The number of patients with opioid addiction who receive opioid agonist therapy (OAT) with methadone and buprenorphine is increasing, so that physicians will more frequently encounter such patients... More patients with opioid addiction are receiving opioid agonist therapy (OAT) with methadone and buprenorphine. As a result, physicians will more frequently encounter patients receiving OAT who de...

Drug overdose deaths in the United States—the majority of which are caused by prescription opioids and heroin—have reached an unprecedented level, having tripled from 2000 to 2014 and surpassed annual mortality from motor vehicle crashes.^1-5 Hospitalizations and emergency department visits for overdose,^6,7 drug treatment admissions,⁸ and new hepatitis C infections⁹ related to opioids have risen dramatically over a similar timeframe. Risk for opioid use disorder (OUD) frequently begins in adolescence and young adulthood, with 7.8% of high school seniors reporting lifetime nonmedical prescription opioid use.¹⁰ Two-thirds of individuals in treatment for OUD report that their first use was before age 25 years, and one-third report that it was before 18 years.⁸ Intervening early in the development of OUD is critical for preventing premature death and lifelong harm.¹¹ However, only 1 in 12 adolescents and young adults (collectively termed youth)¹² who need care for any type of addiction receive treatment.¹³ Compounding this situation, black and Hispanic youth are even less likely than white youth to receive addiction treatment.^14,15

Screening and brief intervention (SBI) for unhealthy alcohol use is among the most efficacious and cost-effective of preventive services¹; systematic reviews support their recommendation by the US Preventive Services Task Force (USPSTF). Based in part on extrapolation from these data, the United States has invested heavily over the past decade to disseminate and implement SBI for alcohol and other drugs.^2,3 Federal health agencies encourage SBI for illicit drug use and prescription drug misuse.^4,5

Opioid addiction is a chronic, relapsing brain disease that affects millions of Americans and produces tremendous burden on the health care system.^1,2 Recent epidemiologic studies³ have revealed alarming increases in opioid addiction and overdoses, particularly with regard to prescription opioids. Less than 25% of individuals addicted to opioids receive addiction treatment.³ For more than 45 years, research has confirmed that opioid agonist therapy (ie, methadone hydrochloride) is a highly effective treatment for opioid addiction provided outside primary care.^4-6 In 2002, US physicians gained the opportunity to treat opioid-addicted patients with buprenorphine hydrochloride in primary care settings, commonly referred to as office-based opioid treatment (OBOT).⁷ This treatment has been shown to be effective in primary care settings^8-15; however, it remains underused in traditional care models.¹⁶ One consistently cited barrier preventing OBOT expansion is lack of adequate clinical support given the additional needs for patient monitoring.^16-18 Although collaborative care improves management of other chronic diseases (eg, hypertension¹⁹ and diabetes mellitus²⁰), experience with this model for the treatment of opioid addiction in primary care has not been described.²¹