{"doi":"10.3389/fpsyt.2025.1624642","title":"Research agenda evaluating measurement-based care for opioid use disorder among patients with co-occurring depressive disorders","abstract":"Buprenorphine and other medication treatments for opioid use disorder (OUD) in general medical settings are effective in preventing drug overdoses related to opioid use, although treatment retention is often challenging. Real-world data indicate high medication discontinuation rates at 6 months or greater following treatment initiation, partially indicative of a common failure to optimize medication dosing to minimize side effects, maximize therapeutic effects, and sustain treatment engagement and adherence (1,2). These barriers hinder the achievement of optimal clinical outcomes in managing conditions like OUD, which is often a chronic relapsing condition and frequently associated with mood disorders. Measurement-based care (MBC) may be defined as an evidence-based healthcare approach in which systematic outcome monitoring of disease severity and symptomatology over time yields actionable feedback to providers to guide their clinical decision-making on how to customize medication dosing promptly to improve patients' treatment outcomes.MBC clinical trials in substance use disorders are in their early stages, particularly in vulnerable individuals with co-occurring mood disorders. Pragmatic implementation research is needed to determine how stepped care management of medication treatments for OUD (MOUD) utilizing MBC can be effectively operationalized to enhance symptom control, improve overall functioning, and increase treatment retention, compared to conventional treatment approaches in community-based programs and office-based MOUD settings. MBC relies on brief, validated measures assessing clinically relevant parameters related to OUD. These parameters encompass the level of opioid use, withdrawal symptom severity, craving, the duration and severity of subjective effects when opioids are used, and their side effects. Validated brief assessments provide ratings for these parameters to guide providers' decision-making. Some examples include, but are not limited to, the 7-item PROMIS-based Opioid Use Monitor (OUM) to evaluate these clinically meaningful parameters, and core OUD signs and symptoms based upon the five DSM-5 OUD domains from the Marsden et al. (2019) measure to assess treatment outcomes. Such ratings inform providers to make necessary adjustments to medication regimens and dosing when treatment outcomes fall short (3,4).These assessments can be deployed to create actionable clinical work plans where providers adjust medication dosing guided by MBC feedback, followed by re-evaluating clinical effectiveness through regular, repeated measurement over time after making titration adjustments. MBC is often conducted through a shared decision-making process between patients and their providers, fostering an environment of patient coaching and problem-solving. This approach equips patients to self-manage their condition actively, to engage in clinical decision-making, and to adopt health-promoting behaviors that enhance overall wellness, treatment retention, and recovery in chronic disease management (3,4).In people addicted to opioids, depressive symptomatology may co-occur with prolonged opioid withdrawal and complicate recovery, mediated by extended amygdala neurocircuitry allostatic changes (5,6). When individuals with OUD become addicted and are less sensitive to the pleasurable effects of opioids over time, they tend to show intolerance to stressors and are more sensitive to aversive symptoms of opioid withdrawal, which increase the likelihood for relapses to temporarily relieve this negative emotional state (5,6). Until recently, illicit opioid use in the United States has been on the rise for much of the decade since 2015, along with increases in opioid-related overdose deaths (7). There has been a parallel increase in rates of depressive disorders in the United States over this timeframe (8). A significant contributor to rising mortality in the United States for much of the last decade includes deaths of despair","journal":"Frontiers in Psychiatry","year":2025,"id":571927,"datarank":0.0,"base_score":0.0,"endowment":0.0,"self_citation_contribution":0.0,"citation_network_contribution":0.0,"self_endowment_contribution":0.0,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":0,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.9549,"is_data_producer":false,"deposit_databanks":null,"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2025-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":299648,"name":"Udi E. Ghitza","orcid":"0000-0001-9964-8066","position":0,"is_corresponding":true}],"reference_count":15,"raw_metadata":null,"created_at":"2026-07-19T02:57:19.669553Z","pmid":"40852142","pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}