Behavioral health operators and regulators have largely advocated integrating substance use disorder (SUD) screenings and primary care to improve access to treatment.
New evidence underscores the importance of this integration and the extent to which mental health and substance use overlap.
More than 20% of people who die of drug overdoses also have mental health conditions not related to substance use, a new Centers for Disease Control and Prevention (CDC) report found. Almost a quarter of those who died of a drug overdose in 2022 had at least one opportunity for potential intervention within a month of their death.
“Each of these [intervention opportunities] reflects a possible missed opportunity to implement overdose prevention,” the CDC report’s authors wrote. “This finding emphasizes the need to strengthen care integration among persons with [non-substance-related mental health disorders] (MHD) and SUD and to ensure harm reduction and linkage to treatment and care services are provided during overdose response.”
Researchers analyzed data from the CDC’s State Unintentional Drug Overdose Reporting System to determine rates and types of mental health conditions among people who died of unintentional or undetermined drug overdoses in 2022.
The analysis revealed that, among the 63,424 people who died by overdose in 2022, the most common co-occurring mental health condition was depression, with 13% of people being diagnosed with the condition. Anxiety was the second most common at 9%, followed by bipolar disorder at 6%.
Fentanyl was found to be a significant driver of drug overdose deaths. Approximately 80% of the analyzed deaths involved opioids, most of which were illegally manufactured fentanyls.
Opioid use varied based on the existence of a co-occurring mental health condition.
People who did not have a non-substance-related mental health condition were more likely to have a known history of opioid use or misuse.
People who did have a mental health condition were more likely to have antidepressants, benzodiazepines and prescription opioids involved in their death. This finding suggests the need for clinicians to screen for SUDs when prescribing these drugs to mitigate overdose deaths, researchers wrote.
Increased screenings in primary care settings could be the key to reducing overdoses and improving patients’ mental health overall, the report’s authors wrote.
One in 10 people with a mental health condition who died by overdose were in SUD treatment when they died. Integrating mental health and SUD care could reduce potential harms and better link patients to treatment, according to the report.
“This finding emphasizes the need to strengthen care integration among persons with MHD and SUD and to ensure harm reduction and linkage to treatment and care services are provided during overdose response,” researchers wrote.
SUD treatment providers have increasingly tacked on service lines in addition to addiction care to improve efficacy of and access to care. Some specialties targeted by providers include mental health treatment, cancer care and women’s health.
Providers have also looked to integrated care models to prepare for shifts in payers’ expectations. Recovery Centers of America, for example, has developed a full continuum of care so the company can engage in at-risk contracts.
While integrated SUD care boasts clinical and operational benefits, providers must jump over significant billing-related hurdles when offering comprehensive care services that may not have a high reimbursement value.
