Opioid, Alcohol Use Reduced With Collaborative Care

Collaborative care interventions are associated with more access to treatment and abstinence from alcohol and drugs compared with usual care among individuals with opioid and/or alcohol use disorders (OAUD), according to a recent study.

Primary care is often underutilized for the treatment of OAUD. Although collaborative care is known to be effective in other settings, it has not yet been studied in patients with OAUD.
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For the SUMMIT randomized clinical trial, the researchers assessed 377 primary care patients with OAUD at 2 clinics from June 3, 2014, to January 15, 2016. A total of 77 (20.4%) patients were female, and mean patient age at baseline was 42 years.

Patients were randomly assigned to receive either collaborative care (n = 187) or usual care (n = 190). According to the researchers, the collaborative care intervention was designed to increase the delivery of either 6 sessions of brief psychotherapy and/or medication-assisted treatment with either sublingual buprenorphine or naloxone for patients with opioid use disorders or long-acting injectable naltrexone for patients with alcohol use disorders. In contrast, patients who received usual care were informed that the clinic provided treatment for OAUD and were provided with a number for appointment scheduling and a list of community referrals.

Primary outcomes included the use of any evidence-based treatment for OAUD and self-reported abstinence from opioids or alcohol for 6 months. Secondary outcomes included the 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. 

At 6-month follow-up, more patients who received collaborative care had also received OAUD treatment vs those who had received usual care (39.0% vs 16.8%). Furthermore, following linear probability model adjustment for covariates, more patients in the collaborative care group had reported abstinence from opioids or alcohol vs those in the usual care group at 6 months (32.8% vs 22.3%).

Secondary analysis showed that more patients in the collaborative care group vs the usual care group had met HEDIS initiation (31.6% vs 13.7%) and engagement (15.5% vs 4.2%) measures. Additionally, more patients who had received collaborative care reported abstinence from opioids, cocaine, methamphetamines, marijuana, and any alcohol, compared with those who had received usual care (15.5% vs 4.2%).

“Among adults with OAUD in primary care, the SUMMIT 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.

—Christina Vogt

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. JAMA Intern Med. 2017;177(10):1480-1488. doi:10.1001/jamainternmed.2017.3947.