Tools to implement measurement-based care (MBC) in the treatment of opioid use disorder (OUD): toward a consensus
Abstract Background The prevalence and associated overdose death rates from opioid use disorder (OUD) have dramatically increased in the last decade. Despite more available treatments than 20 years ago, treatment access and high discontinuation rates are challenges, as are personalized medication do...
| Main Authors: | , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2024-02-01
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| Series: | Addiction Science & Clinical Practice |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s13722-024-00446-w |
| _version_ | 1827326587806154752 |
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| author | A. John Rush Robert E. Gore-Langton Gavin Bart Katharine A. Bradley Cynthia I. Campbell James McKay David W. Oslin Andrew J. Saxon T. John Winhusen Li-Tzy Wu Landhing M. Moran Betty Tai |
| author_facet | A. John Rush Robert E. Gore-Langton Gavin Bart Katharine A. Bradley Cynthia I. Campbell James McKay David W. Oslin Andrew J. Saxon T. John Winhusen Li-Tzy Wu Landhing M. Moran Betty Tai |
| author_sort | A. John Rush |
| collection | DOAJ |
| description | Abstract Background The prevalence and associated overdose death rates from opioid use disorder (OUD) have dramatically increased in the last decade. Despite more available treatments than 20 years ago, treatment access and high discontinuation rates are challenges, as are personalized medication dosing and making timely treatment changes when treatments fail. In other fields such as depression, brief measures to address these tasks combined with an action plan—so-called measurement-based care (MBC)—have been associated with better outcomes. This workgroup aimed to determine whether brief measures can be identified for using MBC for optimizing dosing or informing treatment decisions in OUD. Methods The National Institute on Drug Abuse Center for the Clinical Trials Network (NIDA CCTN) in 2022 convened a small workgroup to develop consensus about clinically usable measures to improve the quality of treatment delivery with MBC methods for OUD. Two clinical tasks were addressed: (1) to identify the optimal dose of medications for OUD for each patient and (2) to estimate the effectiveness of a treatment for a particular patient once implemented, in a more granular fashion than the binary categories of early or sustained remission or no remission found in The Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5). Discussion Five parameters were recommended to personalize medication dose adjustment: withdrawal symptoms, opioid use, magnitude (severity and duration) of the subjective effects when opioids are used, craving, and side effects. A brief rating of each OUD-specific parameter to adjust dosing and a global assessment or verbal question for side-effects was viewed as sufficient. Whether these ratings produce better outcomes (e.g., treatment engagement and retention) in practice deserves study. There was consensus that core signs and symptoms of OUD based on some of the 5 DSM-5 domains (e.g., craving, withdrawal) should be the basis for assessing treatment outcome. No existing brief measure was found to meet all the consensus recommendations. Next steps would be to select, adapt or develop de novo items/brief scales to inform clinical decision-making about dose and treatment effectiveness. Psychometric testing, assessment of acceptability and whether the use of such scales produces better symptom control, quality of life (QoL), daily function or better prognosis as compared to treatment as usual deserves investigation. |
| first_indexed | 2024-03-07T14:47:45Z |
| format | Article |
| id | doaj.art-872c8f9e94a54aaabb65e5a203cceb99 |
| institution | Directory Open Access Journal |
| issn | 1940-0640 |
| language | English |
| last_indexed | 2024-03-07T14:47:45Z |
| publishDate | 2024-02-01 |
| publisher | BMC |
| record_format | Article |
| series | Addiction Science & Clinical Practice |
| spelling | doaj.art-872c8f9e94a54aaabb65e5a203cceb992024-03-05T19:53:11ZengBMCAddiction Science & Clinical Practice1940-06402024-02-0119111510.1186/s13722-024-00446-wTools to implement measurement-based care (MBC) in the treatment of opioid use disorder (OUD): toward a consensusA. John Rush0Robert E. Gore-Langton1Gavin Bart2Katharine A. Bradley3Cynthia I. Campbell4James McKay5David W. Oslin6Andrew J. Saxon7T. John Winhusen8Li-Tzy Wu9Landhing M. Moran10Betty Tai11Duke-NUS Medical School, The National University of Singapore, Duke University School of MedicineThe Emmes CompanySchool of Medicine & Division of Medicine at Hennepin Healthcare, University of MinnesotaKaiser Permanente Washington Health Research InstituteKaiser