Opioid use disorder Cascade of care framework design: A roadmap

Arthur Robin Williams, Kimberly A. Johnson, Cindy Parks Thomas, Sharon Reif, Eugenia M. Socías, Brandy F. Henry, Charles Neighbors, Adam J. Gordon, Constance Horgan, Bohdan Nosyk, Karen Drexler, Noa Krawczyk, Gregg S. Gonsalves, Scott E. Hadland, Bradley D. Stein, Marc Fishman, A. Taylor Kelley, Harold A. Pincus, Mark Olfson

Research output: Contribution to journalArticlepeer-review

2 Scopus citations


Unintentional overdose deaths, most involving opioids, have eclipsed all other causes of US deaths for individuals less than 50 years of age. An estimated 2.4 to 5 million individuals have opioid use disorder (OUD) yet a minority receive treatment in a given year. Medications for OUD (MOUD) are the gold standard treatment for OUD however early dropout remains a major challenge for improving clinical outcomes. A Cascade of Care (CoC) framework, first popularized as a public health accountability strategy to stem the spread of HIV, has been adapted specifically for OUD. The CoC framework has been promoted by the NIH and several states and jurisdictions for organizing quality improvement efforts through clinical, policy, and administrative levers to improve OUD treatment initiation and retention. This roadmap details CoC design domains based on available data and potential linkages as individual state agencies and health systems typically rely on limited datasets subject to diverse legal and regulatory requirements constraining options for evaluations. Both graphical decision trees and catalogued studies are provided to help guide efforts by state agencies and health systems to improve data collection and monitoring efforts under the OUD CoC framework.

Original languageEnglish (US)
Pages (from-to)1207-1214
Number of pages8
JournalSubstance Abuse
Issue number1
StatePublished - 2022

All Science Journal Classification (ASJC) codes

  • Medicine (miscellaneous)
  • Psychiatry and Mental health


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