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Randomized Controlled Trial
. 2025 Sep 1;185(9):1079-1089.
doi: 10.1001/jamainternmed.2025.2535.

Clinical Decision Support System for Primary Care of Opioid Use Disorder: A Randomized Clinical Trial

Rebecca C Rossom  1 , A Lauren Crain  1 , Eric A Wright  2 , Anthony W Olson  3 , Irina Haller  3 , Jacob Haapala  1 , Steven P Dehmer  1 , Stephanie A Hooker  1 , Leif Solberg  1 , Patrick J O'Connor  1 , Caitlin Borgert-Spaniol  1 , Jule Gorodisher  1 , Kathleen Miley  1 , Katrina Romagnoli  2 , Clayton Allen  3 , Lorraine Tusing  2 , Heidi Ekstrom  1 , Deepika Appana  1 , JoAnn M Sperl-Hillen  1 , Maria Kobylinski  2 , Kristen Huntley  4 , Jennifer McCormack  5 , Wei Chen  5 , Gavin Bart  6
Affiliations
Randomized Controlled Trial

Clinical Decision Support System for Primary Care of Opioid Use Disorder: A Randomized Clinical Trial

Rebecca C Rossom et al. JAMA Intern Med. .

Abstract

Importance: Nearly 727 000 individuals in the US died of opioid overdoses between 1999 and 2022. The current workforce of addiction medicine specialists is inadequate to address the scale of this crisis, and primary care clinicians (PCCs) do not feel sufficiently supported to treat opioid use disorder (OUD).

Objective: To evaluate whether an electronic health record-integrated clinical decision support system (CDSS) increases OUD diagnosis and treatment in primary care.

Design, setting, and participants: This pragmatic cluster randomized clinical trial was conducted from April 2021 to December 2023. Primary care clinics in 3 health systems in 4 US states were randomized to receive or not receive an electronic health record-integrated CDSS aimed at improving OUD diagnosis and treatment. Eligible patients were aged 18 to 75 years, visited a randomized clinic, and had an OUD diagnosis in the last 2 years, opioid overdose in the last 6 months, or risk score indicating high risk of OUD or opioid overdose. Data were analyzed from September 2023 to October 2024.

Interventions: The OUD CDSS provided personalized treatment recommendations to patients and PCCs in intervention clinics.

Main outcomes and measures: Primary outcomes were likelihood to receive (1) an OUD diagnosis (among high-risk patients without a baseline OUD diagnosis), (2) a naloxone prescription, or (3) a prescription of a medication for OUD (MOUD) or specialty referral, all within 30 days of first eligible (index) visit, and (4) days covered by a MOUD prescription in the 90 days after index.

Results: Among 10 891 patients meeting eligibility criteria, 5918 (54.3%) were female, and the mean (SD) age was 48.0 (13.9) years. There was no difference in OUD diagnoses within 30 days between groups. Patients in the intervention group had more naloxone orders (80 of 5538 [1.4%] vs 40 of 5353 [0.7%]; odds ratio, 1.76; 95% CI, 1.14-2.72) and orders for MOUDs or treatment referral (775 of 5538 [14.0%] vs 503 of 5353 [9.4%]; odds ratio, 1.48; 95% CI, 1.05-2.08) within 30 days. There were no differences in median (IQR) days covered by MOUD over 90 days postindex between intervention (84 [55-90] days) and usual care (83 [55-90] days; rate ratio, 1.00; 95% CI, 0.93-1.08) or in overdose or death rates during the intervention period.

Conclusions and relevance: In this cluster randomized clinical trial, the intervention improved rates of naloxone orders and OUD treatment in primary care but did not affect days covered by a MOUD over 90 days postindex or overdose or death rates. These findings demonstrate an OUD CDSS can help increase access to OUD treatment in primary care.

Trial registration: ClinicalTrials.gov Identifier: NCT04198428.

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Conflict of interest statement

Conflict of Interest Disclosures: Dr Rossom reported grants from the National Institute on Drug Abuse during the conduct of the study. Dr Crain reported grants from the National Institute on Drug Abuse during the conduct of the study. Dr Haapala reported grants from the National Institutes of Drug Abuse’s Clinical Trial Network during the conduct of the study. Dr Dehmer reported grants from the National Institutes of Health during the conduct of the study. Dr Solberg reported grants from the National Institutes of Health during the conduct of the study. Dr Gorodisher reported grants from the National Institutes of Health during the conduct of the study. Dr Miley reported grants from the National Institutes of Health during the conduct of the study. Dr Ekstrom reported grants from the National Institute on Drug Abuse during the conduct of the study. Dr McCormack reported institutional grants from the National Institute on Drug Abuse during the conduct of the study. Dr Chen reported institutional grants from the National Institute on Drug Abuse during the conduct of the study. Dr Bart reported personal fees from the Providers Clinical Support System and personal fees from Opioid Response Network outside the submitted work. No other disclosures were reported.

Comment on

References

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