Chronic Care Management Still Misses the Opportunity to Increase Provision of Addiction Pharmacotherapies in Primary Care

Pharmacotherapies are effective for the treatment of substance use disorders but are infrequently prescribed in primary care. Chronic care management (CCM), coordinated patient-centered care delivered by a multidisciplinary team, offers a unique opportunity to increase the prescription of these medications. The Addiction Health Evaluation And Disease management (AHEAD) trial was a randomized clinical trial that tested the effectiveness of CCM for substance use disorders in a primary care setting. The study found that participants receiving CCM had an increased use of addiction medications compared with those receiving usual primary care. This secondary data analysis examined factors associated with prescription of addiction medications in the 282 patients who were randomized to CCM.

• Among participants with alcohol use disorder, 17% were prescribed medications, compared with 9% of those with drug use disorder. Among patients with an opioid use disorder, only 15% received opioid agonist treatment.
• Psychiatric medications were prescribed to 64% of the patients.
• Absence of co-morbid drug dependence was associated with prescription of alcohol dependence medications. Lower alcohol addiction severity and recent opioid use were associated with prescription of drug dependence medications.

Comments:

Despite an intervention specifically designed to increase prescription of addiction medication in practice, only a minority of eligible patients received medications in this trial. Not all patients, however, had a drug use disorder for which there are effective medications. Future research should focus on addressing clinician and system barriers as well as implementation efforts to improve provision of these evidence-based treatment options for patients with addiction.

Jeanette M. Tetrault, MD

Reference:

Park TW, Samet JH, Cheng DM, et al. The prescription of addiction medications after implementation of chronic care management for substance dependence in primary care. J Subst Abuse Treat. 2015;52:17–23.