Essential Information About the Treatment of Opioid Use Disorders
There are different types of medications used to treat opioid use disorders. The medications work differently – some medications suppress opioid cravings and withdrawal symptoms and others block the effects of opioids. For these medications to be most beneficial, they need to be coupled with counseling, relapse prevention, medical care, trauma-specific recovery services, vocational and education services, and other related assessment and treatment services. The following resources provide additional information on medications used for the treatment of opioid use disorders.
Can the Science of Addiction Help Reduce Stigma? Nora Volkow, M.D., Director, National Institute on Drug Abuse describes advances made in the treatment of opioid and other substance use disorders based on an increased understanding of addiction as a brain disease. Dr. Volkow discusses medication-assisted treatment as critical to addressing the opioid epidemic. http://www.naadac.org/assets/1959/aar_fall2015_web.pdf (PDF 5.8 MB)
The American Society of Addiction Medicine (ASAM) National Practice Guidelines for the Use of Medications in the Treatment of Addiction Involving Opioid Use: Provides information on evidence-based treatment for opioid use disorders. Includes guidelines on assessment and diagnosis; treatment – includes an overview of the medications used to treat opioid dependence. http://www.asam.org/quality-practice/guidelines-and-consensus-documents/npg
Treatment Improvement Protocol (TIP) 43: Medication-Assisted Treatment for Opioid Addiction in Opioid Treatment Programs. Gives a detailed description of medication-assisted treatment for addiction to opioids, including comprehensive maintenance treatment, detoxification, and medically supervised withdrawal. Discusses screening, assessment, and administrative and ethical issues. https://store.samhsa.gov/shin/content/SMA12-4214/SMA12-4214.pdf
Substance Abuse and Mental Health Services Administration (SAMHSA): Clinical Use of Extended-Release Injectable Naltrexone in the Treatment of Opioid Use Disorder, A Brief Guide. Offers guidance on the use of medication-assisted treatment (MAT) with extended-release injectable naltrexone for the treatment of an opioid use disorder. Covers patient assessment, initiating MAT, monitoring progress, and deciding when to end treatment. http://store.samhsa.gov/shin/content/SMA14-4892R/SMA14-4892R.pdf
Treatment Improvement Protocol (TIP) 40: Clinical Guidelines for the Use of Buprenorphine in the Treatment of Opioid Addiction. Practice guidelines help physicians make decisions about using buprenorphine to treat opioid addiction. Includes information on patient assessment; protocols for opioid withdrawal; and the treatment of pregnant women, teens, and polysubstance users. https://store.samhsa.gov/shin/content/SMA05-4003/SMA05-4003.pdf
Providers' Clinical Support System (PCSS): A national training and mentoring project developed in response to the prescription opioid misuse epidemic and the availability of newer pharmacotherapies to address opioid use disorders. The goal of PCSS-MAT is to make available the most effective medication-assisted treatments to serve patients in a variety of settings, including primary care, psychiatric care, and pain management settings. A variety of resources are available at http://www.pcssmat.org.
Medication-Assisted Treatment for Opioid Addiction: Facts for Families and Friends. Gives families and friends information about medication-assisted treatment for opioid addiction. Describes prescribed opioid medications, their proper use and side effects, withdrawal symptoms, and how medications fit with counseling in the recovery process. https://store.samhsa.gov/shin/content/SMA09-4443/SMA09-4443.pdf (PDF 1.4 MB)
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Recent Research Studies
- Nelson, L.S., Juurlink, D.N., & Perrone, J. (2015). Addressing the Opioid Epidemic. Journal of the American Medication Association, 314 (14), 1453-1454. doi: 10.1001/jama.2015.12397.
Findings from this study include: emergency department visits for nonmedical use of prescription opioids more than doubled from 2004 to 2011; deaths have more than tripled since 1999, with an estimated 16 235 deaths attributable to prescription opioids in 2013. https://jamanetwork.com/journals/jama/article-abstract/2456149
- Han, B., Compton, W.M., Jones, C.M., & Cai, R. (2015). Nonmedical Prescription Opioid Use and Use Disorders Among Adults Aged 18 Through 64 Years in the United States, 2003-2013. Journal of the American Medication Association, 314(14), 1468-1478. doi: 10.1001/jama.2015.11859.
The study found significant increases in the prevalence of prescription opioid use disorders, high-frequency use, and related mortality among adults aged 18 through 64 years. The increases occurred in the context of increasing heroin use and heroin-related overdose deaths. These findings support a need to address nonmedical use of prescription opioid and heroin abuse in a coordinated and comprehensive manner. https://jamanetwork.com/journals/jama/fullarticle/2456166
- Compton, W. M., Jones, C. M., Pharm, D., & Baldwin, G. T. (2016). Relationship between nonmedical prescription-opioid use and heroin use. The New England Journal of Medicine, 374(1), 154-163. DOI: 10.1056/NEJMra1508490
The study found that approximately three-quarters of persons who use heroin report prior nonmedical use of prescription opioids, as well as current abuse or dependence on additional substances such as stimulants, alcohol and marijuana. Conversely a small percentage, approximately four percent, of persons with nonmedical use of prescription drugs initiate heroin use. However given the 10.3 million persons who reported nonmedical use of prescription drugs in 2014, this small percentage of conversion to heroin generates several hundred thousand new heroin users. http://www.nejm.org/doi/full/10.1056/NEJMra1508490?query=TOC&