MATTERS Published in AAEM’s Common Sense

MATTERS: A Multi-State Solution to Linking People with Substance Use Disorder to High Quality Treatment

By: Joshua Lynch, DO and Lucy Connery, MPH

Program Success and Scalability

Since its inception, MATTERS has consistently followed a methodical approach, initiating its services on a small scale, rigorously evaluating outcomes, and expanding based on demonstrated efficacy and need. For instance, when developing a rapid referral system, the MATTERS team needed to address the perception that outpatient treatment organizations were unable to accept new patients (Kruger et al., 2024). The program conducted outreach and found that treatment organizations were accepting new patients but needed flexibility when scheduling appointments. MATTERS approached this concern by gathering weekly appointment availability for participating treatment organizations and offering those slots to patients being referred through the program. To ameliorate any gaps in access to medication, MATTERS developed a referral protocol for participating clinicians that includes a suggested buprenorphine bridge prescription for up to fourteen days. Several studies have found that emergency department-initiated medication for opioid use disorder (MOUD) programs improve follow-up rates and retention in treatment for OUD (Clemency et al., 2022; D’Onofrio et al., 2017; Reuter et al., 2022). However, MATTERS recognizes that many people seeking treatment for OUD experience financial and transportation barriers to long-term care. 

In response to these issues, MATTERS sought region-specific and statewide grant funding to provide patients with transportation for their first follow-up appointment and a voucher that covers the cost of any buprenorphine/naloxone prescription for the uninsured for up to two weeks. As an added layer of support, everyone referred through the program can choose to be linked to a peer in recovery to navigate the early stages of recovery. These services help individuals navigate common barriers to treatment, improve follow-up rates, and provide a one-stop solution for clinicians linking people with OUD to treatment (see Figure 2).  MATTERS continually searches for additional ways to refine the program to reduce even more barriers that patients may encounter.  

Still, the opioid crisis has continued to challenge clinicians; the COVID-19 pandemic led to an increase in people using drugs alone and a subsequent rise in opioid overdose deaths across the United States. When telemedicine prescribing flexibilities were offered nationally, MATTERS launched two virtual emergency departments to provide evaluations, prescriptions, and referrals to treatment for OUD. Although these emergency departments are based in Buffalo, NY, the program serves individuals across all of New York State and received an average of 185 calls related to OUD each month in 2023. With the support of a SAMSHA MAT-PODA grant, MATTERS and community-based partners concurrently launched the Western New York Opioid Addiction Hotline, a 24-hour service for individuals seeking treatment for substance use disorder (Connery & Lynch, 2022). In 2023, this hotline completed over 1,600 visits for substance use disorder, 80% of which resulted in linkage to medication, and 60% received a MATTERS referral to treatment. Individuals referred from virtual settings receive the same support as those who sought care in-person, including MATTERS’ medication and transportation vouchers. 

MATTERS’ Medical Director of Telemedicine, Renoj Varughese, MD stated “Telemedicine has emerged as a critical tool in the fight against the opioid and substance use disorder epidemic. By increasing access to life-saving medications, counseling, and support services, telemedicine is breaking down barriers to treatment and offering a lifeline to those struggling with addiction, especially in underserved communities and areas with provider shortages.” To secure long-term funding to sustain these services, leadership from the MATTERS program have documented the program’s success through several research publications. A recent MATTERS publication (Lynch et al., 2024) found that individuals referred from telemedicine settings (when compared to the emergency department) were more likely to attend their initial follow-up appointment (65% vs.32%) and were more likely to be retained in treatment after 30 days (53% vs. 22%). This information is vital when advocating for legislation to expand telemedicine services for substance use disorder. 

Lastly, in August of 2022 MATTERS launched its fentanyl test strip distribution program with the support of the New York State Office of Addiction Services and Supports (NYSOASAS). The program began by distributing to hospitals to demonstrate the success of a mail-based harm reduction supply distribution system. MATTERS Harm Reduction Manager, Shelby Arena, highlights the importance of offering harm reduction services to support patient success: “Harm reduction services can be a tool to connect people who use drugs (PWUD) to vital resources and treatment. By using a ‘no wrong door’ approach, we can link individuals seeking harm reduction supplies to a robust offering of support services like housing, mental health support, substance use treatment, and beyond. Harm reduction not only reduces overdose risk but truly meets people where they are to build trust and relationships while facilitating access to care.”   

In only a few months, the MATTERS program expanded its test strip distribution service to allow any individual or organization to request free supplies and today it is the primary distributor of fentanyl and xylazine test strips in New York State, shipping over 20 million strips across the region. The MATTERS team is currently evaluating the behavioral changes associated with using test strips and plans to release its research for other health systems to utilize. To further augment its harm reduction services, the program is also researching the potential utilization of new test strips for medetomidine, benzodiazepines, and nitazenes. 

To improve access to drug test strips and naloxone, MATTERS launched its harm reduction vending machine program and introduced nearly twenty machines into communities across New York State in 2024. Introducing these resources to the community required vetting applicants, building strategic partnerships, and establishing memorandums of understanding with organizations seeking to host a machine. Vending machines are accessible 24/7, temperature-controlled, and hosted at various locations, including treatment organizations, bus stops, law enforcement agencies, and convenience stores.  These machines currently dispense free drug test strips and naloxone to anyone and collect basic demographic information to support future research on the success of these programs. 

These rates also increased for individuals over age 65, which underscores the need for targeted, population-specific interventions and equitable access to evidence-based treatments such as medication for addiction treatment (MAT).

Looking Towards the Future

MATTERS is constantly expanding and responding to the ongoing opioid crisis. The program plans to expand its referral system to support inter-state referrals between New York, New Jersey, and Pennsylvania. Additionally, MATTERS recently formalized its follow-up support services; staff members follow up with everyone referred through the program 72 hours after linkage to treatment. These dedicated staff follow up again 30, 60, and 90 days after the referral was submitted to navigate any barriers to treatment and support continuity of care (see Figure 3). 

In 2025, MATTERS will launch its syringe services program, a mail-based initiative to provide sterile injection supplies to individuals across New York. Supplies will be delivered via mail, through vending machines, and through emergency departments. The program also plans to install additional harm reduction vending machines into communities across New York State. MATTERS is proud to serve as a model for a rapid referral network linking individuals to treatment and resources for OUD. Interested in learning more on the program or how to collaborate on bringing MATTERS resources to your area? Contact the MATTERS team at 765-MATTERS (628-8377), download the free “MATTERS Network” app on Google Play or the Apple App Store, or visit mattersnetwork.org. 

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