Tier-Based Treatment for Opioid Use Disorder in the Primary Care Setting

Heather Angier, Joan Fleishman, Leah Gordon, Deborah J. Cohen, Rebecca E. Cantone, Steffani R. Bailey

Research output: Contribution to journalArticlepeer-review


Background: Two primary care clinics implemented an opioid use disorder (OUD) treatment program that integrates behavioral health counseling with buprenorphine treatment and uses tiers. This project aimed to understand how patients moved through tiers in this program. Method: We purposively sampled 20 patients with at least 10 OUD-related treatment visits; we documented tier changes at all visits between September 1, 2016 and December 31, 2018 using a standard data collection instrument. These data were used to construct run-charts. Results: About 45% of sampled patients had at least one relapse noted and 60% of patients dropped in tier during the study. Reductions in tier often happened when the patient was navigating difficult psychosocial situations in their life, whereas increases in tier often accompanied positive life events. We also found variation in use of the tiers. Discussion: OUD treatment from two clinics by tier illustrates that recovery is an individualized process based on patient need that can fluctuate due to psychosocial triggers and significant life events. Having tiers can guide treatment and provide both clinicians and patients with information about what to expect during treatment while still allowing the flexibility to meet patients where they are

Original languageEnglish (US)
Pages (from-to)345-350
Number of pages6
JournalFamilies, Systems and Health
Issue number2
StatePublished - 2021


  • Buprenorphine
  • Office-based opioid treatment
  • Opioid use disorder
  • Primary care

ASJC Scopus subject areas

  • Applied Psychology
  • Psychiatry and Mental health


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