Rapid access addiction medicine (RAAM) clinics are associated with improved clinical outcomes for people with problematic opioid use, leading to fewer emergency department visits, hospitalizations, and deaths, according to a new study.
In a retrospective cohort study of almost 900 patients in Ontario, Canada, RAAM clinics were associated with a 32% reduction in risk for emergency department visits, hospitalization, or death.
The model of care, which is designed to provide quick, flexible, and low-barrier access to those who need help with substance abuse, also appears to reduce the burden on emergency rooms, which can lead to lower wait times and improve health system flow.
"Our data indicate that this model of care makes a real difference for clients and families. The mental health and substance use healthcare system is often fragmented and can be difficult to navigate," lead author Kim Corace, vice president of innovation and transformation at the Royal Ottawa Mental Health Centre and a clinician scientist at the Institute of Mental Health Research at the University of Ottawa, Ottawa, Ontario, Canada, told Medscape Medical News.
"Wait times for comprehensive, evidence-based treatment can be long, and many people with opioid use disorder cycle repeatedly through emergency departments. Lack of access to care and wait times are harmful to people with problematic opioid use and their families and have devastating impacts on our communities," she said. "RAAM fills a gap in care by providing treatment that is effective and easy to access — no referral or appointment is needed."
The study was published online November 22 in JAMA Network Open.
Providing Rapid Access
RAAM clinics were established in Ontario in 2015 to provide quick access to care from multidisciplinary teams of addiction medicine physicians, nurse practitioners, nurses, and social workers. The RAAM model emphasizes continuity of care through assessment, pharmacotherapy, counseling, harm reduction, triage to an appropriate level of care, and navigation to community services and primary care.
The investigators conducted a retrospective cohort study with a matched control group to understand the associations between RAAM clinics and outcomes such as emergency department visits, hospitalizations, and mortality. The research team analyzed health administrative data from Ontario alongside anonymized data from four Ontario RAAM clinics (in Ottawa, Toronto, Oshawa, and Sudbury). They compared data from 440 patients who received care at participating RAAM clinics with data from 436 geographically matched controls who didn’t receive care at a RAAM clinic.
For the primary composite measure of 30-day all-cause emergency department visits, hospitalizations, or mortality, the pooled odds ratio (OR) favored the RAAM model (OR, 0.68). When looking at opioid-related cases only, the same outcome also favored the RAAM model (OR, 0.47).
At 90 days, comparison of the odds of the composite outcome favored the RAAM model, but the difference was not statistically significant (OR, 0.78). Among opioid-related cases, the composite favored the RAAM model and showed a significant difference (OR, 0.52).
In addition, the analyses for individual outcomes — of emergency department visits, hospitalizations, and mortality at 30-day and 90-day follow-ups — also favored the RAAM model. In most cases, the comparisons were statistically significant, the authors found.
"The data generated from our studies of RAAM clinics also help us to better understand the needs of people with problematic opioid use and identify where further system improvements can be made," said Corace. "Estimating real-world effectiveness provides insight into the impacts of expanding access to RAAM clinics and their contributions to a comprehensive strategy to address rising rates of opioid-related harms and potentially other substance use harms."
In future research, Corace plans to investigate ways to expand the reach of RAAM clinics across Canada and other countries. The research team has increased access to RAAM by creating a digital version called RAAM Digital Front Door, which seeks to replicate an in-person visit through a virtual connection.
Provincial initiatives can also help patients with substance use disorders to find these resources. For instance, META:PHI, which supports providers by offering care models, clinical decision tools, and resources for patients, has a directory of RAAM clinics across Ontario.
Radical Shift Needed
Commenting on the findings for Medscape, Kate Hardy, administrative director of the META:PHI program, said, "This research offers the most conclusive evidence to date supporting the RAAM model’s effectiveness, demonstrating that low-barrier treatment for substance use reduces mortality and utilization of acute healthcare services."
Hardy, who wasn’t involved with this study, has conducted a randomized controlled trial of RAAM for patients with substance use disorders. She and her colleagues found that rapid access to treatment led to greater engagement with addiction medicine services and fewer emergency department visits at 6 months.
"These findings suggest the need for a radical shift in public health policy toward greater support for convenient, accessible, and flexible treatment options," she said. "Furthermore, these findings offer insight into how continued spread of the RAAM model could dramatically improve health outcomes for individuals with problematic substance use."
The study was funded by a catalyst grant from the Canadian Institutes of Health Research. Corace and Hardy report no relevant financial relationships.
Carolyn Crist is a health and medical journalist who reports on the latest studies for Medscape, MDedge, and WebMD.
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