ASAM is working with the Treatment Research Institute (TRI) to develop a guideline for evidenced-based clinical treatment of opioid addiction. The forthcoming “National Practice Guideline for Medications for the Treatment of Opioid Use Disorder” will help assist in the decision-making process related to prescribing pharmacotherapies and psychosocial interventions to addiction patients.
To date, TRI researchers have completed a literature review of studies that examined the efficacy of combining psychosocial interventions and medications for the treatment of opioid use disorder. The results generally support that clinical outcomes can be improved by providing psychosocial therapy in conjunction with medications. However, more information is needed to determine specifics like which medications work best in combination with which types of psychosocial interventions. Additional questions remain, such as: do outcomes vary depending on the specific phase of treatment or patient subpopulation that receives the psychosocial intervention?
This guideline initiative solidifies ASAM’s renewed focus on opioid-related quality improvement activities and will help improve addiction treatment along side several other recent ASAM clinical documents, such as ASAM's "Standards of Care: For the Addiction Specialist Physician."
The Quality Improvement Council (QIC), chaired by Dr. Margaret Jarvis, is overseeing the guideline development and a Guideline Committee was formed to address specific treatment scenarios and aid in writing. This committee was selected with the help of the QIC and is comprised of ten experts from multiple disciplines, including researchers and clinicians from gynecology, internal medicine, addiction medicine, and psychiatry.
To ensure scientific rigor, the guideline is being developed through the use of the RAND/UCLA Appropriateness Method (RAM), a process which combines scientific evidence and clinical knowledge to determine the appropriateness of a set of clinical procedures. As part of this process, each member of the Guideline Committee rated 240 hypothetical clinical statements on a nine-point scale of “appropriateness,” which is the relative weight of a medical or surgical intervention’s potential benefit and harm. These appropriateness statements are meant to address and clarify any gaps in existing guidelines and research literature. Upon completion of the individual member ratings, TRI collected the data and identified the statements for which a consensus wasn’t reached.
On September 15th, the Guideline Committee met in DC to discuss the hypothetical clinical statements. At this meeting, chaired by Dr. Kyle Kampman, MD, of the University Of Pennsylvania Medical School Department Of Psychiatry, the committee explored several treatment interventions and came to some consensus. Following the meeting, TRI used the information gathered to revise several of the statements and asked the guideline committee to rerate the revised statements.
The committee members are now in the process of reviewing the revised hypothetical statements for appropriateness and will then determine which hypotheticals rise to the level of necessity. Those rated as being necessary will be included in the Guideline.
Upon receipt of these final ratings, TRI will draft the guideline and the committee will provide input. Once the first draft is completed in January, the QIC will play a larger role in the guideline effort, conducting the external review process, arbitrating the comments received, and submitting the guideline to the ASAM Board of Directors for approval in the spring. The final version of the National Practice Guideline is expected in April 2015.
According to Dr. Jarvis, “The National Practice Guideline will be an invaluable document for the addiction medicine field. It will address knowledge gaps about the benefits of treatment medications and their role in recovery, while guiding evidence-based coverage standards by payers. This guideline will assure a more uniform delivery of quality patient care.”