Developing a clinical decision support for opioid use disorders: a NIDA center for the clinical trials network working group report

• Published in: Addiction science & clinical practice 2020-01, Vol.15 (1), p.4-12, Article 4
• Main Authors: Bart, Gavin B, Saxon, Andrew, Fiellin, David A, McNeely, Jennifer, Muench, John P, Shanahan, Christopher W, Huntley, Kristen, Gore-Langton, Robert E
• Format: Article
• Language: English
• Subjects: Access; Addiction; Addictions; Addictive behaviors; Alcohol; Alcohol related disorders; Alcoholism; Algorithms; Clinical assessment; Clinical decision making; Clinical decision support (CDS); Clinical research; Clinical trials; Decision making; Decision support systems; Decision Support Systems, Clinical - organization & administration; Drinking (Alcoholic beverages); Drug; Drug abuse; Drug overdose; Drug use; Electronic health records; Electronic Health Records - organization & administration; Electronic records; Epidemic; Epidemics; Evidence-based medicine; Government agencies; Health care delivery; Health care industry; Health care reform; Health Services Accessibility - organization & administration; Heroin; Humans; Information technology; Innovations; Local government; Mass Screening; Medical personnel; Medical records; Medical screening; Medications for opioid use disorder (MOUD); Meeting Report; Mental health; Narcotics; National Institute on Drug Abuse (U.S.) - organization & administration; Opiate Substitution Treatment - methods; Opioid abuse; Opioid use disorder (OUD); Opioid-Related Disorders - diagnosis; Opioid-Related Disorders - therapy; Opioids; Overdose; Overdoses; Prescription drugs; Preventive medicine; Primary care; Primary Health Care - organization & administration; Private sector; Quality; Quality control; Quality management; Specialists; Substance abuse treatment; Substance use disorder; Technological change; Technology; Tobacco; Treatment methods; United States; Working groups
• ISSN: 1940-0640; 1940-0632; 1940-0640
• DOI: 10.1186/s13722-020-0180-2

There is an urgent need for strategies to address the US epidemic of prescription opioid, heroin and fentanyl-related overdoses, misuse, addiction, and diversion. Evidence-based treatment such as medications for opioid use disorder (MOUD) are available but lack numbers of providers offering these services to meet the demands. Availability of electronic health record (EHR) systems has greatly increased and led to innovative quality improvement initiatives but this has not yet been optimized to address the opioid epidemic or to treat opioid use disorder (OUD). This report from a clinical decision support (CDS) working group convened by the NIDA Center for the Clinical Trials Network aims to converge electronic technology in the EHR with the urgent need to improve screening, identification, and treatment of OUD in primary care settings through the development of a CDS algorithm that could be implemented as a tool in the EHR. This aim is consistent with federal, state and local government and private sector efforts to improve access and quality of MOUD treatment for OUD, existing clinical quality and HEDIS measures for OUD or drug and alcohol use disorders, and with a recent draft grade B recommendation from the US Preventative Services Task Force (USPSTF) for screening for illicit drug use in adults when appropriate diagnosis, treatment and care services can be offered or referred. Through a face-to-face expert panel meeting and multiple follow-up conference calls, the working group drafted CDS algorithms for clinical care felt to be essential for screening, diagnosis, and management of OUD in primary care. The CDS algorithm was reviewed by addiction specialists and primary care providers and revised based on their input. A clinical decision support tool for OUD screening, assessment, and treatment within primary care systems may help improve healthcare delivery to help address the current epidemic of opioid misuse and overdose that has outpaced the capacity of specialized treatment settings. A semi-structured outline of clinical decision support for OUD was developed to facilitate implementation within the EHR. Further work for adaptation at specific sites and for testing is needed.