Optimizing Care for People with Opioid Use Disorder and Mental Health Conditions

The Research Need

There is an urgent need to identify effective approaches to treat people who have an opioid use disorder (OUD) and co-occurring mental health conditions, especially in primary care settings. Data from the 2016 National Survey on Drug Use and Health suggest that among adults who misused opioids in the prior year, 42.8 percent also had a mental illness and 15.6 percent had a serious mental illness.

The collaborative care model is a promising approach to meeting the needs of people who have both OUD and mental health conditions. Collaborative care is a specific service delivery model for treating mental and behavioral conditions in primary care settings.

Strong evidence supports collaborative care for treating people with common mental disorders, including those who have physical health conditions. Researchers have demonstrated that collaborative care improves clinical outcomes and is associated with improvements in access to care (getting people care who need it), continuity of care (keeping people in care who might otherwise fall through the cracks), and health equity.

Promising but less definitive evidence is available about the effectiveness of collaborative care for treating OUD and other substance use disorders. And less definitive information exists about how best to implement the model in primary care settings for people with both OUD and mental health conditions. Research is needed to help fill gaps about the effectiveness of collaborative care for treating OUD and other substance use disorders and implementing the model in primary care settings for people with both OUD and mental health conditions.

About the Program

This program will support research to develop, optimize, and test the collaborative care model using medication for OUD and evidence-based treatments for mental health conditions that can be delivered within primary care settings.

Researchers will focus on leveraging strong research-practice partnerships and on harnessing the expertise of interdisciplinary teams for the diagnosis and treatment of OUD and mental health disorders. They will develop screening methods to identify people who have OUD and co-occurring mental health disorders and assess the cost, effectiveness, and sustainability of collaborative care strategies. Researchers will also evaluate multiple methods of collaborative care in rural and urban settings and in areas with a shortage of health professionals.

Program Details

To date, through the Helping to End Addiction Long-termSM Initiative, or NIH HEAL InitiativeSM, NIH has awarded four collaborative care research grants  and nine supplement awards to improve the treatment and management of common co-occurring conditions and suicide risk in people affected by the opioid crisis, totaling $56.3 million. Each awardee will carry out clinical trials to test not only whether collaborative care improves clinical outcomes but also whether it improves outcomes related to access to care and continuity of care. Each awardee will also conduct economic analyses to investigate how to make their collaborative care models financially feasible in clinical practices once the research concludes.

VIDEO: Stigma Prevents Better Pain Management and Addiction Treatment

Joshua Gordon, MD, PhD, Director of the National Institute of Mental Health, discusses how researchers are considering stigma when planning ways to address the opioid crisis.

Research Examples

These projects will:

  • Use pragmatic designs and deployment-focused interventions that are feasible to implement in existing clinical practice settings.
  • Be conducted in high need locations.
  • Serve diverse patient populations, including racial and ethnic minorities, pregnant women, and participants younger than 18.
  • Take place in clinics with known variation in implementation readiness and existing site resources.
  • Aim to answer research questions about cost and cost-effectiveness and about the reduction of the alarming rates of mortality associated with OUD.
  • Seek to streamline workflows through routine screening and efficient referral pathways to medication-based treatment for OUD and mental health treatment.

  • Brandeis University – Massachusetts 
  • Hennepin Healthcare Research Institute – Minnesota 
  • Henry Ford Health System – Michigan 
  • Kaiser Foundation Research Institute – California
  • Rand Corporation – California
  • The Ohio State University – Ohio
  • University of Connecticut School of Medicine – Connecticut 
  • University of Massachusetts Medical School, Worchester – Massachusetts 
  • University of Michigan at Ann Arbor – Michigan 
  • University of Pennsylvania – Pennsylvania
  • University of Washington – Washington

Funded Projects

Supporting Treatment Access and Recovery for Co-Occurring Opioid Use and Mental Health Disorders (STAR-COD)
Sep 20, 2021
Revision to the HOME Trial: Suicide Treatment Education and Prevention (HOME + STEP)
Sep 29, 2020
Improving the Identification and Management of Suicide Risk among Patients Using Prescription Opioids
Sep 29, 2020
Suicide Prediction and Prevention for People at Risk for Opioid Use Disorder
Sep 29, 2020
Behavioral health Insurance coverage and outcome Risks of Co-occurring conditions among delivering women with opioid use and pain for HEAL: The BIRCH study
Sep 29, 2020