Facilitating rapid access to addiction treatment: a randomized controlled trial

Abstract

Background Obtaining timely access to addiction medicine treatment for patients with substance use disorders is challenging and patients often have to navigate complex referral pathways. This randomized controlled trial examines the effect of providing an expedited pathway to addiction medicine treatment on initial treatment engagement and health care utilization. Methods Individuals with possible alcohol or opioid use disorder were recruited from three residential withdrawal management services (WMS). Subjects randomized to the Delayed Intervention (DI) group were given contact information for a nearby addiction medicine clinic; those randomized to the Rapid Intervention (RI) group were given an appointment at the clinic within 2 days and were accompanied to their first appointment. Results Of the 174 individuals who were screened, 106 were randomized to either the DI or RI group. The two groups were similar in demographics, housing status, and substance use in the last 30 days. In the 6-month period following randomization, 85% of the RI group attended at least one clinic appointment, compared to only 29% in the DI group (p < 0.0001). The RI group had a mean of 6.39 ED visits per subject in the 12 months after randomization, while the DI group had a mean of 13.02 ED visits per subject in the same 12-month period (p = 0.0469). Other health utilization measures did not differ between the two groups. Conclusion Providing immediate facilitated access to an addiction medicine service resulted in greater initial engagement and reduced emergency department visits at 6 months. Trial registration This trial is registered at the National Institutes of Health (ClinicalTrials.gov) under identifier #NCT01934751.

Rapid Access Addiction Medicine Clinics for People With Problematic Opioid Use

“…These results contribute to increasing evidence of the effectiveness of rapid access care models, particularly the impact on reducing acute health care use. Srivastava et al 31 conducted a randomized clinical trial of individuals with POU or PAU residing in withdrawal management services. Individuals in the rapid intervention group (ie, those given an appointment at an addiction medicine clinic within 2 days) had fewer ED visits in the 6 months after their referral compared with individuals in the delayed intervention group (ie, those given contact information for the addiction medicine clinic).…”

Effectiveness and Public Health Impact of Safer Supply and Opioid Agonist Treatment: A Narrative Review with Recommendations

“…An analysis of 440 client charts showed a high treatment retention rate at 1 year and high levels of client satisfaction 75 . Community access to OAT can also be improved through low-barrier strategies such as rapid access clinics and mobile clinics 76,77 …”

“…75 Community access to OAT can also be improved through low-barrier strategies such as rapid access clinics and mobile clinics. 76,77 OAT retention rates and outcomes can also be improved by providing wrap-around services include primary care, case management, and counselling. In a qualitative study of patients attending three Safer Supply programs in Ontario, patients reported greater access to primary care, improved management of chronic disease, improved income, and less food and housing insecurity.…”