Treatment, Recovery, and Harm Reduction

Treatment, Recovery, and Harm Reduction

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Recommendation Evidence Summary Intervention Type
Encourage lawmakers to institute Good Samaritan laws or revise existing laws to provide additional legal protections for persons who require emergency assistance in the event of an overdose. Experience-based for reducing fatal opioid overdose: Research suggests that Good Samaritan Laws increase the likelihood that bystanders or individuals who experience an opioid overdose will call 911. This, in turn, may reduce risks of fatal overdoses. However, research to support this policy for reducing fatal opioid overdose is insufficient. Policy
Advocate for legislation that requires health insurance companies to reimburse health providers for comprehensive pain management services. Experience-based for preventing opioid misuse: Preliminary data suggest that comprehensive pain management services are effective in reducing pain symptoms, emotional distress, and  functional limitations among chronic pain patients. This, in turn, may reduce risk of opioid misuse. However, research to support this policy for reducing opioid use disorder is insufficient. Policy
Support regulations that insure payers comply with behavioral health parity laws, like The Mental Health Parity and Addiction Equity Act (MHPAEA), to ensure adequate coverage for addiction treatment and recovery services. Experience-based for reducing opioid misuse and preventing relapse: Research suggests a relationship between insurance coverage for substance use services and substance use treatment utilization. However, research to support behavioral health parity laws for reducing opioid use disorder is insufficient. Policy
Promote clinic-based SBIRT models, such as The Brief Negotiation Interview and Emergency Department-Initiated Buprenorphine/Naloxone for Moderate/Severe Opioid Use Disorder (ED-BNI). Evidence-based for reducing opioid use disorder: At least one randomized controlled trial found that ED-BNI reduced self-reported illicit opioid use. Program
Promote integrated, systems-based models of care for addiction treatment, like hub and spoke models, Medicaid health homes, Project ECHO, and collaborative care models (including collaborative opioid prescribing models). Experience-based for reducing opioid use disorder: Research suggests that integrated, systems-based approaches to addiction treatment increase access to care. This, in turn, is likely to reduce rates of substance use disorders. However, research to support this practice for reducing opioid use disorder  is insufficient. Program
Expand use of telemedicine and telehealth addiction treatment and pain management programs, such as Project ECHO, to increase access to treatment, especially for rural and underserved populations. Evidence-informed for reducing opioid use disorder: At least one systematic review found Project ECHO to increase participant knowledge and patient access to healthcare in remote locations. Program
Promote new and alternative entry points (or "touch points") for treatment and recovery by providing "warm handoff" (in-person referral) to treatment and recovery support services in alternative settings. Evidence-informed for reducing opioid use disorder: At least one randomized controlled trial found that a syringe exchange program successfully referred  individuals suffering opioid use disorder to a methadone maintenance program. Referrals to MAT may increase access to care for opioid use disorder. Practice
Support evidence-based programs, like interim methadone maintenance (IMM), that provide counseling services to adults who are addicted to opioids while they are on waiting lists to receive medication-assisted treatment. Evidence-based for reducing opioid use disorder: At least one randomized controlled trial found that IMM delivered with heroin-dependent patients reduced heroin use four and 10 months after baseline. Program
Supplement medication-assisted treatment with community reinforcement approaches like the Community Reinforcement and Family Training for Treatment Retention (CRAFT-T) program, for people with substance use disorders and their loved ones. Evidence-based for reducing opioid use disorder: At least one randomized controlled trial found that CRAFT-T resulted in higher rates of abstinence from opioid use and lower levels of opioid use among patients enrolled in detox programs. Program
Supplement medication-assisted treatment with evidence-based, couples-focused approaches found to reduce opioid use, like behavioral couples therapy (BCT), which is designed to reinforce abstinence from opioids. Evidence-based for reducing opioid use. At least one randomized controlled trial conducted with methadone-maintained men and their partners found that BCT decreased men's scores on the Addiction Severity Index. Program
Supplement medication-assisted treatment with evidence-based behavioral interventions like contingency management to incentivize treatment participation or drug abstinence. Evidence-based for reducing opioid use disorder: At least one randomized controlled trial found that contingency management resulted in longer periods of abstinence from opioids than standard care and that effects were maintained through the six-month follow-up period. Practice
Supplement medication-assisted treatment with evidence-based motivational interviewing programs to motivate participation in treatment. One such program is REBOOT, which includes at least four sessions of motivational interviewing delivered by trained counselors. Evidence-based for reducing opioid overdose: At least one randomized controlled trial suggests that REBOOT reduces likelihood of overdose and number of overdose events. Program
Fund and implement syringe exchange programs to reduce the transmission of HIV among individuals with opioid use disorder. Evidence-based for reducing harm: At least one meta-analysis found that syringe exchange programs reduced rates of HIV, and at least one randomized controlled trial found that a syringe exchange program successfully referred individuals with opioid use disorder to a methadone maintenance program. This, in turn, may reduce the severity of opioid use disorder. Program
Promote peer education programs for injection drug users to reduce risk of HIV and Hepatitis C virus (HCV) infection, like The Drug Users Intervention Trial Peer Education Intervention (DUIT-PEI). Evidence-informed for reducing harms associated with injection drug use: At least one multisite randomized controlled trial found that DUIT-PEI led to a decrease in injection risk behaviors. Decreased injection risk behaviors, may, in turn, reduce risk of contracting HIV and HCV. Program
Expand the implementation and reach of peer-delivered interventions to prevent or treat opioid use disorder, or to support health promotion and promote their recovery. Evidence-informed for reducing opioid use disorder: At least one systematic review found that peer-delivered interventions resulted in less alcohol use, and at least one randomized controlled trial found that a peer-delivered intervention reduced crack or cocaine use. Practice
Fund and implement safe injection sites to reduce risk of fatal overdose. Evidence-based for reducing fatal opioid overdose: At least one systematic review found that safe injection sites enhance access to primary healthcare and reduce the frequency of fatal overdose. Program
Encourage providers treating chronic pain to co-prescribe naloxone when prescribing opioids. Experience-based for reducing fatal opioid overdose: A non-randomized study found that long-term opioid therapy patients co-prescribed naloxone had fewer opioid-related emergency-department visits in the six months following the prescription than those not prescribed naloxone. However, research to support this practice for reducing opioid overdose is insufficient. Practice