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May 18, 2018

The Importance of Integrated Care in Fighting Opioid Use Disorder

Caroline Carney, MD, MSc, is the chief medical officer for Magellan Rx Management, the pharmacy benefit management division of Magellan Health. She joined Magellan Health in 2016 and previously served as the chief medical officer for Magellan Healthcare. In her current role, Carney is broadly responsible for supporting Magellan Rx in building differentiated, industry-leading clinical programs and services. Prior to joining Magellan, Carney served in chief medical officer roles, working with Medicare, Medicaid, commercial, and exchange populations. She was trained in and practiced psychiatry, internal medicine, and psychosomatic medicine. Carney has a Master’s degree in preventive medicine, focusing on health services research and epidemiology. She also brings strong public sector expertise having served as medical director for Indiana’s Office of Medicaid Policy and Planning where she oversaw quality, pay for performance, and initiatives for behavioral and physical health.
One out of 4 patients who receive long-term opioid therapy in primary care settings struggle with opioid use disorder, according to CDC research. While conversations around opioid addiction are beginning to impact physician prescribing patterns, there is still much progress to be made around treatment and recovery solutions for those battling opioid use disorder.

One important option that requires greater attention: the need to leverage an integrated team approach in opioid treatment and recovery.

Recent research points to the value of a holistic approach to opioid recovery delivered in a community setting. Such an approach may include relapse prevention medications; group and individual counseling; physician visits for medication management; mental health therapy; and psychiatric treatment for co-occurring disorders. But there are barriers to accessing holistic opioid recovery treatment within the patient’s community, such as a lack of mental health resources, stigmas associated with certain treatment options, limited availability of specialized providers, difficulties navigating the complexities of substance abuse treatment, and insufficient capacity.

Overcoming the challenges to a holistic approach to opioid recovery is critical to engaging patients safely and comfortably, and to supporting sustained recovery. The following 5 elements contribute to a successful integrated approach.

1. Confront the stigmas associated with opioid addiction treatment

Medication-assisted treatment (MAT), an evidence-based approach that combines medication with psychosocial intervention, is considered the gold standard in treatment for opioid addiction. MAT works by decreasing opioid cravings and mitigating the effects of withdrawal. It has been proven to be highly effective in treating opioid addiction: In 1 study, more than half of patients treated with MAT reported opioid abstinence 18 months after beginning treatment.

However, there is a stigma often associated with MAT—both on the part of medical professionals, including addiction recovery professionals, and family members. Some believe use of MAT simply replaces 1 addiction with another. Additionally, physicians who treat patients addicted to opioids often cite a lack of care management staff, space, and psychosocial support services as barriers to MAT treatment. Lack of understanding around how, and how long to administer MAT also contributes to low adoption rates.

Confronting the stigmas associated with the use of MAT is critical to supporting successful recovery. By providing MAT education for physicians, addiction professionals, and family members, healthcare leaders not only will support improved outcomes for patients, but also help to erase the stigma associated with prescribing such treatment. Consider lunch-and-learn sessions for physicians, nurses and other healthcare professionals, presentations for family support groups, and online education for family members.  

2. Combine MAT with supportive psychosocial interventions

When combined with psychosocial interventions, MAT not only saves lives, but helps patients gain the skills and social networks needed to support long-term recovery. Psychosocial interventions address the whole healthcare needs of those suffering from opioid addiction by identifying and addressing conditions that may have led to abuse. Research shows that patients using opioids who are treated with MAT combined with psychosocial interventions experience better outcomes than those who are not. Explore partnerships with behavioral health specialists for a holistic approach to care that results in patient-specific treatment plans.

3. Address the physical problems that could contribute to addiction

Pain relief is the most common reason patients misuse opioids, according to the 2015 National Survey on Drug Use and Health. That’s one reason why an integrated, team-based approach to opioid treatment and recovery is so important: treatment of pain is patient-specific, and specially trained professionals are needed to ensure an effective approach.

Pain management professionals can help those suffering from opioid addiction find alternative medications or techniques for managing the pain of their underlying physical condition. For example, pain management coaches can work 1-on-1 with opioid addicts to explore healthy, effective approaches for pain relief, such as through digital therapy and motivational interviewing. Getting the right kind of exercise is a mainstay for persons with chronic pain—and working with a physical therapist or pain specialist is important in matching the right type of exercise to the specific reason that pain may be occurring. Cognitive-based therapy, a form of psychotherapy, is also as effective as pain medications in many cases. 

4. Consider a virtual or mixed-model approach to treatment

In communities with limited resources for 1-on-1 opioid recovery support, telehealth services or a combination of virtual and in-office services provide the basis for an integrated care approach. For example, telehealth case managers can serve as the addict’s first point of contact throughout the recovery process. They can also assist physicians and staff in detecting the warning signs of opioid addiction and relapse. Additionally, telehealth counselors can help meet the mental and behavioral health needs of difficult-to-treat patients.

Certified recovery specialists also are an effective support resource for those recovering from opioid addiction—and this support can be provided in person or virtually. Through coaching, encouragement and connection with community resources, certified recovery support specialists create supportive environments for people in treatment that aid in their recovery journey.

5. Involve family members in the opioid recovery process

Difficulties managing family conflict are a key contributor to opioid abuse. When families are involved in the recovery process, healthcare professionals find opportunities not only to holistically address the family dynamics that may have contributed to abuse, but also learn more about the patient from those who know the patient best. Such insights could prove essential not only in designing an individualized treatment plan, but also in uncovering details regarding the patient’s history, habits and relationships that may impact treatment.

Supporting a Successful Return to Health

In the fight against the opioid epidemic, a holistic view of the whole health needs of those suffering from addiction is critical. Without widespread access to an integrated treatment approach, patients face a challenging battle in their transition from addiction to health. Innovative and integrated approaches to opioid recovery and treatment are key to empowering patients to overcome their addiction and lead healthy, vibrant lives.

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