Provider experiences delivering collaborative care for co-occurring opioid and mental health disorders: a qualitative study

Abstract

Background

Opioids are the primary contributor to overdose death in the USA and represent a major public health crisis despite the availability of highly effective evidence-based treatments. A co-occurring mental health disorder further complicates efforts to utilize effective treatments and leads to poorer outcomes. Collaborative care has shown promise in improving care for those with substance use disorders and those with mental health disorders. This study explores the experiences of providers participating in a randomized controlled trial of collaborative care for both opioid use disorder (OUD) and co-occurring depression and/or posttraumatic stress disorder (COD).

Methods

Semi-structured interviews were conducted with healthcare providers of collaborative care as part of a randomized controlled trial at two health systems. Interviewed participants included primary care providers, care coordinators, behavioral health providers, clinic administrators, and psychiatric consultants. Data was analyzed with content analysis to identify common themes and subthemes among experiences.

Findings

Participants perceived differences between patients diagnosed with only OUD and those with COD, such as heightened stigma, greater symptom severity, and more barriers to treatment. They perceived the positive impacts of the collaborative care intervention for patients with COD and the clinics and providers caring for this population, and identified considerations for future implementation efforts.

Conclusions

Although participants noted challenges in treating patients with COD compared to those with only OUD, they also perceived the benefits of using collaborative care in this complex population. Participants supported using collaborative care in the future, but noted important systems and policy suggestions needed for successful implementation.

co-occurring disorders, collaborative care, opioid use disorder, posttraumatic stress disorder, depression