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Program Successfully Combines Primary Care, Substance Abuse Treatment

Sending patients away for substance abuse treatment might not always be the best way for primary care providers to deal with those problem, a new study shows.

The study in JAMA Internal Medicine suggests that combining substance abuse treatment with regular primary medical care might be a better way to deal with patients who have an opioid or alcohol addiction issue.

The RAND Corporation study points out that the model is a good option for expanding treatment and lowering costs. Researchers report that patients enrolled in the program that combined substance abuse treatment with primary medical care were more than twice as likely to receive treatment for opioid or alcohol abuse, as compared to peers who received usual primary care services.

Those patients also were significantly more likely to report abstinence from opioids or alcohol six month after beginning care, which is one of the indicators of successful recovery.

"This new model of integrating treatment for substance use disorders with a patient's primary medical care could expand access to drug treatment at a lower cost and in a more accessible fashion," said lead author Katherine E. Watkins, MD, MSHS, a senior physician scientist at RAND, a nonprofit research organization. "This is a way to increase access to evidence-based substance use treatment, without having to convince patients to go to a specialized drug treatment center."

The report emphasizes that specialty care treatment is important for patients with severe dependence, but that access is limited and it creates significant stigma.

For the study, researchers focused on 377 people with opioid or alcohol abuse disorders who received medical care at two locations operated by a safety net medical provider in the Los Angeles area.

In the randomized clinical trial conducted from June 3, 2014, to Jan. 15, 2016, with six months of follow-up, about half the patients were randomized to collaborative care and the others to usual care.

The collaborative care (CC) program included some or all of the following: a six-session brief psychotherapy treatment, medication-assisted treatment with either sublingual buprenorphine/naloxone for opioid use disorders, or long-acting injectable naltrexone for alcohol use disorders.

Meanwhile, usual care participants were told that the clinic provided substance abuse treatment and given a number for appointment scheduling and list of community referrals.

After six months, the proportion of participants who received any substance abuse treatment was higher in the CC group compared with usual care — 39% vs. 16.8%, with a greater proportion of CC participants reporting abstinence from opioids or alcohol at that point — 32.8% vs. 22.3%.

Study authors point out that “primary care offers an important and underutilized setting to deliver treatment for opioid and/or alcohol use disorders.”

"Our findings suggest that it is possible to successfully treat people who are addicted to opioids or alcohol in a primary care setting," Watkins added. "The collaborative care model can be a lower-cost and more accessible way to treat opioid addiction than expanding the nation's supply of specialty care clinics."

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