Treatment of Refractory Opioid Use Disorder

In their informative and timely review of medication treatment options for opioid use disorder in the United States (U.S.) and Canada, Kimmel et al. present the case of a patient hospitalized 27 times over 2 years for complications related to his opioid use disorder who may have benefitted from treatment options such as injectable opioid agonist therapy not currently available in the U.S.1 The authors depict the interactions between this patient and the healthcare system over 36 months in a linear timeline, populated with discrete time points representing his addiction interventions, intensive inpatient hospitalizations, post-acute care, and episodes of voluntary departure from care. The aggregation of his numerous hospitalizations and a circuitous record of medication for opioid use disorder illustrate, qualitatively, a complex narrative of care engagement.

We propose “journey mapping” as an alternative technique for visualizing patients’ care experiences and have found it to be a useful analytic strategy to capture common paths and patterns of care among individuals with OUD-associated endocarditis.2, 3 Initially developed for business to understand customer experiences from first contact to long-term engagement, it has been applied within the healthcare setting to elucidate patients’ experiences in an increasingly complex healthcare system.4 Insights from journey mapping the experiences, concerns, and thoughts of individuals with opioid use disorder have delineated critical areas for improvement including interpersonal provider-patient dynamics and institutional care models.5 In addition to capturing patient experiences, journey mapping can provide a practical guide for health systems to evolve and better meet the needs of their patients.

Journey mapping is a more patient-centered and dynamic alternative to a traditional timeline. It allows for quantitative interpretation of an individual’s periods of engagement and disengagement from addiction care, visualization of their movement through different sectors of the healthcare system, and longitudinal mapping of remission and relapse. Journey mapping allows the viewer to “follow” a patient as they navigate the healthcare system. Additionally, journey maps offer a framework by which to compare the unique journeys of different individuals and identify salient moments for intervention. A comparative analysis of individuals’ care engagement may reveal a pattern of inadequate treatment options supporting the approval of alternate medications, formulations, and dispensing strategies for the treatment of opioid use disorder in the United States.


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Dr. Bearnot is supported by NIDA under award K12DA043490.

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MYL, JAM, and BIB conceived of this idea. MYL wrote the first draft. JAM and BIB edited the manuscript.

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Correspondence to Mimi Yen Li BA.

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Yen Li, M., Mitton, J.A. & Bearnot, B.I. Treatment of Refractory Opioid Use Disorder. J GEN INTERN MED (2021).

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