Patients with co-occurring mental illness and opioid use disorders in a low-resource community engaged with a collaborative care treatment program and stuck with it, according to a study in JAMA Network Open today.
“Opioid use disorders (OUDs) remain undertreated, particularly when co-occurring with mental illness,” wrote Katherine E. Watkins, M.D., M.S.H.S., with the RAND Corporation in Santa Monica, California, and colleagues. “The collaborative care model (CoCM), an evidence-based approach for integrating behavioral health treatment in primary care, offers a potential solution, but the extent to which the CoCM can engage high-risk populations with fidelity in community settings is poorly understood.”
Watkins and colleagues tapped into data from a randomized clinical trial in 14 low-resourced primary care clinics in New Mexico involving adults with probable OUD and co-occurring mental illness who were assigned to a six-month CoCM program between 2021 and 2023. About one-quarter of the adults had used fentanyl or heroin in the 30 days prior to enrollment, and three-quarters were prescribed medications for OUD.
The CoCM deployed addiction-certified psychiatric consultants, primary care clinicians, and community health workers as care managers, supported by a caseload tracking tool. Engagement was defined as participating in an intake interview, while fidelity was defined as having at least two care manager encounters, at least two assessments of OUD and mental health symptom severity, and a treatment plan review by a psychiatric consultant.
Of the 369 adults assigned to the CoCM, 297 participants (81%) engaged with it. Of those who engaged, 206 (69%) stuck with the CoCM, with a median of nine care encounters. Rates varied by substance used: Just 54% of individuals with stimulant co-use participated with fidelity, whereas 81% of those who misused only prescription pain medication did so.
Further work is needed to determine whether fidelity to the CoCM is associated with positive patient outcomes, the authors wrote. Limitations included the study’s use of observational data from one arm of a clinical trial in just one state with high OUD rates.
“Our results indicate that the CoCM may offer a solution to the undertreatment of OUD for patients with complex conditions,” researchers wrote. “When community health workers are used, the CoCM may be an efficient approach to address behavioral health professional shortages.”
For related information, see the Psychiatric News article “Three Health Systems Find Success With Collaborative Care.”
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