Mental Health and Psychosocial Needs of Patients Being Treated for Opioid Use Disorder in a Primary Care Residency Clinic

Abstract

Purpose: Primary care is an ideal setting to deliver efficacious treatments for opioid use disorder (OUD). Primary care providers need to be aware of other concerns patients with OUD might have in order to provide comprehensive care. This study describes the prevalence of mental health, comorbid substance use, and psychosocial concerns of patients seeking treatment for OUD in primary care and their relation to 6-month treatment retention. Methods: Patients (N = 100; M age = 34.9 years (SD = 10.8), 74% white, 46% female) with OUD who were starting treatment with buprenorphine at an academic family medicine residency clinic completed surveys of mental health concerns (depression, anxiety, trauma), psychosocial needs (food insecurity, income, transportation, employment), and demographic variables. Chart reviews were conducted to gather information on comorbid substance use, mental health diagnoses, and 6-month treatment retention. Results: Mental health symptoms were highly prevalent in this sample (44% screened positive for anxiety, 31% for depression, and 52% for posttraumatic stress disorder). Three-quarters reported use of illicit substances other than opioids. Many patients also had significant psychosocial concerns, including unemployment (54%), low income (75%), food insecurity (51%), and lacking reliable transportation (64%). Two-thirds (67%) of the sample were retained at 6 months; patients who previously used intravenous opioids were more likely to discontinue treatment ( P = .003). Conclusions: Many patients receiving treatment for OUD have significant mental health problems, comorbid substance use, and psychosocial concerns; interestingly, none of these factors predicted treatment retention at 6 months. Primary care clinics would benefit from having appropriate resources, interventions, and referrals for these comorbid issues in order to enhance overall patient well-being and promote recovery.

Systematic content analysis of patient evaluations of START NOW psychotherapy reveals practical strategies for improving the treatment of opioid use disorder

“…Specifically, in the United States, 13.8% with serious mental illness and 8.8% with any mental illness misused opioids in the past year compared to 2.5% in adults without mental illness [2]. Because of these impairing, widespread, and numerous comorbidities, many groups of clinicians have suggested that, at the very least, access to screening and treatment of these comorbidities in individuals with OUD is important for improving overall health and likely opioid treatment success [6,11,13]. From our experience and perspective, there is a need for integrated, comprehensive interventions-that take into account all co-existing comorbidities-in order to effectively treat OUD.…”

Prevalence of Mental Health Disorders among Individuals Enrolled in an Emergency Response Program for Treatment of Opioid Use Disorder

“…inpatient treatment, criminal justice, population surveys) 60 , 61 or already registered in a SUD treatment program. 36 , 40 , 41 …”

“…inpatient treatment, criminal justice, population surveys) 60,61 or already registered in a SUD treatment program. 36,40,41 There have been prior studies estimating the prevalence of dual diagnoses. Kidorf et al 40 found that 48% of individuals who injected opioids had a dual mental health diagnosis.…”

“…24,25 Individuals with co-occurring OUD and mental illness are more likely to continue using nonprescription opioids, 26 have increased risk of chronic and acute physical illness, 27 and are at increased risk of accidental 28 and intentional overdose, 29,30 thereby increasing opioid-related mortality. 31 A bulk of research on adults with co-occurring OUD and mental health over the past decade is largely based on national epidemiological surveys, 19,[32][33][34][35][36] retrospective data analysis, 2,[37][38][39] or surveys of individuals in treatment. 40,41 This exposes a potentially significant research gap in OUD and co-occurring mental health disorders, specifically among individuals who have entered treatment via an emergency response, but were not considered to be treatment seeking.…”

“…A bulk of research on adults with co-occurring OUD and mental health over the past decade is largely based on national epidemiological surveys, 19 , 32 - 36 retrospective data analysis, 2 , 37 - 39 or surveys of individuals in treatment. 40 , 41 This exposes a potentially significant research gap in OUD and co-occurring mental health disorders, specifically among individuals who have entered treatment via an emergency response, but were not considered to be treatment seeking.…”