Journal Article Annotations
2017, 3rd Quarter
Annotations by S. Alex Sidelnik, MD, and Diana Robinson, MD
The finding: A collaborative care intervention for alcohol and opioid use disorders was successfully implemented and led to a significantly increased use of evidence-based treatments including behavioral therapies and medication-assisted treatment in addition to improving self-reported abstinence from opioids and alcohol at six months.
Strength and weaknesses: The study was a multisite, randomized control trial of a collaborative care intervention in over three hundred primary care patients with opioid or alcohol use disorders treated in Federally Qualified Health Centers (FQHCs). The study group received a collaborative care intervention characterized by measurement-based care, pharmacotherapy consultation, care coordination, and access to behavioral treatments while the control group received treatment as usual. The strengths of the study included a diverse study population that may be applicable to other FQHCs, developing a relevant and translatable treatment solution, and utilizing a robust collaborative care intervention. The limitations included potential reporting bias of abstinence due to use of self-reporting, a large number of patients lost to follow-up, and a patient-level rather than clinic-level randomization.
Relevance: As mortality rates from substance used disorders continue to rise, providing access to evidence-based treatments is increasingly necessary. This is the first study showing that a collaborative care intervention for opioid and alcohol use disorders can improve patient outcomes and be implemented effectively in primary care settings.
The finding: This phase 2 study found that a novel formulation of buprenorphine as a weekly subcutaneous depot formulation was safely tolerated, produced opioid blockade, and suppressed withdrawal. One of 47 patient did not complete the study due to ventricular extra systole. 81% of patients (n=38) experienced one or more adverse events, most commonly constipation (19%) and injection-site pain (11%).
Strength and weaknesses: The strengths of this study included being a multisite, double-blinded, randomized within-patient study in 47 adult patients over a six-month period. The weaknesses of the study include the small sample size, skewed male population (76%), and low racial diversity (50% black and 48% white).
Relevance: As morbidity and mortality rise due to intentional and unintentional overdose on opioids, the development of novel treatments for opioid use disorder is critical. Given the limitations of including daily sublingual buprenorphine can be skipped, misused, and diverted, a safe sustained release formulation may improve treatment of opioid use disorders. A long-acting depot formulation could also be helpful given the scarcity of mental health services in many areas that are particularly afflicted with high rates of opioid use disorders.