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Abstract
Amid worsening opioid overdose death rates, the nation continues to face a persistent
addiction treatment gap limiting access to quality care for opioid use disorder (OUD).
Three FDA-approved medications (methadone, buprenorphine, and extended-release naltrexone)
have high quality evidence demonstrating reductions in drug use and overdose events,
but most individuals with OUD do not receive them. The development of a unified public
health framework such as a Cascade of Care could improve system level practice and
treatment outcomes. In response to feedback from many stakeholders over the past year,
we have expanded upon the OUD Treatment Cascade, first published in 2017, with additional
attention to prevention stages and both individual-level and population-based services
to better inform efforts at the state and federal level. The proposed cascade framework
has attracted considerable interest from federal agencies including the CDC and NIDA
along with policy makers nationwide. We have reviewed recent literature and evidence
based interventions related to prevention, identification, and treatment of individuals
with OUD and modeled updated figures from the 2016 National Survey on Drug Use and
Health. Many currently employed interventions (prescriber guidelines, prescription
monitoring programs, naloxone rescue) address prevention of OUD or downstream complications
but not treatment of the underlying disorder itself. An OUD Cascade of Care framework
could help structure local and national efforts to combat the opioid epidemic by identifying
key targets, interventions, and quality indicators across populations and settings
to achieve these ends. Improved data collection and reporting methodology will be
imperative.