Treating opioid use disorder with a new, more personalized approach

Northwestern University clinical psychologist and scientist Kelli Scott is trying to re-envision care at opioid treatment programs (OTPs) to help patients receive more personalized treatment based on measuring their progress, which will hopefully lead to better health outcomes and keep them in recovery longer.

OTPs, also known as methadone clinics, use methadone as a replacement therapy to block the addictive effects of opioids and diminish withdrawal symptoms from drugs such as fentanyl, heroine and oxycontin.

“We currently don’t have a lot of great measures that can evaluate how folks are doing in opioid treatment or have any ways to predict negative outcomes or the potential for folks to drop out of treatment,” said Scott, assistant professor of medical social sciences with a focus on implementation science and outcome and measurement science at Northwestern University Feinberg School of Medicine. “One way to improve the quality of care is to measure how patients are doing over time and help share that data with them to help guide their treatment and think about what to do next.”

The goal is to be collaborative about treatment so that patients feel like they have ownership of their recovery and stay in recovery longer.”

Scott also wants to potentially identify patients who might not be doing as well as they had hoped so clinicians can intervene earlier. The aim is to keep patients in treatment and help them feel more involved in the decision-making process, she said.

This practice is called measurement-based care. It is common in physical and mental health care settings but hasn’t previously been applied to opioid treatment programs. The evidence-based practice relies on patients to report how they’re feeling throughout the course of their treatment so their clinician can work with them to adjust their medication, set up counseling and more.

Current treatment follows a typical doctors-office approach in which patients fill out paperwork for their health records but follow-up can be hit or miss, Scott said.

“Maybe someone fills out a depression screener but then no one comes to talk to them about it or refer them out for counseling,” Scott said.  

With Scott’s measurement-based care system in place, her hope is that when patients fill out their initial paperwork at intake, that’s just the beginning of the conversation.

Scott has recently received a new grant from the National Institute on Drug Abuse (NIDA) and a National Institutes of Health (NIH) Trailblazer honorary mention for her innovative work to end long-term opioid addiction. The new grant adds to Scott’s existing portfolio, which includes a NIDA-funded early career grant (for $940,000) and is informed by her existing small pilot study in and around Chicago that is implementing measurement-based care in OTPs.

The second award, a five-year, $7.8 million grant, will fund a collaboration with scientists at the University of Pittsburgh School of Pharmacy’s Program Evaluation and Research Unit as part of the NIH’s Helping to End Addiction Long-term® Initiative, or NIH HEAL Initiative®. The scientists will build off the work from the Chicago pilot to implement measurement-based care at 20 community opioid treatment programs across Pennsylvania, which is among the top-10 most affected by the opioid overdose crisis.

The next step will be to figure out how to scale up the tool in urban and rural settings and among very diverse patient populations, she said.

“We don’t need to retrain an entire workforce on how to provide counseling, but if we can at least get folks monitoring how their patients are doing, asking them consistent questions and being collaborative about treatment so that patients feel like they have ownership in their recovery and can provide feedback on how things are going in a really difficult period of their life,” Scott said. “That, alone, might be able to move the needle on keeping folks in treatment, on engaging more folks who need treatment and promoting better outcomes in terms of recovery.”

The hope for this project is to have an influence on the policy level, on the delivery of care and how people value opioid treatment, Scott said, “so that ultimately we can compensate our counselors better and help patients to become better advocates for themselves.”

The HEALing Measures Center will also include collaborations between scientists at the (RTI) International, and community partners at the Pennsylvania Department of Human Services, UPMC and the Community Care Behavioral Health Organization.

This research is supported by the National Institute on Drug Abuse of the National Institutes of Health under award numbers 5K23DA050729-04 and 1RM1DA059395-01. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.