Linking People with Opioid Use Disorder to Medication Treatment

A resource for action of policy, programs, and practices

Key points

Millions of Americans are living with opioid use disorder (OUD). Medications for opioid use disorder (MOUD), such as methadone, buprenorphine, and naltrexone, can effectively treat OUD, reduce overdoses, and save lives. This resource offers strategies to support linkage to care for clinicians and service providers.

A clinician writes on a notepad while meeting with a patient in an open clinic setting.

A resource to inform decision-making

Linking people with opioid use disorder to medication treatment
CDC's resource for linkage to care

Millions of Americans are living with opioid use disorder (OUD).1 Healthcare professionals and community leaders in public health, education, criminal justice, social services, business, and government all have a role to play in increasing access and linkage to MOUD. To offer strategies to support linkage to care for each sector based on the best available evidence, CDC released the Resources for Action for Linking People with Opioid Use Disorder to Medication Treatment [PDF – 48 pages]. The resource has five sections:

  • Introduction and overview
  • The cascade of care for opioid use disorder
  • Opportunities for linkage to care
  • Best practices across populations
  • Barriers and facilitators of treatment access

Linkage to care best practices by care setting

Implementation strategies described in this document focus on creating accessible, equitable, sustainable, and culturally competent approaches to linking people living with OUD to evidence-based care. Commitment, cooperation, and leadership from numerous sectors, including public health, education, criminal justice, health care, social services, business, labor, and government are key to successful implementation.

All care settings, in addition to the specific opportunities outlined below, can improve linkage to care when it is welcoming, nonjudgmental, respectful, and empathetic.2

Primary care

As healthcare professionals who form long-term relationships with many of their patients, primary care providers may be positioned to earn the trust of patients. Those relationships may position these clinicians to provide long-term support for chronic conditions, including OUD. Primary care can improve opportunities for linkage to care when:

• Screening for OUD is universal.2

• Patients reporting polysubstance use, previous substance use treatment, or co-occurring mental disorders are assessed to determine whether other treatment or support is needed.34

• Medical issues often associated with substance use are recognized and followed with screening, assessment, and appropriate care.2

• Patients at higher overdose risk are identified, trained to respond to overdose, and provided with naloxone.56

• When OUD is identified at the visit and MOUD is indicated, patients begin induction immediately.7

• Ongoing MOUD is integrated into primary care rather than offered through referral to a specialist.8

Emergency departments

Screening for OUD in emergency departments (ED) may identify patients who could benefit from MOUD who would not be screened elsewhere. EDs can improve opportunities for linkage to care when:

  • Referral to community care is conducted through a warm handoff.9
  • Patients at higher overdose risk are identified, trained to respond to overdose, and provided with naloxone prior to discharge.10
  • A trained peer recovery coach is available to consult with the patient if desired.11

Inpatient hospitalization

Clinicians and support staff providing care to people admitted to inpatient care have extended close contact with patients. People living with OUD who are admitted to inpatient care can be offered medically supervised detoxification to alleviate their withdrawal symptoms, creating an opportunity to discuss and initiate long-term MOUD. Teams providing care to inpatients can improve opportunities for linkage to care when:

  • Complex financial and systems needs associated with large hospitals are integrated into planning and implementing improved linkage-to-care services.12
  • Patients with OUD are screened to assess risk behaviors and severity of substance use disorders and triaged into appropriate care.13
  • Any intervention provided to the inpatient is followed by continued MOUD after discharge.14
  • Patients at higher overdose risk are identified, trained to respond to overdose, and provided with naloxone prior to discharge.10

Syringe services programs

Linkage to MOUD from a syringe service program (SSP) may take various forms, including warm handoffs to partnering MOUD prescribers with ongoing patient navigation or peer support; co-located (or closely located) SSP and MOUD services; and integrated SSP and MOUD care with onsite medication induction and continuation of care. SSPs can improve opportunities for linkage to care when:

  • SSP staff and volunteers can build meaningful and trusting relationships with participants over time.15
  • Effective case management is provided to facilitate linkage and entry into treatment.16
  • SSP participants have access to qualified health insurance plans and are supported in initiating and completing enrollment.17
  • Linkage to care is bundled with linkage to other services that alleviate common barriers to treatment success, including housing support and transportation assistance.1618
  • SSP interventions are supported by policies that allow possession and distribution of harm reduction supplies,192021 sufficiently funded,22 supported by the community, including public safety partners,2324 and can implement interventions that meet participants' needs.

Prenatal and postpartum care

Prenatal and postpartum healthcare professionals can offer wrap-around care for pregnant people through a collaborative care model that brings together care related to pregnancy, birth, and OUD in a single setting.25 Teams providing prenatal and postpartum care can improve opportunities for linkage to care when:

  • Verbal screening for risky substance use behaviors with a validated tool is universal for all pregnant people seeking prenatal care—beginning at the first prenatal visit.26
  • Care is approached through nonpunitive means and when the patient doesn't feel at risk of legal repercussions (including the involvement of child protective services and the risk of forcible removal of their children) for disclosing substance use during pregnancy.2728
  • Care is delivered through a collaborative care model with supportive providers working in tandem.2529
  • Pregnant patients with OUD are not forced to withdraw from opioids30 but are instead maintained on opioid agonist medications if acceptable to the patient.2831

Outpatient mental health and behavioral health care

The co-occurrence of mental health disorder and OUD suggest that mental health professionals are in a unique position to link patients with OUD to MOUD while treating mental health co-morbidities that may be associated with substance use.32 Teams providing mental and behavioral health care can improve opportunities for linkage to care when:

  • Treatment services for OUD and other mental disorders are integrated and co-located.33
  • Services for co-occurring mental disorders are established prior to the initiation of treatment for OUD.34

Healthcare settings during incarceration and community supervision

Linking persons with OUD to evidence-based treatment while they are incarcerated or under community supervision reduces illegal drug use, overdose risk, and rates of drug-related crime and increases engagement with other essential forms of health care.35363738 Linkage to care in health care settings during incarceration and community supervision works best when:

  • Treatment with MOUD is uninterrupted for those receiving care prior to incarceration.39
  • MOUD can be initiated in criminal justice settings.40
  • Persons have access to all FDA-approved MOUD. This choice is essential, as some people fare much better (or worse) on one of these drugs than on the others.41
  • Dosages of opioid agonist MOUD are not restricted. For example, methadone dosages greater than or equal to 60 mg are needed to retain patients in treatment and to generate reduction in illicit opioid use in community care settings.42 Evidence does not support using lower dosages in incarcerated settings.
  • An effective system for referral and linkage to care is in place so that persons on MOUD can receive a warm handoff to providers who can continue their care, without interruption, upon release.43
  • MOUD is offered with evidence-based psychosocial counseling; however, according to SAMHSA's best practices for providing MOUD in criminal justice settings, no justification exists for denying access to MOUD because psychosocial services are unavailable or because someone is unwilling to engage in those services.44
  • Community practitioners who provide MOUD meet with people who are incarcerated prior to their release. They assess health care and social support needs so that a smooth transition to community care which can begin immediately upon release.44
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