BoulderCare, the de facto substance use disorder (SUD) provider, has been awarded $1.8 million in National Institutes of Health funding to design and test care pathways across marginalized settings.
Millions of Americans suffer from opioid use disorder. Medications to treat opioid use disorder (MOUD), such as buprenorphine and naltrexone, are considered the gold standard of treatment, but fewer than one in five people receive them. The disparities are even greater in underserved settings, which Boulder plans to focus his grant on. Participants must be Medicaid enrolled.
“We have all the tools in place to provide this excellent health care across the country. It’s important to recognize where the cracks are in the system,” Dr. Aisha Apa told Fierce Healthcare.
Dr. Boulder will use NIH funding to coordinate a virtual MOUD pathway for patients in the following settings:
- Community corrections and reentry programs: The risk of overdose increases up to 129 times two weeks after release.
- Pregnancy and postnatal care environment: Overdose is the leading cause of pregnancy-related death. Discontinuing MOUD after delivery increases the risk of overdose and relapse.
- Tribal Nation Health System: Indigenous peoples have the highest prevalence of SUDs and face significant barriers to treatment access.
- Transitioning from a home treatment environment: Nearly half of Medicaid enrollees discharged from rehabilitation facilities do not receive timely outpatient visits or MOUD.
- Transition from the emergency department: Patients who present to the emergency department with an overdose have a 6% risk of dying in the next year. However, only 16% of patients with private insurance receive follow-up care.
“We know it works. There’s great efficacy data,” Appa said of telemedicine. This funding will be used to go one step further and find ways to design telemedicine for patients who need help the most.
As part of the study, Boulder will work with five facilities to provide patients with smartphones preloaded with the Boulder app, as well as cellular service and Wi-Fi, setting-specific infrastructure, and transition support between care settings. Mr. Boulder creates care pathways tailored to each population, delivers care, and measures outcomes. Approximately 50 patients per facility will participate.
So far, study sites selected include an acute care hospital in Oregon, a perinatal program in Ohio, and a correctional program in Washington. The study measures both continuity of care and retention, as well as other factors such as employment, incarceration, ED, hospital visits, and quality of life.
“Medicine is good at asking, ‘Does a treatment work?’ Implementation science is about asking the next question, ‘How can we get that treatment to the people who need it in the real world?'” Appa said.
The City of Boulder is already seeing promising results through an existing partnership with Jackson County Community Justice, which provides parole, probation, detention, and residential services in Oregon. An analysis of 290 people in 2026 found that for those who received Boulder treatment for at least six months after release, the average number of arrests per year decreased from 3.4 to 0.9. The average time for incarcerated individuals to receive buprenorphine was 0.8 days, and the time from expressing interest to receiving buprenorphine was 2 days.
“We know that the moment of post-release fracture is this critical clinical vulnerability, but also a real system failure that needs to be bridged,” Appa said.
The NIH study is expected to last about two years. Boulder’s grant is supported by the NIH’s National Institute on Drug Abuse.
