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Treating Opioid Addiction pp 197–222Cite as

Enhancing Treatment Access and Effectiveness: Toward Patient-Centered Models of Care

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Part of the book series: Current Clinical Psychiatry ((CCPSY))

Abstract

In the United States, despite the availability of safe and effective pharmacotherapy and behavioral treatments for opioid use disorder (OUD), a minority of people who need treatment receive it. Improving treatment uptake will require OUD treatments that are available, accessible, and acceptable to people with OUD. The objectives of this chapter are (1) to describe barriers to OUD treatment; (2) to present patient preferences for OUD treatment; (3) to recommend modifications to current OUD treatment models in the United States that would make treatment more available, accessible, and acceptable to people with OUD; and (4) to present a patient-centered model of OUD care that focuses on engagement, retention in care, and harm reduction while serving both people who want to stop illicit opioid use and those who do not. Though many people with OUD enter stable recovery without using formal treatment, many barriers to care do exist for people who want and could benefit from evidence-based OUD treatments. Societal change will be needed to reduce stigma regarding OUD and agonist treatments. Policy change will be needed to make the full spectrum of OUD treatments more available and affordable in every community. Modifying OUD treatment models to be more patient-centered could also increase treatment uptake by improving acceptability and desirability of treatment. There will be no easy way to stem the increasing harms from the opioid epidemic, but bringing people into care is an important first step.

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Abbreviations

HCV:

Hepatitis C virus (HCV)

HIV:

Human immunodeficiency virus

LGBTQ:

Lesbian, gay, bisexual, transgender, queer

MMT:

Methadone maintenance treatment

NSDUH:

National Survey on Drug Use and Health

OTP:

Opioid treatment program

OUD:

Opioid use disorder

SUD:

Substance use disorder

US:

United States

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Authors and Affiliations

  1. Department of Medicine, Division of General Internal Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA

    Aaron D. Fox & Andrea U. Jakubowski

  2. Opioid Treatment Program, Division of Correctional Health Services, NYC Health + Hospitals, New York, NY, USA

    Jonathan Giftos

Authors
  1. Aaron D. Fox
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  2. Andrea U. Jakubowski
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  3. Jonathan Giftos
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Correspondence to Aaron D. Fox .

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Editors and Affiliations

  1. Elizabeth R. Spallin Professor of Psychiatry in Addiction Medicine, Harvard Medical School, Boston, MA, USA

    John F. Kelly

  2. Department of Medicine, Harvard Medical School, Boston, MA, USA

    Sarah E. Wakeman

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Fox, A.D., Jakubowski, A.U., Giftos, J. (2019). Enhancing Treatment Access and Effectiveness: Toward Patient-Centered Models of Care. In: Kelly, J., Wakeman, S. (eds) Treating Opioid Addiction. Current Clinical Psychiatry. Humana, Cham. https://doi.org/10.1007/978-3-030-16257-3_10

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