Patients with substance use disorder had greater access to treatment and were more likely to refrain from using drugs when cared for within a primary-care setting that had an integrated behavioral health component compared with patients who only received a referral to see an addiction treatment specialist, according to a new study.
The study, published Monday in JAMA Internal Medicine, found 39% of patients treated in a collaborative primary-care model received addiction treatment versus just 17% of the group who received standard primary care. Also, 32% of patients in the collaborative model reported remaining abstinent from opioids or alcohol after six months compared to 22% of patients in standard primary care.
“These findings suggest that treatment for opioid and alcohol use disorders can be integrated into primary care, and that primary care-based treatment is effective for opioid and alcohol use disorders,” the study concluded.
More than 20 million Americans are estimated to have some sort of substance use disorder, according to the American Society of Addiction Medicine (PDF), of which, roughly 15 million have a dependence to alcohol and more than 2 million abuse either prescription pain relievers or heroin.
However, only 2.2 million receive any type of treatment for their addiction, according to a 2016 report by the U.S. surgeon general, with more than 63% receiving such treatment within a specialty substance use disorder treatment program.
“There’s a huge unmet need for addiction treatment,” said study lead author Dr. Katherine Watkins, a senior physician policy researcher at RAND Corp. “And some of that unmet need is because people look for care and can’t get it; and some of it is because they don’t know they have a problem; and some of it is because they don’t want care.”
Watkins said primary care allows for patients of all three types to receive addiction treatment in a setting where they feel less stigmatized than if they were to visit a rehabilitation clinic.
“I think for the vast majority of patients who are not willing to go to specialty care, primary care is an excellent option,” Watkins said.
The rise in the number of people across the U.S. who have developed a substance use disorder due to the proliferation of prescription pain relievers, as well as the recent influx of illegal narcotics such as heroin and fentanyl, has helped exacerbate a shortage in substance abuse treatment professionals that had already existed for years.
According to the Pew Charitable Trusts, there are an average of 32 behavioral health specialists for every 1,000 people nationally, which they surmise is not enough to meet the demand for such services brought on by the opioid epidemic.
Despite efforts to increase the capability of physicians to prescribe medication-assisted treatments such as buprenorphine, many of those therapies remain under-prescribed. Only 44% of doctors with a waiver to prescribe the medication opt to provide the maximum number of patients with the treatment—275 per year after the first year of prescribing medication-assisted treatments.
Many primary-care physicians have been reluctant to provide medication-assisted treatment because they felt it was beyond their specialty to properly manage.
A collaborative-care approach can assuage those concerns, Watkins said.
“While there might be some people who need specialty care, certainly there are many people for whom primary care-based addiction treatment works and is effective,” Watkins said. “There is no reason why this model can’t be expanded.”
Researchers examined patients who visited a federally qualified health center in Los Angeles from June 2014 through January 2016. Nearly 400 patients screened positive for substance use disorder and were randomly placed in a coordinated-care or usual-care setting.
Patients receiving coordinated care had access to an on-site behavioral health specialist and were assigned care coordinators who tracked their progress for up to six months after treatment. Patients who received care within the more standard primary-care arm were just given information about the addiction treatment services the clinic offers as well as a list of community referrals, and were given a number to schedule an appointment.
The ability to provide substance use disorder treatment within a primary-care setting could potentially expand access to such therapies for millions.
“Although treatment in specialty settings is important for individuals with severe dependence, limited availability and stigma mean that specialty care alone is insufficient to address treatment needs,” study authors wrote. “Primary care offers an important and underutilized setting for opioid and alcohol use disorder treatment.”