Measurement-based care using DSM-5 for opioid use disorder: can we make opioid medication treatment more effective?

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dc.contributor.authorMarsden, J.
dc.contributor.authorTai, B.
dc.contributor.authorAli, R.
dc.contributor.authorHu, L.
dc.contributor.authorRush, A.J.
dc.contributor.authorVolkow, N.
dc.date.issued2019
dc.description.abstractContext and Purpose: Measurement-based care (MBC) is an evidence-based health-care practice in which indicators of disease are tracked to informclinical actions, provide feedback to patients and improve outcomes. The current opioid crisis in multiple countries provides a pressing rationale for adopting a basic MBC approach for opioid use disorder (OUD) using DSM-5 to increase treatment retention and effectiveness. Proposal: To stimulate debate, we propose a basic MBC approach using the 11 symptoms of OUD (DSM-5) to inform the delivery of medications for opioid use disorder (MOUD; including methadone, buprenorphine and naltrexone) and their evaluation in office-based primary care and specialist clinics. Key features of a basic MBC approach for OUD using DSM-5 are described, with an illustration of how clinical actions are guided and outcomes communicated. For core treatment tasks,we propose that craving and drug use response to MOUD should be assessed after 2 weeks, and OUD remission status should be evaluated at 3, 6 and 12 months (and exit from MOUD treatment) and beyond. Each of the 11 DSM-5 symptoms of OUD should be discussed with the patient to develop a case formulation and guide selection of adjunctive psychological interventions, supplemented with information on substance use, and optionally extended with information from other clinical instruments. A patient-reported outcome measure should be recorded and discussed at each remission assessment. Conclusions: MBC can be used to tailor and adapt MOUD treatment to increase engagement, retention and effectiveness. MBC practice principles can help promote patient-centred care in OUD, personalized addiction therapeutics and facilitate communication of outcomes.
dc.description.statementofresponsibilityJohn Marsden, Betty Tai, Robert Ali, Lian Hu, A. John Rush, Nora Volkow
dc.identifier.citationAddiction, 2019; 114(8):1346-1353
dc.identifier.doi10.1111/add.14546
dc.identifier.issn0965-2140
dc.identifier.issn1360-0443
dc.identifier.orcidMarsden, J. [0000-0002-1307-2498]
dc.identifier.orcidAli, R. [0000-0003-2905-8153]
dc.identifier.urihttps://hdl.handle.net/2440/145851
dc.language.isoen
dc.publisherWiley
dc.rights© 2018 The Authors. Addiction published by John Wiley & Sons Ltd on behalf of Society for the Study of Addiction. This is an open access article under the terms of the Creative Commons Attribution-NonCommercial License,which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes.
dc.source.urihttps://doi.org/10.1111/add.14546
dc.subjectDSM-5; measurement-based care (MBC); medications for opioid use disorder (MOUD); opioid use disorder (OUD); patient reported outcome (PRO); psychological intervention
dc.subject.meshHumans
dc.subject.meshOpioid-Related Disorders
dc.subject.meshMethadone
dc.subject.meshBuprenorphine
dc.subject.meshNaltrexone
dc.subject.meshAnalgesics, Opioid
dc.subject.meshNarcotic Antagonists
dc.subject.meshRemission Induction
dc.subject.meshEvidence-Based Medicine
dc.subject.meshDiagnostic and Statistical Manual of Mental Disorders
dc.subject.meshInternational Classification of Diseases
dc.subject.meshPatient Reported Outcome Measures
dc.titleMeasurement-based care using DSM-5 for opioid use disorder: can we make opioid medication treatment more effective?
dc.typeJournal article
pubs.publication-statusPublished

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