Research Trials for Opioid Use Disorder Collaborative Care

Michael Freed, PhD, presented a session at the American Psychiatric Association meeting addressing collaborative care for co-occurring psychiatric disorders and opioid use disorder, with emphasis on access to care, treatment sequencing, implementation science, and financing.¹

Freed drew a parallel between the evolution of posttraumatic stress disorder (PTSD) psychotherapy trials, which progressively elevated the standard of care comparator from waitlist control to present-centered therapy—and what his group observed in collaborative care trials: a rising baseline level of usual care that made detecting superiority more difficult, while still demonstrating meaningful clinical benefit. He reiterated that treatment sequencing is not essential, stating that initiating care for PTSD and opioid use disorder simultaneously is both feasible and clinically preferable, particularly given that patients with co-occurring conditions face competing demands that make retention in care challenging. He noted that in 2019 only approximately 20% of patients with opioid use disorder received any specific treatment in the prior year, a figure that has increased only marginally since.²

Freed described another study testing components of MISSION—an evidence-based intervention with 26 supporting trials but prohibitive cost in its full form—developed in collaboration with third-party payers from the outset to identify willingness-to-pay thresholds, with the goal of producing findings that would translate directly into reimbursable clinical practice.

On the structural advantages of collaborative care, Freed highlighted the disease registry as a mechanism for maintaining "eyes on patients" beyond those actively presenting for care, enabling care managers to engage patients who are not actively seeking help and to support them through high-risk transitions, including buprenorphine induction and treatment transitions more broadly, periods associated with elevated suicide and mortality risk. He emphasized that even minimal engagement within a collaborative care framework is associated with improved outcomes.

Dr Freed is chief of the services research and clinical epidemiology branch at the National Institute of Mental Health.

References

1. Freed MC. HEAL supplements to improve the treatment and management of common co-occurring conditions and suicide risk in people affected by the opioid crisis. National Institute of Mental Health. February 4, 2020. Accessed May 26, 2026. https://www.nimh.nih.gov/funding/grant-writing-and-application-process/concept-clearances/2020/heal-supplements-to-improve-the-treatment-and-management-of-common-co-occurring-conditions-and-suicide-risk-in-people-affected-by-the-opioid-crisis

2. Only 1 in 5 US adults with opioid use disorder received medications to treat it in 2021. National Institute on Drug Abuse. August 7, 2023. Accessed May 26, 2026. https://nida.nih.gov/news-events/news-releases/2023/08/only-1-in-5-us-adults-with-opioid-use-disorder-received-medications-to-treat-it-in-2021