(95) Individual and Population Opioid Use Disorder Needs: A Multi-State ASAM Criteria Database

Introduction: Opioid use disorder (OUD) is a chronic disease with significant health and socioeconomic consequences. During 2018 in the United States, approximately 10.3 million individuals 12 and older engaged in opioid use that was not medically directed. Opioid-implicated overdose deaths in the U.S. increased by 26% from 2020 to 2021. On a population basis, data regarding real-world, real-time treatment needs are sparse and temporal changes in the nation’s epidemic call for a means of capturing such needs over time. While medication for opioid use disorder (MOUD) is well-established as first-line treatment, less is known about OUD patients’ need for concurrent behavioral addiction treatment. We used de-identified OUD data from the database of a multi-state clinical assessment that implements the ASAM Criteria to investigate addiction level of care needs among a geographically diverse OUD patient population.

Methods: We analyzed data from all computer-assisted assessments (ASAM CONTINUUM®) completed in a single month (July 2021) to determine:

1. Rates of OUD diagnoses,
   
2. the number of individuals with OUD who received computer-generated recommendations for MOUD via Opioid Treatment Services (OTS; office-based opioid treatment services) and/or Opioid Treatment Programs (OTP; federally regulated methadone programs), and
   
3. the distribution of concurrent other level of care (L0.5 – L4) recommendations for people with OUD.

Results: The final sample consisted of 5,154 unique assessments. Approximately 48% of completed assessments generated an OUD diagnosis. Of those diagnosed with OUD, 99.96% received a recommendation for OTS and/or OTP, and 70.09% received a recommendation for other (non-OTS/OTP) levels of care. These other level of care (L) recommendations were as follows: L0.5 (0.0%), L1 (9.47%), L2 (34.56%), L3 (18.95%), and L4 (7.11%). One-third (33.33%) of these other level of care recommendations specified a need for co-occurring mental health services, while 14.17% specified biomedical enhanced services.

Discussion: Overall, about half of individuals assessed with CONTINUUM had an OUD diagnosis. Essentially all of these were recommended for OTS/OTP. In addition to MOUD treatment, however, about 44% of people with an OUD were recommended for an outpatient Level of Care (L1/L2), and approximately 26% were recommended an inpatient level of care (L3/L4).

These preliminary findings indicate that patients with OUD often need behavioral therapy specifically adjunctive to MOUD across multiple levels of care, as well as care for other mental health and biomedical problems. The results also indicate the importance of “unbundling”, i.e., providing for a patient’s MOUD needs in concert with another level of care, rather than only in a single OTS/OTP setting. The data underscore the potential value – for both individual patients and populations – of evaluating patients with OUD using comprehensive multidimensional assessment to determine full biopsychosocial treatment needs.

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