Psychosocial Interventions As Part of Office Based Opioid Treatment in Primary Care: A Systematic Review

Background and Purpose: In the U.S., the opioid crisis has reached a national health emergency. To address a rapidly escalating epidemic of opioid use, Medication-Assisted Treatment (MAT) in Office-Based Opioid Treatment (OBOT) in primary care settings has been increasingly deployed to expand access to treatment for opioid use disorders (OUD). As an evidence based-approach, MAT combines behavioral health and medication to treat OUD and requires coordination of services across the health system. However, specific psychosocial interventions used in MAT programs in OBOT primary care have not been emphasized and the knowledge, skills, or competencies needed by providers is relatively unknown. In order to address this gap, this presentation reviews findings from a systematic review of psychosocial interventions as part of MAT in OBOT primary care settings.  

Methods: The systematic review focused on two research questions: (a) What are the psychosocial interventions as part of MAT in OBOT programs in primary care settings for OUD? (b) What knowledge, skills or competencies are required to deploy psychosocial interventions as part of MAT in OBOT programs in primary care settings for OUD? A comprehensive review protocol was adapted from Cochrane Collaboration and PRISMA guidelines and published on PROSPERO. Inclusion criteria consisted of peer-reviewed English-language journal articles between 1995–2017, intervention and observational studies, that included a psychosocial intervention as part of MAT in OBOT programs within primary care setting in the U.S. Five databases were searched using search strings developed with a reference librarian. Forward and backward citation chaining was used to identify articles not identified in the formal search. Data were extracted by two independent raters about the psychosocial intervention, study design, location, patient population, and team composition.

Results: After removing duplicates, 531 articles were identified for a title and abstract review, which yielded 59 articles for a full-text review. Of these, 25 studies met a priori criteria for inclusion. All studies occurred in primary care, 56% were in academic medical centers and 8% were focused on a comorbid HIV population. Almost 76% were conducted in the Northeastern U.S. but there was geographic variability in location. Patient population generally included participants aged 20—77. The majority of studies (64%) provided limited information on the psychosocial components of the MAT intervention whereas 36% described the intervention in more detail. Psychosocial interventions described included substance use counseling, group therapy, psychiatric care, and referral. Psychosocial interventions were provided by a mix of providers including physicians, nurses, psychologists, drug and alcohol counselors, and social workers. Motivational interviewing, cognitive behavioral therapy, group psychotherapy, and brief counseling were identified as frequently used modalities of psychosocial intervention. Knowledge of medication treatment, interdisciplinary collaboration, and team coordination emerged as important on-the-job competencies.

Conclusions and Implications: Overall, the psychosocial components of MAT were not well defined in identified studies. Despite progress in expanding MAT in OBOT settings, continued work remains on identifying and supporting concurrent psychosocial interventions. Given social worker expansion in primary care settings this presentation will offer workforce and training implications for social work practice and future research.