‘Whole Person Health’: Inside Weill Cornell Medicine’s Research in Integrated Opioid Use Disorder Care
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More than 806,000 Americans have died from opioid overdose since the opioid epidemic began in the 1990s. Effective opioid use disorder treatments exist, and ensuring that patients can access care remains essential to tackling the crisis
Here’s how researchers at Weill Cornell Medicine are taking an interdisciplinary approach to understanding the barriers between impacted Americans and access to opioid use disorder care
Substance use disorder treatments have not historically existed as integrated parts of mainstream medical care.
For patients with mental or physical health conditions in addition to OUD, this separation may result in structural barriers to receiving care senior research associate in population health sciences at Weill Cornell and research director of the Cornell Health Policy Center
“Thinking about all these different aspects that we as humans deal with…if you have to get your substance use disorder treatment here, your mental health disorder treatment here [and] your general medical care somewhere else, that creates barriers to care,” Tormohlen said
In the case of OUD, medications like buprenorphine, methadone and naltrexone reduce opioid cravings and have existed for decades. However, methadone, for example, must be dispensed through an opioid treatment program outside of a typical clinical setting, according to the Substance Abuse and Mental Health Services Administration
Understanding Current OUD Care Integration
Tormohlen researches how policies influence healthcare access and how they might be used to improve access to care. One area of her research centers on health systems — defined as healthcare organizations that include hospitals and physicians — with integrated substance use disorder care. The goal of this research is to better understand how these health systems improve care quality and patient outcomes
“There’s really this idea around coordinated management of whole person health in which OUD is co-managed alongside other comorbidities such as mental illness and chronic pain,” Tormohlen said
Tormohlen leads a project studying these integrated health systems alongside Beth McGinty, chief of the Division of Health Policy and Economics at Weill Cornell and a founding director of CHPC.
The ongoing project — conducted through the National Institutes of Health’s HEAL Data2Action Program, which supports research aimed at mitigating the opioid crisis — maps health systems to provide a visual representation of how substance use disorder treatments, including OUD treatments, operate within the system’s context.
“It’s been different across each of these systems, and not necessarily in negative or positive ways,” Tormohlen said. “The way their health systems are structured then impacts the way that they integrate care.”
The maps consider factors such as the departments in which this care might be delivered and whether the treatment is inpatient or outpatient. Understanding substance use disorder care integration within health systems can then be used to inform researchers and health policy leaders on how barriers to care might be addressed
This project also maps links between types of services — such as referral systems or team-based care involving primary care providers, addiction specialists and pain specialists — to show how and where OUD care, as well as substance use disorder care more broadly, is integrated.
“It’s always a goal [to understand] how existing policies, or a lack of policies, impact the way that people access care,” Tormohlen said, “and then being able to understand ways that we can change or implement policies to improve access to care.”
Analyzing the Costs of OUD Care Integration
Through its partnership in the Center for Health Economics of Treatment Interventions for Substance Use Disorders, HCV and HIV, Weill Cornell also approaches OUD care integration through an economic lens, studying its associated costs, benefits and outcomes.
“We have a limited amount of money, so how do we most efficiently allocate that money to have the biggest impact?” asked Prof. Bruce Schackman, population health sciences, the director of CHERISH
A recent study led by Danielle Ryan, senior research coordinator in population health sciences, in collaboration with CHERISH affiliates analyzed the costs of implementing emergency department-initiated buprenorphine, which is one way that OUD care can be integrated into mainstream healthcare. Unlike methadone, buprenorphine is an OUD treatment that does not require participation in an opioid treatment program.
ED-initiated buprenorphine refers to buprenorphine treatment that is begun in the ED of a medical facility and followed by referral to ongoing care, according to the NIH. While a 2015 study found that starting buprenorphine care in the ED was associated with an increase in OUD patients continuing to receive care, implementing this care comes with logistical and systemic barriers, including the preparedness of ED physicians for treating OUD
To better understand how these barriers might be addressed, Ryan’s paper broke down the cost of an implementation strategy in which experts guide EDs in the integration of these new practices. Researchers created a budget impact tool for stakeholders to understand potential costs of integrating buprenorphine care into the ED. These efforts aim to demystify a promising strategy for OUD care integration
With opioid overdose fatalities decreasing nearly 27% between 2023 and 2024, Schackman discussed how the focus of research around opioid use may shift away from overdose towards other aspects of OUD
“We want to … keep the focus on what works so that we continue to see that trend go down,” Schackman said, “but [we] also understand that fatal overdoses are only one aspect of the challenges for people who use drugs.”
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