Outpatient Care Key to Success in Treating Opioid Use Disorder

People with opioid use disorder who enter treatment are at risk for relapse, overdose, or death if they engage in fewer than two outpatient visits in their first month of care, according to researchers at Columbia University and Rutgers University.

The study, published in The American Journal of Psychiatry, examined the likelihood of patients continuing treatment for opioid use disorder during their first month in care based on how often they engaged in outpatient visits or other professional services.

Arthur Robin Williams, MD, assistant professor in the Department of Psychiatry at Columbia and lead author of the study, said the study is clinically meaningful and could guide the development of interventions to prioritize stabilization of high-risk patients early in treatment.

"Without early engagement, the great majority of patients will be lost to relapse and possible death,” Dr. Williams said.

To conduct their study, the researchers analyzed data reported between 2011 and 2019 from a multisite buprenorphine clinic throughout eight states, examining the relationship between participating in outpatient visits and care retention in nearly 20,000 individuals.

The patients were predominately male and non-Hispanic, which is broadly representative of people nationwide who are using buprenorphine for opioid use disorder treatment, according to prior research from the study authors.

The researchers found that nearly half of patients who participated in multiple outpatient visits in their first month of care remained in treatment for a minimum of six months, whereas 2.9% of patients who didn’t participate in multiple visits remained in treatment after six months.

Stephen Crystal, PhD, director of the Center for Health Services Research at the Rutgers Institute for Health, Health Care Policy and Aging Research and a coauthor of the study, said that participating in outpatient visits or professional services during treatment appears to be a necessary condition for adequate care retention.

 “Monitoring this engagement may help identify and address barriers and disparities in outcomes,” said Dr. Crystal, who is also a professor at the Rutgers School of Social Work.

More studies are needed to identify patients at the greatest risk for overdose, and further research could demonstrate the importance of milestones in opioid use treatment to develop performance measures of care.

The study’s findings align with the priorities of organizations, such as the Substance Abuse and Mental Health Services Administration, which support care coordination and peer navigation services early in treatment to help stabilize patients who otherwise may fail to follow up.

“Many of these services are not currently reimbursable by payers, so insurance plans need to create bundled rates to be more innovative,” Dr. Williams said.

Columbia University coauthors include Mark Olfson, MD, MPH, the Elizabeth K. Dollard Professor of Psychiatry, Medicine, and Law; Tianshu Feng, MS, biostatistician in the Division of Biostatistics (Psychiatry); and Christine Mauro, PhD, assistant professor, biostatistics, Mailman School of Public Health.