The Center for Addiction Medicine leads and supports research and evaluation efforts that generate, assess, and integrate evidence into practice to prevent and treat substance use disorders.
We utilize a learning health system model to coordinate and integrate addiction services across the health system and broader community.
Several Center for Addiction Medicine research projects have focused on rigorously assessing care navigation interventions to increase linkage to and retention in treatment.
Question: Does dedicated care navigation that incorporates contingency management result in better linkage to treatment for patients with methamphetamine use disorder?
Findings: In a randomized controlled trial of 192 patients with methamphetamine use disorder, patients receiving a dedicated care navigation intervention that included contingency management were not more likely to link to treatment within 30 or 90 days.
Meaning: Patients with methamphetamine use disorder have considerable health related social needs that create significant barriers to care. The lack of an observed intervention effect may indicate the need for more extensive wrap-around services, longer duration of intervention, and more robust treatment options for methamphetamine use disorders.
Question: Does dedicated care navigation enhance engagement and retention in care for opioid use disorder?
Findings: In a randomized controlled trial of 102 patients who initiated treatment on buprenorphine for opioid use disorder, those receiving a dedicated care navigation intervention were twice as likely to be retained in care at 180 days compared to those receiving usual care.
Meaning: It is hard for people to prioritize treatment when their basic needs are not being met. Continuing to build the evidence base to support the effectiveness of dedicated case management and care navigation to address the social support needs of persons with substance use disorders is critical.
Accurate data, definitions, and phenotypes to identify and track patients along the cascade of care is critical to quantifying and targeting efforts to reduce gaps along the cascade. Development of the initial Opioid Cascade of Care Model in 2019 served as a building block in establishing the Center for Addiction Medicine. CAM has invested in ongoing development of cascade of care models for other substance use disorders, including alcohol and methamphetamine.
Read our most recent Cascades of Care Report.
Opioid Use Disorder Continuum
Opioid Agonist Treatment Disparities
Question: Do patients with opioid use disorder that receive opioid agonist treatment (OAT) differ from those that don’t in terms of sociodemographic and other health factors? Likewise, are patients that stay retained in OAT different from those that don’t?
Findings: In this cohort study, associations between patient characteristics and OAT receipt and retention suggest three patterns: cumulative disadvantage with factors associated with both lower treatment and retention (e.g. lacking insurance coverage); uneven disadvantage for factors associated with either decreased treatment or retention (e.g. non-Hispanic Black race/ethnicity for receipt); and inverse associations wherein factors showed benefit in one stage but disadvantage in the other (e.g. older age showed association with lower OAT receipt and higher OAT retention).
Meaning: The identified disparities are unlikely to be resolved without addressing the structural barriers that obstruct equitable access to, and retention in, treatment.
Alcohol Use Disorder Continuum
AUD Treatment Survey
In June 2023, the CAM Knowledge Management Team conducted a survey of 174 clinicians from 22 service areas who served patients with alcohol use disorder (AUD). The goal of the survey was to understand factors influencing AUD treatment decisions and current practices and patterns of pharmacological and behavioral health treatments. See our full report or read the executive summary.
Methamphetamine Use Disorder Continuum
Methamphetamine Use Markers in the Electronic Health Record
Question: How accurately can we identify methamphetamine use in electronic health records (EHR) and what is the computational lift?
Findings: Results provide multiple options to consider when extracting data on methamphetamine use from EHRs with guidance on computational lift and complexity of different markers. Users can select specific definitions of methamphetamine use depending on the project, technical capacity, time, and EHR system.
Meaning: Findings from this study can provide quality improvement, research, and evaluation efforts around methamphetamine use with better tools and multiple options to identify patients using methamphetamine in EHRs.
A cornerstone of the Center for Addiction Medicine is our rigorous evaluation of clinical programs to inform continuous improvements in clinical practice. Below are examples of recent evaluation efforts.
Novel Methadone Restart Protocol
Question: Are individualized higher methadone restart doses after a gap in daily dosing associated with safety and effectiveness?
Findings: In this cohort study, a new clinical protocol that individualized methadone restart doses by accounting for maintenance of opioid tolerance after a gap in methadone treatment was associated with significantly higher restart doses without any changes in opioid-related harms or treatment retention.
Meaning: These results suggest that more individualized methadone restart dosing that accounts for maintenance of opioid tolerance may promote higher restart doses that are closer to therapeutic levels without increased patient harm.
Vaccinations at OBHS
Question: Is a collocated vaccination model at an opioid treatment program able to vaccinate patients for vaccine-preventable illnesses and vaccinate patients that may not be reached in other settings?
Findings: This evaluation provided a descriptive comparison of patients receiving vaccinations at a collocated vaccine clinic at an OTP compared to all patients at an OTP and patients receiving vaccinations at other parts of the integrated health system. Collocated vaccination at an OTP was able to vaccinate patients for vaccine-preventable illnesses.
Meaning: Our analysis supports providing preventative health care in nontraditional settings that are a place of trust. This offers the potential to engage populations who are often unable to access care in traditional settings due to stigma or social determinants of health.
A major focus of CAM’s data management workgroup is developing infrastructure for substance-related data from the electronic health record and other data systems.
Integration of SUD treatment program data into the Electronic Health Record
Question: What are the benefits of integration of SUD treatment program data into the electronic health record (EHR), in light of 42 CFR Part II revisions?
Findings: New EHR infrastructure, including a treatment referral order and a treatment episode, supported a “hub and spoke” model of coordinated SUD treatment and care, at a large safety-net healthcare system
Meaning: Other health care systems can use these lessons learned to leverage their own data integration efforts to support SUD engagement, treatment, and recovery services within their communities.
