Addiction Treatment Outcomes Improved With Collaborative Care

Collaborative care was found to improve access to treatment and abstinence among patients with opioid and/or alcohol use disorders (OAUD), according to a recent study.

The randomized clinical trial included 377 primary care patients with OAUD, 77 (20.4%) of whom were female. A total of 187 participants were assigned to receive collaborative care and 190 participants were assigned to usual care.
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Participants assigned to the collaborative care system, which was designed to increase access to therapies for OAUD, underwent either 6 brief psychotherapy sessions and/or received medication-assisted treatment with either sublingual buprenorphine/naloxone for opioid use disorder or long-acting injectable naltrexone for alcohol use disorder. Those assigned to usual care were informed by primary care physicians that the clinic provided OAUD treatment and were given a number to schedule an appointment and a list of referrals. 

The primary outcomes included the use of evidence-based treatment for OAUD and self-reported abstinence from opioids or alcohol at 6 months. Secondary outcomes included Healthcare Effectiveness Data and Information Set (HEDIS) initiation and engagement measures, abstinence from other substances, heavy drinking, health related quality of life, and consequences from OAUD.

After 6 months, OAUD treatment was accessed by more participants who received collaborative care compared with those who received usual care (73 [39%] vs 32 [16.8%], respectively). Likewise, more participants who received collaborative care reported abstinence from opioids and/or alcohol at 6 months compared with those who received usual care (32.8% vs 22.3%, respectively). 

The proportion of participants who met the HEDIS initiation and engagement measures was higher among participants who received collaborative care (31.6% and 15.5%, respectively) compared with those who received usual care (13.7% and 4.2%, respectively).

In addition, 26.3% of participants who received collaborative care reported abstinence from opioids, cocaine, methamphetamines, marijuana, and any alcohol compared with 15.6% of participants who received usual care.

“Among adults with OAUD in primary care, the [Substance Use, Motivation, Medication and Integrated Treatment] collaborative care intervention resulted in significantly more access to treatment and abstinence from alcohol and drugs at 6 months, than usual care,” the researchers concluded. “Effective treatment for opioid and alcohol use disorders can be integrated into primary care using a collaborative care intervention.”

—Melissa Weiss

Reference:

Watkins KE, Ober AJ, Lamp K, et al. Collaborative Care for Opioid and Alcohol Use Disorders in Primary Care: The SUMMIT Randomized Clinical Trial [published online August 28, 2017]. JAMA Intern Med. doi:10.1001/jamainternmed.2017.3947.