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      Treatment and Prevention of Opioid Use Disorder: Challenges and Opportunities

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          Abstract

          Treatment for opioid use disorder in the United States evolved in response to changing federal policy and advances in science. Inpatient care began in 1935 with the US Public Health Hospitals in Lexington, Kentucky, and Fort Worth, Texas. Outpatient clinics emerged in the 1960s to provide aftercare. Research advances led to opioid agonist and opioid antagonist therapies. When patients complete opioid withdrawal, return to use is often rapid and frequently deadly. US and international authorities recommend opioid agonist therapy (i.e., methadone or buprenorphine). Opioid antagonist therapy (i.e., extended-release naltrexone) may also inhibit return to use. Prevention efforts emphasize public and prescriber education, use of prescription drug monitoring programs, and safe medication disposal options. Overdose education and naloxone distribution promote access to rescue medication and reduce opioid overdose fatalities. Opioid use disorder prevention and treatment must embrace evidence-based care and integrate with physical and mental health care.

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          The Prescription Opioid and Heroin Crisis: A Public Health Approach to an Epidemic of Addiction

          Andrew Kolodny, David T Courtwright, Catherine Hwang … (2015)
          Annual Review of Public Health, 36(1), 559-574
          Article 0 comments Cited 381 times – based on 0 reviews     Review now
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            American Society of Addiction Medicine (ASAM) National Practice Guideline for the Use of Medications in the Treatment of Addiction Involving Opioid Use

            Kyle Kampman, Margaret Jarvis (2015)
            The Centers for Disease Control have recently described opioid use and resultant deaths as an epidemic. At this point in time, treating this disease well with medication requires skill and time that are not generally available to primary care doctors in most practice models. Suboptimal treatment has likely contributed to expansion of the epidemic and concerns for unethical practices. At the same time, access to competent treatment is profoundly restricted because few physicians are willing and able to provide it. This “Practice Guideline” was developed to assist in the evaluation and treatment of opioid use disorder, and in the hope that, using this tool, more physicians will be able to provide effective treatment. Although there are existing guidelines for the treatment of opioid use disorder, none have included all of the medications used at present for its treatment. Moreover, few of the existing guidelines address the needs of special populations such as pregnant women, individuals with co-occurring psychiatric disorders, individuals with pain, adolescents, or individuals involved in the criminal justice system. This Practice Guideline was developed using the RAND Corporation (RAND)/University of California, Los Angeles (UCLA) Appropriateness Method (RAM) – a process that combines scientific evidence and clinical knowledge to determine the appropriateness of a set of clinical procedures. The RAM is a deliberate approach encompassing review of existing guidelines, literature reviews, appropriateness ratings, necessity reviews, and document development. For this project, American Society of Addiction Medicine selected an independent committee to oversee guideline development and to assist in writing. American Society of Addiction Medicine's Quality Improvement Council oversaw the selection process for the independent development committee. Recommendations included in the guideline encompass a broad range of topics, starting with the initial evaluation of the patient, the selection of medications, the use of all the approved medications for opioid use disorder, combining psychosocial treatment with medications, the treatment of special populations, and the use of naloxone for the treatment of opioid overdose. Topics needing further research were noted.
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              Reduction in overdose mortality after the opening of North America's first medically supervised safer injecting facility: a retrospective population-based study.

              Christopher J. Marshall, Thomas Kerr, Evan Wood … (2011)
              Overdose from illicit drugs is a leading cause of premature mortality in North America. Internationally, more than 65 supervised injecting facilities (SIFs), where drug users can inject pre-obtained illicit drugs, have been opened as part of various strategies to reduce the harms associated with drug use. We sought to determine whether the opening of an SIF in Vancouver, BC, Canada, was associated with a reduction in overdose mortality. We examined population-based overdose mortality rates for the period before (Jan 1, 2001, to Sept 20, 2003) and after (Sept 21, 2003, to Dec 31, 2005) the opening of the Vancouver SIF. The location of death was determined from provincial coroner records. We compared overdose fatality rates within an a priori specified 500 m radius of the SIF and for the rest of the city. Of 290 decedents, 229 (79·0%) were male, and the median age at death was 40 years (IQR 32-48 years). A third (89, 30·7%) of deaths occurred in city blocks within 500 m of the SIF. The fatal overdose rate in this area decreased by 35·0% after the opening of the SIF, from 253·8 to 165·1 deaths per 100,000 person-years (p=0·048). By contrast, during the same period, the fatal overdose rate in the rest of the city decreased by only 9·3%, from 7·6 to 6·9 deaths per 100,000 person-years (p=0·490). There was a significant interaction of rate differences across strata (p=0·049). SIFs should be considered where injection drug use is prevalent, particularly in areas with high densities of overdose. Vancouver Coastal Health, Canadian Institutes of Health Research, and the Michael Smith Foundation for Health Research. Copyright © 2011 Elsevier Ltd. All rights reserved.
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                Author and article information

                Journal
                Journal ID (nlm-journal-id): 8006431
                Journal ID (pubmed-jr-id): 1309
                Journal ID (nlm-ta): Annu Rev Public Health
                Journal ID (iso-abbrev): Annu Rev Public Health
                Title: Annual review of public health
                ISSN (Print): 0163-7525
                ISSN (Electronic): 1545-2093
                Publication date Nihms-submitted: 5 March 2018
                Publication date (Electronic): 22 December 2017
                Publication date (Print): 01 April 2018
                Publication date PMC-release: 01 April 2019
                Volume: 39
                Pages: 525-541
                Affiliations
                [1 ]Oregon Health & Science University–Portland State University School of Public Health, Portland, Oregon 97239, USA
                [2 ]Department of Psychiatry, School of Medicine, Oregon Health & Science University, Portland, Oregon 97239, USA
                [3 ]MD/PhD Program, School of Medicine, Oregon Health & Science University, Portland, Oregon 97239, USA
                [4 ]Addiction Medicine Section, Department of Medicine, School of Medicine, Oregon Health & Science University, Portland, Oregon 97239, USA
                Article
                Manuscript ID: NIHMS947740
                DOI: 10.1146/annurev-publhealth-040617-013526
                PMC ID: 5880741
                PubMed ID: 29272165
                SO-VID: 2c223559-2581-4ae2-8442-9b16c72ab385
                License:

                This work is licensed under a Creative Commons Attribution 4.0 International License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. See credit lines of images or other third-party material in this article for license information

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                Subject: Article

                Keywords: opioid use disorder,treatment for opioid use disorder,opioid agonist therapy,opioid antagonist therapy,opioid overdose prevention
                Data availability:
                Keywords: opioid use disorder, treatment for opioid use disorder, opioid agonist therapy, opioid antagonist therapy, opioid overdose prevention

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