Substance Use Treatment and Recovery Team

NCT ID: NCT05086796

Last Updated: 2025-01-23

Study Results

Results available

Outcome measurements, participant flow, baseline characteristics, and adverse events have been published for this study.

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Basic Information

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Recruitment Status

COMPLETED

Clinical Phase

NA

Total Enrollment

325 participants

Study Classification

INTERVENTIONAL

Study Start Date

2021-11-11

Study Completion Date

2023-12-19

Brief Summary

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This study is a multi-site, randomized pragmatic trial being conducted at three diverse sites. The study, called the Substance Use Treatment and Recovery Team (START), will evaluate whether a collaborative care team increases the use of two interventions-medication for opioid use disorder (MOUD), and opioid use disorder (OUD) focused discharge planning-among hospitalized patients with OUD, and improves linkage to follow-up care relative to usual care. The START consists of an addiction medicine specialist and a care manager who will use evidence-based tools to decrease barriers to MOUD and engage patients with post-discharge OUD care. A total of 414 patients will be randomized from Cedars-Sinai Medical Center in Los Angeles, the University of New Mexico Hospital in Albuquerque, and Baystate Health in Springfield, Massachusetts to receive either START or usual care, stratifying by prior MOUD exposure and site.

Detailed Description

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In the past decade, hospitalizations for OUD nearly doubled. Patients admitted to the hospital with an underlying OUD rarely receive evidence-based treatment for OUD while hospitalized. MOUD is not commonly initiated in the hospital, and patients are seldom linked to outpatient treatment after discharge. Hospitalized patients with OUD who do not initiate MOUD or receive linkage to post-discharge treatment are at high-risk of continued misuse, delays in care, future overdose and costly readmission. This study identifies the inpatient hospital stay as a key opportunity to initiate MOUD and link patients with follow-up care for OUD.

The Substance Use Treatment and Recovery Team (START) is an intervention that adapts the principles of collaborative care to the hospital setting. Prior studies have demonstrated the effectiveness of collaborative care in outpatient settings for patients with opioid and alcohol use disorders, and a series of reports have demonstrated the feasibility and potential efficacy of hospital based consultative teams for substance use disorders. START uses team based, multi-faceted interventions (ie: motivational interviewing, medication treatment, OUD-focused discharge planning), measurement-based care, and patient registries to increase delivery of evidence-based care. The goal of START is to facilitate initiation of MOUD during the inpatient stay and link patients to appropriate post-discharge care.

The START study is a multi-site, randomized trial that will evaluate the intervention improves MOUD initiation and linkage to follow-up care among hospitalized patients with OUD. A total of 414 patients will be randomized from three geographically diverse hospitals (Cedars-Sinai Medical Center in Los Angeles, the University of New Mexico Hospital in Albuquerque, and Baystate Health in Springfield, Massachusetts) to receive either START or usual care, stratifying by prior MOUD exposure and site. The study builds on a pilot randomized controlled trial conducted at Cedars-Sinai by testing the intervention at three geographically distinct locations, thus increasing generalizability.

If the aims of the research are achieved, the investigators will learn whether this model of care increases OUD treatment delivery in general medical hospitals, and decreases the downstream effects of untreated OUD. If effective, this translational model also can be used to increase uptake of evidence-based practices for other substance use and behavioral health disorders.

Conditions

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Opioid-use Disorder Opioid-Related Disorders

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

TREATMENT

Blinding Strategy

NONE

Study Groups

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Substance Use Treatment and Recovery Team (START)

The intervention is administered to participants in this arm. Participants in this arm will work with the Substance Use Treatment and Recovery Team (START), a collaborative care team for inpatients with opioid use disorder.

Group Type ACTIVE_COMPARATOR

Substance Use Treatment and Recovery Team (START)

Intervention Type BEHAVIORAL

START is a model of care based on Collaborative Care. START is team driven, population-focused, measurement based, and focused on promoting adoption of evidence-based interventions. The purpose of this model is to increase adoption of evidence-based interventions for opioid use disorder and to increase linkage to aftercare.

The components of the START intervention are as follows:

1. Triage
2. Engage, Assess, and Plan
3. Treat
4. Communicate and Coordinate
5. Follow up
6. Monitor

Usual Care

Usual care for people with opioid use disorder.

