Enhancing Treatment Access and Effectiveness: Toward Patient-Centered Models of Care

Abstract

In the United States, despite the availability of safe and effective pharmacotherapy and behavioral treatments for opioid use disorder (OUD), a minority of people who need treatment receive it. Improving treatment uptake will require OUD treatments that are available, accessible, and acceptable to people with OUD. The objectives of this chapter are (1) to describe barriers to OUD treatment; (2) to present patient preferences for OUD treatment; (3) to recommend modifications to current OUD treatment models in the United States that would make treatment more available, accessible, and acceptable to people with OUD; and (4) to present a patient-centered model of OUD care that focuses on engagement, retention in care, and harm reduction while serving both people who want to stop illicit opioid use and those who do not. Though many people with OUD enter stable recovery without using formal treatment, many barriers to care do exist for people who want and could benefit from evidence-based OUD treatments. Societal change will be needed to reduce stigma regarding OUD and agonist treatments. Policy change will be needed to make the full spectrum of OUD treatments more available and affordable in every community. Modifying OUD treatment models to be more patient-centered could also increase treatment uptake by improving acceptability and desirability of treatment. There will be no easy way to stem the increasing harms from the opioid epidemic, but bringing people into care is an important first step.