Weekend Reads | Rapid Access Addiction Medicine Clinics Could Be a Better Way to Treat the Opioid Epidemic

by Kevin Schofield

It's certainly no secret that there is an epidemic of opioid-related substance abuse that is ravaging the United States, Canada, and many other countries around the world. But this weekend's read is a research paper looking at the effectiveness of one attempt to deliver medical care to those who have been caught up in this epidemic.

For many of us, when we think about substance abuse treatment, the first image that jumps into our minds is of an inpatient facility: People check in, are treated for several days or weeks, and eventually check out "clean" — or that's the hope. But medical and public health experts are quickly coming to the consensus that inpatient substance abuse treatment will not be the primary solution to opioid addiction. There are three main reasons why. First, it is very expensive. Second, the resources required for inpatient treatment — buildings, space, beds, staff, etc. — can't be scaled up to match the enormity of the problem today. Third, the new generation of opioids available on the street — including, most notably, fentanyl — are so potent they cause physiological changes that often can't be successfully treated with short-term inpatient programs. In fact, using street fentanyl for a period of time could leave one with a physical craving that might take years, or even decades, to subside, even with treatment. A cold-turkey "detox" approach alone often doesn't work.

That points to an unpleasant reality: If there is to be a successful treatment response to the opioid abuse public health crisis, then it will need to be large-scale, outpatient-based, and long-term. Locally, Dr. Caleb Banta-Green of the University of Washington has been arguing for Seattle to adopt such a model, dubbed "health engagement hubs": centers set up in communities where patients could be treated for substance abuse on an ongoing outpatient basis with buprenorphine, methadone, suboxone, or one of the newer treatment options being developed. Patients could also receive treatment for the other health and medical concerns that go hand in hand with opioid addiction, as well as mental health counseling and other services that support life after recovery.

Canada is ahead of the United States on this: It already has such a program, called "Rapid Access Addiction Medicine" (RAAM). Since 2015, Ontario's public health system has set up over 70 RAAM clinics and continues to expand the program. In part, the goal of the RAAM clinics is to redirect support and treatment of those suffering from substance abuse away from hospital emergency departments to locations that are low-barrier, accessible, and multidisciplinary, and that can provide ongoing outpatient treatment services to those who need them (or, in some cases, refer patients to an inpatient facility when their health issues require it).

The research paper compares the outcomes for people who seek treatment at a RAAM with those who go to a hospital emergency department instead, after 30 days and 90 days. The researchers found that in both cases, those who went to a RAAM had lower odds of a subsequent visit to an emergency department, and substantially lower odds of hospitalization or death.

That makes the RAAM program a win-win: It provides a better health outcome for the patients, while better utilizing health care facilities (using clinics focused on substance abuse, instead of hospital emergency departments). In fact, the researchers' data suggests the RAAM clinic program may reduce the use of health care resources altogether by keeping patients healthier through regular engagement.

That said, the researchers also point out there is more research to be done on the RAAM program, including understanding if, and to what extent, it improves the quality of life of the patients who utilize it, as well as whether there are disparities in outcomes or additional access barriers for any underrepresented communities when attempting to engage with the RAAM clinics. Also, they need to understand whether a RAAM clinic in an urban setting, such as Ottawa or Toronto, has the same outcomes as one serving a rural population.

Nevertheless, it's a sign of hope that governments are trying new approaches to address the opioid public health crisis, and that some of those approaches seem to be having some level of success — or at least are an improvement on the state of affairs today. The RAAM program suggests we should be able to create programs that are accessible, outpatient-based, long-term, and scaled up to the size of the problem.

Rapid Access Addiction Medicine Clinics for People with Problematic Opioid Use

Featured image via Net Vector/Shutterstock.com.