Group Type NO_INTERVENTION

No interventions assigned to this group

Interventions

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Substance Use Treatment and Recovery Team (START)

START is a model of care based on Collaborative Care. START is team driven, population-focused, measurement based, and focused on promoting adoption of evidence-based interventions. The purpose of this model is to increase adoption of evidence-based interventions for opioid use disorder and to increase linkage to aftercare.

The components of the START intervention are as follows:

1. Triage
2. Engage, Assess, and Plan
3. Treat
4. Communicate and Coordinate
5. Follow up
6. Monitor

Intervention Type BEHAVIORAL

Eligibility Criteria

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Inclusion Criteria

* Admitted to an inpatient bed at Cedars-Sinai Medical Center (CSMC),University of New Mexico Hospital (UNM), or Baystate Health (BH)
* Age 18 and older
* Have a probable OUD diagnosis, defined by scores of \> 3 on the opioid section of the Alcohol, Smoking, and Substance Involvement Screening test (ASSIST)
* Speaks English or Spanish as primary language
* Willing to participate in follow-up calls and interview by telephone and able to provide contact information for follow-up calls
* Able to provide informed consent

Exclusion Criteria

* Currently receiving FDA-approved medication treatment for an opioid use disorder
* \< 6 months life expectancy
Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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RAND

OTHER

Sponsor Role collaborator

University of New Mexico

OTHER

Sponsor Role collaborator

Baystate Health

OTHER

Sponsor Role collaborator

National Center for Advancing Translational Sciences (NCATS)

NIH

Sponsor Role collaborator

National Institute on Drug Abuse (NIDA)

NIH

Sponsor Role collaborator

Stanford University

OTHER

Sponsor Role collaborator

University of Pittsburgh

OTHER

Sponsor Role collaborator

Cedars-Sinai Medical Center

OTHER

Sponsor Role lead

Responsible Party

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Itai Danovitch

Professor and Chair Department of Psychiatry & Behavioral Neurosciences

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Itai Danovitch, MD

Role: PRINCIPAL_INVESTIGATOR

Cedars-Sinai Medical Center

Allison J Ober, PhD

Role: PRINCIPAL_INVESTIGATOR

RAND

Locations

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Cedars Sinai Medical Center

Los Angeles, California, United States

Site Status

Baystate Medical Center

Springfield, Massachusetts, United States

Site Status

University of New Mexico Hospital

Albuquerque, New Mexico, United States

Site Status

Countries

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United States

References

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Ober AJ, Murray-Krezan C, Page K, Friedmann PD, Anderson J, Osilla KC, Ryzewicz S, Huerta S, Mazer MW, Hoskinson RA, Garvey R, Peltz A, Watkins KE, Nuckols T, IsHak WW, Mariano LT, Danovitch I. Hospital Addiction Consultation Service and Opioid Use Disorder Treatment: The START Randomized Clinical Trial. JAMA Intern Med. 2025 Jun 1;185(6):624-633. doi: 10.1001/jamainternmed.2024.8586.

Reference Type DERIVED
PMID: 40193131 (View on PubMed)

Ober AJ, Murray-Krezan C, Page K, Friedmann PD, Chan Osilla K, Ryzewicz S, Huerta S, Mazer MW, Leamon I, Messineo G, Watkins KE, Nuckols T, Danovitch I. The Substance Use Treatment and Recovery Team (START) study: protocol for a multi-site randomized controlled trial evaluating an intervention to improve initiation of medication and linkage to post-discharge care for hospitalized patients with opioid use disorder. Addict Sci Clin Pract. 2022 Jul 28;17(1):39. doi: 10.1186/s13722-022-00320-7.

Reference Type DERIVED
PMID: 35902888 (View on PubMed)

Provided Documents

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Document Type: Study Protocol

View Document

Document Type: Statistical Analysis Plan

View Document

Document Type: Informed Consent Form

View Document

Other Identifiers

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5U01TR002756-02

Identifier Type: NIH

Identifier Source: secondary_id

View Link

1U01TR002756-01A1

Identifier Type: NIH

Identifier Source: secondary_id

View Link

STUDY00000515

Identifier Type: -

Identifier Source: org_study_id

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