Promising Strategies for Improving Opioid Use Disorder Treatment

Opioids—including heroin, fentanyl, and prescriptions opioids like oxycodone—killed more people in 2016 than any other year on record. This statistic makes it clear: The United States is facing an opioid crisis, as evidenced by the more than 2 million Americans who are addicted to opioids and an increasing number of opioid overdose deaths each year. What remains unclear is how to best combat the epidemic in the fastest, most accessible, and most cost-effective manner.

To confront the opioid crisis, there has been a push for new research on non-opioid pain treatments as well as on new medications and interventions for those suffering from opioid use disorder (OUD). Advances in opioid research will undoubtedly be useful in fighting the epidemic.

However, evidence-based treatments (EBTs) for OUD have already been developed; the problem lies in putting these proven practices to work.

The Gap Between Knowing and Doing

The leap from research to practice is a well-documented challenge in many areas of health; opioid treatment is no exception. For many program managers, the question is not whether to implement an EBT—the questions are how to best implement it, when to implement it, and which model is most efficient in each setting.

For example, medication-assisted treatment (MAT)—or the use of medicines like methadone, buprenorphine, and naltrexone to treat OUD—has been proven to be effective when implemented properly. However, less than a third of patients in private treatment facilities who may benefit from MAT actually receive it. 

Implementation and sustainment facilitation (ISF) is one promising strategy that may help effective treatments, including treatments for OUD, to be implemented into practice and sustained.

Putting Knowledge to Work with ISF

As part of the Substance Abuse Treatment to HIV Care (SAT2HIV) Project, funded by the National Institute on Drug Abuse, we at RTI International have been experimentally testing the effectiveness of the ISF strategy. The strategy tests an intervention designed specifically to help an organization optimize the consistency and quality of their implementation. This is sometimes referred to as implementation effectiveness.

The use of an implementation advisor—an outside expert in improvement and implementation efforts—is the overarching approach for a multifaceted ISF strategy. However, additional approaches include the following:

• Developing tools for quality improvement
• Organizing implementation team meetings
• Identifying and preparing champions
• Assessing for readiness and identifying barriers
• Conducting local consensus discussions
• Conducting cyclical small tests of change  

Based on preliminary evidence, ISF shows great potential for improving the implementation of effective treatments. With only 1 in 10 people with substance use disorders receiving specialty treatments, many opportunities exist to put ISF and implementation science to use to begin making a bigger impact.