Collaborative Care Superior to Standard Care for Opioid Use Disorder
The Substance Use Motivation and Medication Integrated randomized clinical trial examined the benefits of collaborative care vs standard addiction care for the treatment of opioid use disorder.
Patients with opioid and/or alcohol use disorders (OAUD) have better treatment access and greater rates of alcohol and drug abstinence at 6 months with collaborative care vs standard addiction care, according to results from the Substance Use Motivation and Medication Integrated Treatment (SUMMIT; Clinicaltrials.gov identifier: NCT01810159) randomized clinical trial published in JAMA Internal Medicine.1
Researchers compared the use of collaborative care, which involves the integration of behavioral health strategies into primary care, with usual care among 377 patients with OAUD in a federally qualified health center (FQHC). In this study, the investigators sought to identify differences between the 2 groups in terms of the delivery of evidence-based treatment to patients and rates of reported abstinence from drugs or alcohol. The Healthcare Effectiveness Data and Information Set (HEDIS) was used in secondary analyses to determine engagement measures among the 2 groups.
Patients in the collaborative care group (n=187) reported higher abstinence from alcohol or opioids compared with patients receiving usual care (n=190) at 6 months (32.8% vs 22.3%; P =.03). Treatment for OAUD was higher in the collaborative care group at 6 months compared with the usual care group (39.0% vs 16.8%; P <.001).
In the collaborative care group, a higher proportion of participants met the HEDIS initiation and engagement measures compared with those receiving usual care (initiation: 31.6% vs 13.7%; P <.001; engagement: 15.5% vs 4.2%; P <.001). A greater number of participants in the collaborative care group also reported higher abstinence from other substances, such as marijuana, cocaine, and methamphetamine, compared with the usual care participants (26.3% vs 15.6%; P =.01).
Because the study was carried out at an FQHC with on-site behavioral health care, the investigators comment that their results may not be applicable to other care settings. In addition, because there was no follow-up after 6 months, the researchers were unable to establish whether the effects of collaborative care were sustained beyond this time period.
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