Most primary care patients with opioid use disorder who start treatment stay engaged

(Press-News.org) Background and Goal: Opioid use disorder (OUD) medication treatment saves lives, yet fewer than one-third of people with OUD receive evidence-based treatment with medication. Researchers examined how often adults who report opioid use and moderate or severe substance-use symptoms begin, and stay on, OUD medication.

Study Approach: Researchers reviewed electronic health record and insurance claims data from 33 primary care clinics in Washington from March 1, 2015, to Jan. 1, 2023. The study included 1,502 adults who, at or just before a primary care visit, completed a substance-use checklist, said they had used opioids in the past year, and had not received OUD medication in the prior 30 days. Treatment initiation was defined as receiving buprenorphine, methadone, or injectable naltrexone within 14 days of the checklist; engagement meant at least one additional dose in the next 34 days.

Main Results

Of the 1,502 patients, 80 (5%) had moderate symptoms of substance use disorder and 542 (36%) patients had severe symptoms. 

Among patients with moderate symptoms, 10% (8 patients) initiated medication treatment, and 75% (6 patients) remained engaged in the following month. 

Among patients with severe symptoms, 26% (141 patients) initiated medication treatment, and 76% of those patients (108) remained engaged in the following month. These patients were significantly more likely to initiate and remain engaged compared to those with moderate symptoms.

Overall, most primary care patients who reported opioid use and moderate or severe substance use disorder symptoms did not initiate opioid use disorder medication treatment. However, most patients who did initiate medication treatment remained engaged in the following month.

Why It Matters: Routine screening alone did not move most patients with clear OUD symptoms into lifesaving treatment. While patients were willing to report use of opioids and substance use symptoms on the checklist, use of the checklist will likely need to be paired with robust implementation strategies and other proactive, patient-centered, population-based systems to engage patients in medication treatment for OUD. 

Primary Care Patients With Opioid Use Disorder Symptoms: Initiation and Engagement in Treatment With Medicine

Claire B. Simon, MD, et al 

Department of Family Medicine, University of Washington, Seattle, Washington

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