Collaborative Care for Opioid Use Disorder in Primary Care: A Hybrid Type 2 Cluster Randomized Clinical Trial

Area of Science:

• Primary Care Research
• Addiction Medicine
• Mental Health Services

Background:

• Medications for opioid use disorder (MOUD) are standard treatment, yet less than 25% of individuals with OUD receive them.
• The collaborative care model (CCM) integrates mental and physical health care in primary settings.
• Expanding CCM to include OUD treatment could improve MOUD initiation rates.

Purpose of the Study:

• To compare the effectiveness of CCM for OUD and co-occurring mental health symptoms against CCM for mental health symptoms alone.
• To evaluate the impact of integrated care on opioid use and mental health outcomes.

Main Methods:

• A hybrid type 2a cluster-randomized trial involving 24 US primary care clinics.
• Participants with OUD and mental health symptoms not receiving specialty care were randomized to intervention (CCM for OUD and mental health) or control (CCM for mental health only).
• Outcomes included past-month opioid use days and mental health scores, assessed at baseline, 3, and 6 months.

Main Results:

• Opioid use days decreased in both groups, but the intervention group showed a significantly greater reduction (adjusted odds ratio, 0.10; P < .001).
• Mental health scores improved slightly in both groups, with no significant difference between intervention and control.
• The intervention demonstrated a medium effect size in reducing opioid use (Cohen d = -0.44).

Conclusions:

• Collaborative care model (CCM) effectively manages opioid use disorder (OUD) within primary care settings.
• Integrating OUD and mental health care through CCM shows particular promise for improving treatment outcomes.
• Primary care clinics should consider implementing CCM for OUD and co-occurring mental health conditions.