Collaborative Care for Opioid Use Disorder and Mental Illness: The CLARO Randomized Clinical Trial

Area of Science:

• Behavioral Health
• Addiction Medicine
• Primary Care Integration

Background:

• Adults with opioid use disorder (OUD) often have co-occurring depression and/or posttraumatic stress disorder (PTSD).
• Collaborative care is an evidence-based model for behavioral health conditions in primary care but is understudied for OUD with comorbid mental illnesses.

Purpose of the Study:

• To evaluate if collaborative care, adapted for low-resource settings, improves outcomes for patients with OUD and co-occurring depression/PTSD more than enhanced usual care (EUC).

Main Methods:

• A pragmatic randomized clinical trial involving 797 adult participants with probable OUD and major depression/PTSD across 18 primary care clinics.
• Intervention group received 6 months of collaborative care involving care managers and addiction psychiatrists; control group received EUC.
• Primary outcomes included time to first buprenorphine prescription, cumulative days of buprenorphine, and scores on depression (PHQ-9) and PTSD (PCL-5) checklists.

Main Results:

• No statistically significant differences were found between collaborative care and EUC for primary outcomes at 6 months.
• Secondary outcomes and exploratory measures also showed no significant differences between groups.
• Both groups demonstrated improvement from baseline, with exploratory analyses suggesting potential benefits in an as-treated population.

Conclusions:

• Collaborative care did not show superior outcomes to EUC for OUD patients with comorbid depression/PTSD in this trial.
• Potential explanations include spillover effects, spontaneous remission, or the model's suitability for complex patients and resource-limited settings.