Primary care models for treating opioid use disorders: What actually works? A systematic review

Abstract

Background

Policy Pathways to Address Provider Workforce Barriers to Buprenorphine Treatment

“…52 Although behavioral health therapy when used to treat OUDs alone or in combination with MAT medications has not been shown in rigorous trials to reduce opioid use or increase adherence to treatment, 20,53,54 these services are recommended to accompany MAT medication and considered best practices. 31,52,55,56 …”

Cost‐effectiveness of expanding the capacity of opioid agonist treatment in Ukraine: dynamic modeling analysis

“…Moreover, even modest OAT capacity increases are not feasible if only specialty addiction clinics provide treatment. It is therefore essential that OAT be expanded to primary care settings—an intervention shown to be effective in many countries and both legal and feasible in the Ukrainian context .…”

“…OAT was introduced in Ukraine in 2004 for HIV prevention but not for treatment of OUD, and is primarily available in specialty addiction treatment clinics with limited expansion to integrated care settings at HIV and tuberculosis clinics , which limits access to treatment. Many countries have successfully implemented OAT provision in primary health‐care settings , and the feasibility of this intervention in Ukraine was recently demonstrated with high levels of retention and reduced stigma, suggesting a plausible route to expand capacity .…”

A systematic review of strategies to improve appropriate use of opioids and to reduce opioid use disorder and deaths from prescription opioids

“…We are aware of a handful of recent systematic reviews that have synthesized the evidence for specific types of strategies, including primary care delivery models for treating opioid use disorders, 8 supervised dosing versus off-site consumption of opioid substitution treatment, 9 community overdose prevention and naloxone distribution programs, [10][11][12][13] supervised consumption sites, 102,103 clinical strategies for reducing aberrant drug-related behavior (e.g., treatment agreements, urine drug testing), 14,15 and prescription opioid policies (namely, guidelines and legislation). 16 Consistent across four reviews was the finding that naloxone and overdose prevention programs are associated with a reduction in overdose mortality and increased odds of recovery.…”

“…The knowledge users interested in this topic are not limited to health care professionals but rather are representatives of diverse groups within our communities, including public health, prevention services, government, law enforcement, regulators, and insurance payers, all of whom are interested in programs, strategies, policies, and regulations to solve the problem of inappropriate opioid use. A few recent systematic reviews have synthesized the evidence for narrow and specific types of strategies, including primary care delivery models for treating opioid use disorders, 8 supervised dosing versus off-site consumption of opioid substitution treatment, 9 community overdose prevention and naloxone distribution programs, [10][11][12][13] clinical strategies for reducing aberrant drug-related behavior (e.g., treatment agreements, urine drug testing), 14,15 and prescription opioid policies (namely, guidelines and legislation). 16 Our goal was to conduct a comprehensive systematic review to more broadly identify existing strategies, programs, policies, and practices aimed at improving the appropriate use of prescription opioids and/or reducing the misuse, abuse, and deaths related to these drugs, with a focus on strategies that can be implemented in North America, the epicenter of the current crisis.…”