Clinical Decision Support for Opioid Use Disorders: NIDA CCTN Working Group Report
There is an urgent need for strategies to address the U.S. epidemic of prescription opioid, heroin, and fentanyl-related overdoses, misuse, addiction, and diversion. Evidence-based treatments like medications for opioid use disorder (MOUD) are available, but there aren’t enough providers offering these services to meet the need.
The NIDA Center for the Clinical Trials Network (CCTN) held a full day workshop in June 2015 to begin developing a clinical decision support tool (CDS) for opioid use disorder treatment — specifically one that could be incorporated into electronic health records (EHRs) and assist non-specialist medical providers in identifying and managing patients with opioid use disorder (OUD) in general medical settings.
Through a face-to-face expert panel meeting and multiple follow-up conference calls, the workgroup drafted CDS algorithms for clinical care they deemed essential for screening, diagnosis, and management of OUD in primary care. This algorithm was reviewed by addiction specialists and primary care providers and revised based on their input.
The CDS workflow is described in detail in this paper (which is free to access online), and involves these steps:
- Make and/or confirm the diagnosis of a substance use disorder (SUD).
- Make the initial decision to assess the severity of the patient’s SUD.
- Present the indication for treatment to the patient and introduce the idea of pursuing treatment.
- Perform an assessment of the patient’s current readiness for treatment.
- Discuss potential options for treatment with the patient (the paper includes details on induction of office-based buprenorphine or naltrexone).
- Clarify the patient’s actual ability and/or willingness for referral to treatment based on appropriate and acceptable options.
- Make and follow through with the referral for the patient.
Conclusions: The current epidemic of opioid misuse and overdose has greatly outpaced the capacity of specialized treatment settings to manage it. A clinical decision support tool for OUD screening, assessment, and treatment within primary care systems may improve healthcare delivery and help address these issues. Further work for adaptation at specific sites and for testing is needed.