To Battle The Opioid Overdose Epidemic, Deploy The ‘Cascade Of Care’ Model

Williams, Arthur; Nunes, Edward; Olfson, Mark

Similar to serologically confirmed undetectable HIV viral load, continuous abstinence from opioids can be objectively monitored with routine toxicology and serve as a biomarker for a primary outcome. Patients abstinent from opioids and on maintenance treatment with buprenorphine, methadone, or injectable naltrexone are at minimal risk for opioid overdose.

Applying quality metrics informed by the Cascade of Care to treatment of opioid use disorder holds great promise to help ensure optimal returns on federal funding for areas hardest hit by overdose. Treatment programs with historically low use of MAT in the face of the worsening epidemic need compelling incentives to change practice. Identifying which patients struggle at which stages of the Cascade to help target clinical and policy interventions can help STR funding achieve its greatest impact.

While the scale of the opioid crisis presents states and policymakers with a daunting and urgent task, adapting the Cascade of Care model to fit today’s crisis will help expedite and scale the programs needed to combat this epidemic.

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August 15, 2017