Defining a recovery-oriented cascade of care for opioid use disorder: A community-driven, statewide cross-sectional assessment

Autoři: Jesse L. Yedinak aff001;  William C. Goedel aff001;  Kimberly Paull aff002;  Rebecca Lebeau aff002;  Maxwell S. Krieger aff001;  Cheyenne Thompson aff002;  Ashley L. Buchanan aff003;  Tom Coderre aff004;  Rebecca Boss aff005;  Josiah D. Rich aff001;  Brandon D. L. Marshall aff001
Působiště autorů: Department of Epidemiology, School of Public Health, Brown University, Providence, Rhode Island, United States of America aff001;  Executive Office of Health and Human Services, State of Rhode Island, Cranston, Rhode Island, United States of America aff002;  Department of Pharmacy Practice, College of Pharmacy, University of Rhode Island, Kingston, Rhode Island, United States of America aff003;  Office of the Governor, State of Rhode Island, Providence, Rhode Island, United States of America aff004;  Department of Behavioral Healthcare, Developmental Disabilities and Hospitals, State of Rhode Island, Cranston, Rhode Island, United States of America aff005;  Department of Medicine, Warren Alpert Medical School, Brown University, Providence, Rhode Island, United States of America aff006
Vyšlo v časopise: Defining a recovery-oriented cascade of care for opioid use disorder: A community-driven, statewide cross-sectional assessment. PLoS Med 16(11): e32767. doi:10.1371/journal.pmed.1002963
Kategorie: Research Article
doi: 10.1371/journal.pmed.1002963



In light of the accelerating and rapidly evolving overdose crisis in the United States (US), new strategies are needed to address the epidemic and to efficiently engage and retain individuals in care for opioid use disorder (OUD). Moreover, there is an increasing need for novel approaches to using health data to identify gaps in the cascade of care for persons with OUD.

Methods and findings

Between June 2018 and May 2019, we engaged a diverse stakeholder group (including directors of statewide health and social service agencies) to develop a statewide, patient-centered cascade of care for OUD for Rhode Island, a small state in New England, a region highly impacted by the opioid crisis. Through an iterative process, we modified the cascade of care defined by Williams et al. for use in Rhode Island using key national survey data and statewide health claims datasets to create a cross-sectional summary of 5 stages in the cascade. Approximately 47,000 Rhode Islanders (5.2%) were estimated to be at risk for OUD (stage 0) in 2016. At the same time, 26,000 Rhode Islanders had a medical claim related to an OUD diagnosis, accounting for 55% of the population at risk (stage 1); 27% of the stage 0 population, 12,700 people, showed evidence of initiation of medication for OUD (MOUD, stage 2), and 18%, or 8,300 people, had evidence of retention on MOUD (stage 3). Imputation from a national survey estimated that 4,200 Rhode Islanders were in recovery from OUD as of 2016, representing 9% of the total population at risk. Limitations included use of self-report data to arrive at estimates of the number of individuals at risk for OUD and using a national estimate to identify the number of individuals in recovery due to a lack of available state data sources.


Our findings indicate that cross-sectional summaries of the cascade of care for OUD can be used as a health policy tool to identify gaps in care, inform data-driven policy decisions, set benchmarks for quality, and improve health outcomes for persons with OUD. There exists a significant opportunity to increase engagement prior to the initiation of OUD treatment (i.e., identification of OUD symptoms via routine screening or acute presentation) and improve retention and remission from OUD symptoms through improved community-supported processes of recovery. To do this more precisely, states should work to systematically collect data to populate their own cascade of care as a health policy tool to enhance system-level interventions and maximize engagement in care.

Klíčová slova:

Drug therapy – Health care policy – Health services administration and management – Heroin – HIV infections – Opioids – United States – Rhode Island


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