Project summary/abstract
This competitive revision aims to better understand the co-occurring conditions of mental health disorders
(MHD), alcohol use disorders (AUD), and/or other substance use disorders (SUD) (e.g. stimulants) among
people with opioid use disorders (OUD), in order to improve the treatment and management of these highly
prevalent co-occurring conditions. The narrow focus to date on OUD and MOUD ignores the fact that many
people with OUD use multiple substances and often have MHD. Attention to the whole person and access to
comprehensive mental health and substance use treatment as well as primary care is needed. The notice of
urgent competitive revisions, HEAL Supplements to Improve the Treatment and Management of Common Co-
occurring Conditions and Suicide Risk in People Affected by the Opioid Crisis (NOT-MH-20-025), emphasizes
this need. Washington State is using two innovative approaches (Hub and Spoke (H&S) and low-barrier Opioid
Treatment Networks (OTN)) to expand access to OUD treatment medications (MOUD). By encouraging the
building of integrated care networks that can treat the holistic needs of people with OUD, these models are
well-situated to improve care for people who with co-occurring disorders. Our parent study (R01DA051067), is
examining these innovations, focused on effectiveness of the models in access to and outcomes of MOUD. We
propose here a competitive revision to expand the scope, focused on co-occurring OUD and MHD and/or other
SUD. The specific aims are to: (1) Test whether the H&S and OTN models improve use of MHD treatment for
individuals with OUD and MHD; (2) Examine the effectiveness of H&S and OTN interventions for individuals
with OUD and alcohol, stimulant or other SUD; and (3) Determine if and where people with OUD and co-
occurring disorders access treatment for OUD, other SUD and MHD. This revision does not change original
aims, research design, data collection, or overall approach of the parent grant. It expands it by: 1) examining
MHD treatment quality measures and outcomes; 2) testing how these innovative treatment models compare to
other OUD treatment for people who have OUD and other SUDs; and 3) considering the ways people with
OUD access co-occurring disorder care. We will use 2015–2019 data already compiled by the parent project,
for care received by people with OUD recorded in Medicaid claims and state data for MHD/SUD agencies.
These data will be refreshed to include 2020-2022, which will also allow assessment of the COVID-19 impact.
We thus will benefit from conceptual, methodological, and data efficiencies with the parent study. The findings
from this study will provide needed information to improve mental health, alcohol, and other SUD treatment for
individuals with OUD, whether or not they are in OUD treatment. Further, in-depth analysis of how care is
delivered in the H&S/OTN networks will allow us to assess whether these models are truly providing integrated
care that includes co-occurring disorders and how effective it is for this vulnerable population. These findings
may provide information to help move the system from siloed efforts to truly integrated care.
