Testing Collaborative Care Models for Opioid Use Disorder

Michael Freed, PhD, at the meeting of the American Psychiatric Association, presented findings from 4 large federally funded trials examining the collaborative care model for patients with co-occurring opioid use disorder and mental health conditions.¹

Freed described the collaborative care model as a structured care delivery system incorporating a care manager, a psychiatric consultant, routine primary care screening, a disease registry, and principles of treat-to-target and measurement-based care. The 4 trials, funded in 2019 as part of federal efforts to address the opioid epidemic, were conducted across a wide variety of clinics with varying levels of implementation readiness and diverse patient populations.²

Across trials, both treatment and control arms frequently showed improvement in opioid use disorder and mental health outcomes—a pattern Freed acknowledged could raise concerns about regression to the mean, but which subgroup analyses suggested reflected genuine clinical benefit from increased engagement with care. He noted that many enrolled patients were already receiving treatment for opioid use disorder, and that adding mental health treatment or vice versa improved outcomes even in trials that did not demonstrate superiority of one comparator over another. One trial also specifically demonstrated that collaborative care achieved a significant effect on opioid use disorder outcomes.

A key clinical implication Freed highlighted was that "clinical practice guidelines suggest that treating mental illness first is not necessary for OUD and the reverse." He emphasized collaborative care's particular strengths in access, continuity, and organization of care—including the capacity to triage higher-acuity patients to specialty services, thereby preserving primary care capacity for mild-to-moderate presentations. He noted that collaborative care has been demonstrated to be cost-effective, with existing financing mechanisms available to support its implementation.

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

References

1. Freed MC. Optimizing multi-component service delivery interventions for people with opioid use disorder, co-occurring conditions, and/or suicide risk (HEAL). 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/optimizing-multi-component-service-delivery-interventions-for-people-with-opioid-use-disorder-co-occurring-conditions-and-or-suicide-risk-heal

2. Dopp AR, Weir RL, Hindmarch GM, et al. Reimbursement potential of collaborative care model (CoCM) billing codes for opioid use disorder co-occurring with mental disorders: descriptive estimates from a pragmatic trial. Adm Policy Ment Health. 2026.