Interim treatment: Bridging delays to opioid treatment access

Abstract

Objective Despite the undisputed effectiveness of agonist maintenance for opioid dependence, individuals can remain on waitlists for months, during which they are at significant risk for morbidity and mortality. To mitigate these risks, the Food and Drug Administration in 1993 approved interim treatment, involving daily medication + emergency counseling only, when only a waitlist is otherwise available. We review the published research in the 20 years since the approval of interim opioid treatment. Methods A literature search was conducted to identify all randomized trials evaluating the efficacy of interim treatment for opioid-dependent patients awaiting comprehensive treatment. Results Interim opioid treatment has been evaluated in four controlled trials to date. In three, interim treatment was compared to waitlist or placebo control conditions and produced greater outcomes on measures of illicit opioid use, retention, criminality and likelihood of entry into comprehensive treatment. In the fourth, interim treatment was compared to standard methadone maintenance and produced comparable outcomes in illicit opioid use, retention and criminal activity. Conclusions Interim treatment significantly reduces patient and societal risks when conventional treatment is unavailable. Further research is needed to examine the generality of these findings, further enhance outcomes, and identify the patient characteristics which predict treatment response.

Using nominal group technique to identify barriers, facilitators, and preferences among patients seeking treatment for opioid use disorder: A needs assessment for decision making support

“…Our findings indicate however, that same-day, low-barrier access is greatly valued by participants. Such delays in treatment entry are also associated with high risk for mortality and other health risks (Sigmon 2015). These findings are generalizable in that they add patient-centered findings to the literature that suggest eliminating delays to treatment may be an important target of intervention in other settings.…”

Comparison of Driving Times to Opioid Treatment Programs and Pharmacies in the US

“…13 In addition, OTPs must comply with state and local laws, including zoning bylaws that limit clinic placement. 35 Several strategies to increase access to methadone maintenance have been proposed, including prescribing methadone through primary care clinics and federally qualified health centers, 7,36 increased use of mobile methadone vans, 37 and increased use of medication units. 38 Medication units are satellite units of OTPs permitted to dispense methadone and obtain urine samples.…”

The Opioid-overdose Reduction Continuum of Care Approach (ORCCA): Evidence-based practices in the HEALing Communities Study

“…When there are waiting lists, these programs may receive regulatory approval to provide medication for up to 180 days while patients await the full array of non-medication services. This is called “interim” treatment and is superior to waiting lists on multiple outcomes including illicit opioid use and treatment retention ( Sigmon, 2015 ). A medication unit is a satellite to a licensed opioid treatment program providing primarily medication dispensing in order to make treatment more accessible to patients ( Office of the Federal Register and Government Publishing Office, 2019b ).…”