Optimizing Care for People with Opioid Use Disorder and Mental Health Conditions
The Research Need
Among the millions of people with opioid use disorder, 27% have a serious mental illness, 64% have any mental illness, and approximately 11% to 26% have alcohol use disorder or another substance use disorder. Among those whose deaths are associated with opioid overdose (more than 80,000 in 2018 alone), up to 30% may be due to suicide, and nonfatal overdoses involving opioids are also associated with elevated suicide risk. Despite this clinical need for people with co-occurring opioid use disorder and mental health conditions and/or suicide risk, access to evidence-based treatments remains low.
About the Program
This program supports innovative research to develop, optimize, and test approaches to improve delivery of treatments and services for people with co-occurring opioid use disorder, mental illness, and/or suicide risk. To expand the reach of effective strategies, this research addresses access, continuity, quality, equity, efficiency, value, and clinical outcomes of care.
The program will leverage strong, interdisciplinary research-practice partnerships to diagnose and treat opioid use disorder and mental illness. Because many individuals who access mental health care quickly fall out of care and/or do not receive guideline-concordant treatment, this research will develop screening methods to identify people with co-occurring conditions and assess the cost, effectiveness, and sustainability of interventions and services in rural and urban settings and in areas with a shortage of health professionals.
This research will also test the relative contributions of various care components for overall effectiveness in individuals with opioid use disorder and mental illness, toward optimizing multi-component service delivery interventions.
To date, through the Helping to End Addiction Long-term® Initiative, or NIH HEAL Initiative®, NIH has funded four cooperative agreements, one research project grant, and nine supplemental awards to improve the treatment and management of services for people with opioid use disorder and co-occurring mental health conditions and/or suicide risk, totaling $63.8 million.
Each awardee is utilizing clinical trial and other high-impact designs to evaluate not only clinical outcomes but also outcomes related to access to care and continuity of care. Awardees are also conducting economic analyses to investigate how to make their treatments and services 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 supported by this program include:
- Using pragmatic and optimization designs to test deployment-focused interventions in existing clinical practice settings in high-need locations
- Serving diverse patient populations, including racial and ethnic minorities, pregnant women, and participants younger than 18 years of age
- Answering research questions about cost and cost-effectiveness
- Streamlining workflows through routine screening and efficient referral pathways to medication-based treatment for opioid use disorder and mental illness
- Identifying high-value components of the collaborative care model and other multi-component service delivery interventions for use in patients with co-occurring mental illness and opioid use disorder
- Building new service-delivery models for people with opioid use disorder and co-occurring mental health problems and/or suicide risk