Abstract
BackgroundObtaining timely access to addiction medicine treatment for patients with substance use disorders is challenging and patients often have to navigate complex referral pathways. This randomized controlled trial examines the effect of providing an expedited pathway to addiction medicine treatment on initial treatment engagement and health care utilization.MethodsIndividuals with possible alcohol or opioid use disorder were recruited from three residential withdrawal management services (WMS). Subjects randomized to the Delayed Intervention (DI) group were given contact information for a nearby addiction medicine clinic; those randomized to the Rapid Intervention (RI) group were given an appointment at the clinic within 2 days and were accompanied to their first appointment.ResultsOf the 174 individuals who were screened, 106 were randomized to either the DI or RI group. The two groups were similar in demographics, housing status, and substance use in the last 30 days. In the 6-month period following randomization, 85% of the RI group attended at least one clinic appointment, compared to only 29% in the DI group (p < 0.0001). The RI group had a mean of 6.39 ED visits per subject in the 12 months after randomization, while the DI group had a mean of 13.02 ED visits per subject in the same 12-month period (p = 0.0469). Other health utilization measures did not differ between the two groups.ConclusionProviding immediate facilitated access to an addiction medicine service resulted in greater initial engagement and reduced emergency department visits at 6 months.Trial registration This trial is registered at the National Institutes of Health (ClinicalTrials.gov) under identifier #NCT01934751.
Highlights
Obtaining timely access to addiction medicine treatment for patients with substance use disorders is challenging and patients often have to navigate complex referral pathways
Oral naltrexone1 and acamprosate are effective first-line treatments for alcohol use disorder (AUD) [2, 3], and opioid agonist therapy (OAT) with buprenorphine or methadone is very effective for opioid use disorder (OUD) [4]; these medications are not routinely prescribed [5,6,7]
A total of 174 individuals at the three withdrawal management services (WMS) sites were screened for eligibility
Summary
Obtaining timely access to addiction medicine treatment for patients with substance use disorders is challenging and patients often have to navigate complex referral pathways. This randomized controlled trial examines the effect of providing an expedited pathway to addiction medicine treatment on initial treatment engagement and health care utilization. In spite of the significant burden of illness from alcohol use disorder (AUD) and opioid use disorder (OUD), access to treatment is often severely limited by lengthy wait lists and complex intake procedures. Oral naltrexone and acamprosate are effective first-line treatments for AUD [2, 3], and opioid agonist therapy (OAT) with buprenorphine or methadone is very effective for OUD [4]; these medications are not routinely prescribed [5,6,7].
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
