Comparing treatment and substance use in case-managed and non-case managed clients receiving opiate replacement therapy with a co-existing mental illness: a cross-sectional study

Abstract

ABSTRACT Objectives This study examines the differences in clinical presentation, treatment, and clinical outcomes for clients with co-existing psychiatric and substance use disorders (CED) undergoing opioid replacement therapy (ORT) through a physician-led metropolitan specialist addiction clinic (SAC), in comparison to clients who receive concurrent community mental health case management (CMH-CM). Method A cross-sectional study of data extracted from electronic medical records was conducted on all active clients identified with CED who were actively engaged with the SAC for ORT over a 2-month period. Results Of 310 clients on ORT, 21% (N = 64) had a CED. CMH-CM was concurrent in a minority of those with a CED (N = 18, 28%). CMH-CM clients were significantly more likely to have a single psychiatric diagnosis (X2 9.2627; P < .01), a diagnosis of psychotic disorder (X2 8.2197; P < .01), and be prescribed antipsychotics (X2 12.863; P < .01). Multiple psychiatric diagnoses (X2 9.2627; P < .01) and a diagnosis other than psychotic disorder (X2 6.7046; P < .01) were significantly more common in Non-CM clients. Conclusions In the absence of fully integrated addiction and CMH services, the provision of evidence-based treatment requires building clinical capacity to identify and manage CED across mental health and addiction services.