionally, they aligned the payment approach with the new treatment model, which allowed them to treat more people with varying needs related to substance use. In 2020, OBAT enrollment was 3,687 and increased 17% to 4,319 in 2024. 

Simultaneously, in fiscal year 2020, non-opioid admissions to OBATS were 639 (17.4% of admissions). These grew to 1,682 (39% of admissions) in fiscal year 2024. 

Providers started admitting clients to their facilities for non-opioid SUD before the official change due to community need, Ms. Miller noted. She also suggested that the nurse-led model may encourage clients to seek care due to reduced stigma and fear. She also remarked that the OBAT centers were simply more accessible. She said, “It feels less daunting to go to, because your primary care might be just down the hall.” 

According to interviews with Pew, Massachusetts’ OBAT model expansion came about in part due to the reality that many treatment centers were already providing care for stimulant use disorder and AUD but they weren’t being adequately paid for the care. 

Before the policy change, in some cases, an individual may have already had another substance as their most important concern, but also needed treatment for OUD. It’s not uncommon to have AUD and OUD. 

Recently, a meta-analysis revealed that in those with OUD, 27.1% had concurrent AUD. As compared to individuals with any SUD, those with AUD are more than five times as likely to have simultaneous OUD. 

With the new OBAT treatment model in Massachusetts, providers can treat clients with co-occurring SUDs and get reimbursed for all the services. The results are clear, as the number of clients admitted to take medication for AUD has increased to 899 (22.5% of admissions) in 2024, from 295 (8.8%) in 2020. 

State Support of OBAT Addiction Treatment Models

Other states utilizing the OBAT model with an aligned payment approach can also expand treatment for those with SUD beyond opioids. This approach will improve health and save lives. 

The director of the Office of Strategy and Innovation at the Massachusetts Bureau of Substance Addiction Services, Nicole Schmitt, said in an interview with Pew that state leaders need to “take a broader perspective and not go down the rabbit hole of focusing on one particular drug.” She also noted that it’s a disservice to be “narrowly focused on opioids and not pay attention to alcohol and stimulants.” 

Virginia and Michigan are both expanding eligibility for OBAT programs. Providers receive enhanced payments for buprenorphine and wraparound services in Virginia, while billing at equivalent rates as those providing treatment to clients with stimulant use disorders and AUD. In Michigan, primary care providers are now allowed to bill for SUD treatment services. 

This includes screening and assessment services, medication, counseling, and care management, no matter the primary substance, as long as the provider can give the client the appropriate level of care. 

Further, access to health home services is allowed in Michigan for individuals with stimulant and alcohol use disorders, which improves care coordination. States currently without these treatment approaches have broader eligibility to establish them. Delaware is doing just that through the Management of Addictions in Routine Care initiative. 

As state leaders establish or expand the OBAT payment model, they should consider dedicated funding. Examples are the state opioid response grants (also used for stimulant use disorder) and the Substance Use Prevention, Treatment and Recovery Services Block Grant, which can be used for any substance disorder. 

These funds can provide technical assistance and ongoing training. Previous research regarding OBAT implementation reveals that offering these supportive services increases the likelihood that providers will prescribe buprenorphine, and may be helpful for other SUD treatment support.

As Schmitt also noted, the technical assistance provided to grant recipients in Massachusetts is “instrumental” and “people may want to do this or see a need to do it, but they may not know how to do it or how to do it well.” 

The experience in Massachusetts illustrates that state leaders can expand services designed for individuals with OUD to those with any type of SUD. Additionally, provider support paired with policy changes can improve access to treatment.

Find Opioid Treatment and Support Near You

If you or someone you love is struggling with opioid addiction, treatment options are available. Medication assisted treatment, including buprenorphine, can reduce cravings and overdose risk while supporting long term recovery.

You can also find NA meetings near you for peer support, or call 800-934-1582(Sponsored) today.