Opioid use disorder Cascade of care framework design: A roadmap

Abstract

Unintentional overdose deaths, most involving opioids, have eclipsed all other causes of US deaths for individuals less than 50 years of age. An estimated 2.4 to 5 million individuals have opioid use disorder (OUD) yet a minority receive treatment in a given year. Medications for OUD (MOUD) are the gold standard treatment for OUD however early dropout remains a major challenge for improving clinical outcomes. A Cascade of Care (CoC) framework, first popularized as a public health accountability strategy to stem the spread of HIV, has been adapted specifically for OUD. The CoC framework has been promoted by the NIH and several states and jurisdictions for organizing quality improvement efforts through clinical, policy, and administrative levers to improve OUD treatment initiation and retention. This roadmap details CoC design domains based on available data and potential linkages as individual state agencies and health systems typically rely on limited datasets subject to diverse legal and regulatory requirements constraining options for evaluations. Both graphical decision trees and catalogued studies are provided to help guide efforts by state agencies and health systems to improve data collection and monitoring efforts under the OUD CoC framework.

Keywords:

• Opioid use disorder; cascade of care; medication for opioid use disorder (MOUD); opioid crisis

Disclosure statement

Dr. Williams receives equity, consulting fees, and travel expenses from Ophelia Health, Inc., a telehealth provider for opioid use disorder. Dr. Socías has received support from Indivior for an investigator-initiated study, not related to the present work. Dr. Fishman receives consulting fees from Alkermes and Drug Delivery LLC, and is an investigator on a grant funded by Alkermes.

Correction Statement

This article has been republished with minor changes. These changes do not impact the academic content of the article.

Additional information

Funding

Financial support for this work was provided by grants from the National Institute on Drug Abuse (NIDA) [K23 DA044342, Williams PI], and the Substance Abuse Mental Health Services Opioid Response Network [TI-18-004 Subaward, Williams PI]. The funding organizations had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; or the decision to submit the manuscript for publication.