In the wake of heavy losses incurred by both people and government in terms of productivity and finances due to opioid epidemic, there is an urgent need for an efficient therapy to control and curb the crisis. Scientists and medical practitioners recently highlighted the effectiveness of an interdisciplinary model of care for managing opioid use disorder (OUD).
Primary care providers, physicians and settings are on the frontline of the health care system, accounting for around 50 percent of all prescription opioids dispensed. Therefore, they can play a decisive role in controlling the menace of opioid crisis by integrating comprehensive behavioral strategies. By combining medication-assisted treatment (MAT) and other psychosocial services, they can effectively reduce the harm and improve the situation.
As per the National Institute on Drug Abuse (NIDA), over 115 Americans succumb to opioid overdose on a daily basis. The foray of synthetic opioids like fentanyl has only aggravated the problem, leading to a serious national crisis affecting public health and socioeconomic welfare of the people.
Integration of medication and psychosocial services offers significant outcomes
Considering the grim situation, the need of the hour is devising interdisciplinary treatment for the problem. Along the same lines, a recent study, published in the journal Annals of Family Medicine, discussed the successful outcomes of the implementation of an interdisciplinary model of care in a rural health clinic in Scappoose and federally qualified health center (FQHC) in Portland, respectively. Both clinics are part of the family medicine department at Oregon Health & Science University in Portland.
This model was built on the concepts of improvement in functioning and harm reduction, highlighting the importance of behavioral health counseling in addition to medicines. Though numerous primary care clinics have developed treatment models for OUD, their outcomes have not been as efficacious as displayed by the above-mentioned clinics. According to Rebecca Cantone, M.D., the lead author of the study, the model, focusing on behavioral health, was created to engage patients in the process of treatment, manage addiction and cravings by addressing the psychosocial factors responsible for causing addiction, etc.
The tier model used by the researchers was adapted as per the requirements of a rural clinic. One of the biggest challenges before Cantone and other researchers was the scarcity of trained staff at the time of hiring. Since both the facilities are manned by family physicians, physician assistants, etc., there was an urgent need to recruit a dedicated behavioral health specialist, trained in providing counseling and preventing a relapse.
One of the key elements of the above treatment model is the collaboration with local treatment and detox centers. This is done as a backup for treating patients displaying no signs of recovery. Trained in motivational interviewing, cognitive behavioral therapy (CBT), trauma-informed care and relapse prevention, behavioral health specialists try to understand the substance use record, family history, social situation, etc. of every patient. They use the American Society of Addiction Medicine criteria to recommend levels of care and follow a dual approach with patients to treat both substance use disorder (SUD) and psychiatric illnesses.
Based on the review of the behavioral health specialist and a registered nurse, the behavioral health problems, medical risks and motivation level for treatment are determined. Based on the combined assessment, their medication and dosage are identified. The Tier 1 stage includes visits twice a week, which is continued on the persistence of cravings and withdrawal symptoms. Thereafter, on the basis of their progress, the patients move to Tier 2 or Tier 3 stages, decreasing the number of visits. The success of this model depends on the strong and understanding relationship between behavioral health specialists and medical providers.
Seek interdisciplinary care
The interdisciplinary model of care can be implemented to address the psychosocial needs of patients with OUD. The success of this treatment model lies on skilled and motivated behavioral health providers. Moreover, a successful collaboration between medical and behavioral health providers will ensure effective outcomes of the program.
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