Can you provide an example of a randomized controlled trial comparing an integrated interagency care model with standard care for adults (18‑55 years) meeting DSM‑5 criteria for opioid or amphetamine use disorder?

Randomized Controlled Trial Example: The SUMMIT Trial

The SUMMIT (Substance Use Motivation and Medication Integrated Treatment) trial is a high-quality randomized controlled trial that directly addresses your question 1. This 2017 study, published in JAMA Internal Medicine, evaluated a collaborative care model for adults with opioid and/or alcohol use disorders in primary care settings.

Study Design and Population

The SUMMIT trial randomized 377 primary care patients with opioid and/or alcohol use disorders (meeting DSM criteria) across 2 clinics in a federally qualified health center 1. Participants were recruited from June 2014 to January 2016 and followed for 6 months:

• 187 participants randomized to collaborative care (CC)
• 190 participants randomized to usual care (UC)
• Mean age: 42 years
• 20.4% female
• Setting: Underserved primary care population

The Integrated Interagency Care Model (Intervention Arm)

The collaborative care intervention was a system-level intervention designed to increase delivery of evidence-based treatments 1:

Core Components:

• Medication-assisted treatment (MAT):

  • Sublingual buprenorphine/naloxone for opioid use disorders
  • Long-acting injectable naltrexone for alcohol use disorders

• Brief psychotherapy: 6-session structured treatment

• Care coordination: System designed to facilitate access and engagement across services

• Patient-centered approach: Participants told clinic provided treatment, given appointment scheduling number and community referral list

Standard Care (Control Arm)

Usual care participants received:

• Information that the clinic provided opioid and alcohol use disorder treatment
• Phone number for appointment scheduling
• List of community referrals
• No active care coordination or system-level support

Primary Outcomes: Morbidity and Quality of Life Impact

Treatment Access (Critical for Reducing Morbidity/Mortality):

At 6 months, collaborative care dramatically outperformed usual care 1:

• 39.0% vs 16.8% received any evidence-based treatment (adjusted OR 3.97; 95% CI 2.32-6.79; P < .001)
• This represents a 2.3-fold increase in treatment access

Abstinence (Direct Mortality/Morbidity Outcome):

Collaborative care showed significant superiority 1:

• 32.8% vs 22.3% achieved abstinence from opioids or alcohol at 6 months (adjusted β = 0.12; 95% CI 0.01-0.23; P = .03)
• 26.3% vs 15.6% achieved complete abstinence from all substances including opioids, cocaine, methamphetamines, marijuana, and alcohol (β = 0.13; 95% CI 0.03-0.23; P = .01)

Secondary Outcomes: Treatment Engagement

The collaborative care model excelled at HEDIS quality measures (Healthcare Effectiveness Data and Information Set) 1:

• Initiation: 31.6% vs 13.7% (adjusted OR 3.54; 95% CI 2.02-6.20; P < .001)
• Engagement: 15.5% vs 4.2% (adjusted OR 5.89; 95% CI 2.43-14.32; P < .001)

These metrics are critical because treatment initiation and engagement directly correlate with reduced overdose mortality and improved long-term outcomes.

Clinical Significance

This trial demonstrates that integrated collaborative care models produce clinically meaningful improvements in both treatment access and abstinence outcomes 1. The effect sizes are substantial:

• Nearly 4-fold increase in odds of receiving treatment
• 10-point absolute increase in abstinence rates
• Nearly 6-fold increase in treatment engagement

Alignment with Guidelines

This trial operationalizes CDC guideline recommendations that clinicians should "offer or arrange evidence-based treatment (usually medication-assisted treatment with buprenorphine or methadone in combination with behavioral therapies)" for patients with opioid use disorder 2, 3. The SUMMIT model integrates both pharmacotherapy and psychosocial interventions within a coordinated primary care framework, addressing the documented gap between guideline recommendations and real-world implementation.

Global Context

While this U.S.-based trial addresses opioid and alcohol use disorders, the question specifically requested amphetamine use disorder examples. No comparable high-quality RCT exists for integrated interagency care specifically for amphetamine use disorder in the 18-55 age range. The available evidence for amphetamine addiction focuses on psychosocial interventions (particularly contingency management combined with community reinforcement approach) rather than integrated care models 4.