Permanente Northern California Division of ResearchPenn Center on the Continuum of Care in the Addictions, Philadelphia VA Center of Excellence in Substance Addiction Treatment and Education, University of PennsylvaniaUniversity of Psychiatry, VISN 4 Mental Illness, Research, Education and Clinical Center Crescenz VA Medical Center, Stephen A. Cohen Military Family Clinic at the Perelman School of MedicineUniversity of Washington and Center of Excellence in Substance Addiction Treatment and Education at the VA Puget Sound Health Care SystemAddiction Sciences, University of Cincinnati College of MedicineDuke University School of MedicineCenter for Clinical Trials Network, National Institute on Drug AbuseCenter for Clinical Trials Network, National Institute on Drug Abuse, National Institutes of HealthAbstract Background The prevalence and associated overdose death rates from opioid use disorder (OUD) have dramatically increased in the last decade. Despite more available treatments than 20 years ago, treatment access and high discontinuation rates are challenges, as are personalized medication dosing and making timely treatment changes when treatments fail. In other fields such as depression, brief measures to address these tasks combined with an action plan—so-called measurement-based care (MBC)—have been associated with better outcomes. This workgroup aimed to determine whether brief measures can be identified for using MBC for optimizing dosing or informing treatment decisions in OUD. Methods The National Institute on Drug Abuse Center for the Clinical Trials Network (NIDA CCTN) in 2022 convened a small workgroup to develop consensus about clinically usable measures to improve the quality of treatment delivery with MBC methods for OUD. Two clinical tasks were addressed: (1) to identify the optimal dose of medications for OUD for each patient and (2) to estimate the effectiveness of a treatment for a particular patient once implemented, in a more granular fashion than the binary categories of early or sustained remission or no remission found in The Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5). Discussion Five parameters were recommended to personalize medication dose adjustment: withdrawal symptoms, opioid use, magnitude (severity and duration) of the subjective effects when opioids are used, craving, and side effects. A brief rating of each OUD-specific parameter to adjust dosing and a global assessment or verbal question for side-effects was viewed as sufficient. Whether these ratings produce better outcomes (e.g., treatment engagement and retention) in practice deserves study. There was consensus that core signs and symptoms of OUD based on some of the 5 DSM-5 domains (e.g., craving, withdrawal) should be the basis for assessing treatment outcome. No existing brief measure was found to meet all the consensus recommendations. Next steps would be to select, adapt or develop de novo items/brief scales to inform clinical decision-making about dose and treatment effectiveness. Psychometric testing, assessment of acceptability and whether the use of such scales produces better symptom control, quality of life (QoL), daily function or better prognosis as compared to treatment as usual deserves investigation.https://doi.org/10.1186/s13722-024-00446-wMeasurement-based careOpioid use disorderAddictionDrugEpidemicOverdose |
| spellingShingle | A. John Rush Robert E. Gore-Langton Gavin Bart Katharine A. Bradley Cynthia I. Campbell James McKay David W. Oslin Andrew J. Saxon T. John Winhusen Li-Tzy Wu Landhing M. Moran Betty Tai Tools to implement measurement-based care (MBC) in the treatment of opioid use disorder (OUD): toward a consensus Addiction Science & Clinical Practice Measurement-based care Opioid use disorder Addiction Drug Epidemic Overdose |
| title | Tools to implement measurement-based care (MBC) in the treatment of opioid use disorder (OUD): toward a consensus |
| title_full | Tools to implement measurement-based care (MBC) in the treatment of opioid use disorder (OUD): toward a consensus |
| title_fullStr | Tools to implement measurement-based care (MBC) in the treatment of opioid use disorder (OUD): toward a consensus |
| title_full_unstemmed | Tools to implement measurement-based care (MBC) in the treatment of opioid use disorder (OUD): toward a consensus |
| title_short | Tools to implement measurement-based care (MBC) in the treatment of opioid use disorder (OUD): toward a consensus |
| title_sort | tools to implement measurement based care mbc in the treatment of opioid use disorder oud toward a consensus |
| topic | Measurement-based care Opioid use disorder Addiction Drug Epidemic Overdose |
| url | https://doi.org/10.1186/s13722-024-00446-w |
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