Overdose Prevention Through Medical Treatment of Opioid Use Disorders

Editorials7 August 2018Overdose Prevention Through Medical Treatment of Opioid Use DisordersNora D. Volkow, MD and Eric M. Wargo, PhDNora D. Volkow, MDNational Institute on Drug Abuse, Bethesda, Maryland (N.D.V., E.M.W.)Search for more papers by this author and Eric M. Wargo, PhDNational Institute on Drug Abuse, Bethesda, Maryland (N.D.V., E.M.W.)Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/M18-1397 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail In 2016, 42 249 Americans fatally overdosed on an opioid (1). Although prescribing of opioid analgesics has declined thanks to greater awareness and new guidelines, increasing numbers of individuals are initiating opioid use with heroin, and nearly half of the fatal opioid overdoses in 2016 involved fentanyl and synthetic analogues. Expanding access to medications for opioid use disorder (OUD) is essential if we are to reverse these trends.The opioid agonist methadone, the partial agonist buprenorphine, and the antagonist naltrexone in its extended-release formulation have been repeatedly shown to reduce opioid use and its health consequences, including overdose, compared with behavioral ...References1. Seth P, Scholl L, Rudd RA, Bacon S. Overdose deaths involving opioids, cocaine, and psychostimulants—United States, 2015-2016. MMWR Morb Mortal Wkly Rep. 2018;67:349-58. [PMID: 29596405] doi:10.15585/mmwr.mm6712a1 CrossrefMedlineGoogle Scholar2. Mattick RP, Breen C, Kimber J, Davoli M. Methadone maintenance therapy versus no opioid replacement therapy for opioid dependence. Cochrane Database Syst Rev. 2009:CD002209. [PMID: 19588333] doi:10.1002/14651858.CD002209.pub2 CrossrefMedlineGoogle Scholar3. Kakko J, Svanborg KD, Kreek MJ, Heilig M. 1-year retention and social function after buprenorphine-assisted relapse prevention treatment for heroin dependence in Sweden: a randomised, placebo-controlled trial. Lancet. 2003;361:662-8. [PMID: 12606177] CrossrefMedlineGoogle Scholar4. Lee JD, Nunes EV, Novo P, Bachrach K, Bailey GL, Bhatt S, et al. Comparative effectiveness of extended-release naltrexone versus buprenorphine-naloxone for opioid relapse prevention (X:BOT): a multicentre, open-label, randomised controlled trial. Lancet. 2018;391:309-18. [PMID: 29150198] doi:10.1016/S0140-6736(17)32812-X CrossrefMedlineGoogle Scholar5. Larochelle MR, Bernson D, Land T, Stopka TJ, Wang N, Xuan Z, et al. Medication for opioid use disorder after nonfatal opioid overdose and association with mortality. A cohort study. Ann Intern Med. 2018;169:137-45. doi:10.7326/M17-3107 LinkGoogle Scholar6. Substance Abuse and Mental Health Services Administration, Center for Behavioral Health Statistics and Quality. Treatment Episode Data Set (TEDS): 2005-2015. National Admissions to Substance Abuse Treatment Services. BHSIS Series:S-91. HHS publication no. SMA 17-5037. Rockville: Substance Abuse and Mental Health Services Administration; 2017. Google Scholar7. Cruciani RA, Knotkova H. Handbook of Methadone Prescribing and Buprenorphine Therapy. New York: Springer Science+Business Media; 2013. Google Scholar8. Substance Abuse and Mental Health Services Administration. 2011 Opioid Treatment Program (OTP) Survey: Data on Substance Abuse Treatment Facilities With OTPs. BHSIS Series: S-65. HHS publication no. SMA 14-4807. Rockville: Substance Abuse and Mental Health Services Administration; 2013. Accessed at www.samhsa.gov/data/sites/default/files/OTP2011_Web/OTP2011_Web/OTP2011_Web.pdf on 1 June 2018. Google Scholar9. D'Onofrio G, Chawarski MC, O'Connor PG, Pantalon MV, Busch SH, Owens PH, et al. Emergency department-initiated buprenorphine for opioid dependence with continuation in primary care: outcomes during and after intervention. J Gen Intern Med. 2017;32:660-6. [PMID: 28194688] doi:10.1007/s11606-017-3993-2 CrossrefMedlineGoogle Scholar10. Lee JD, Friedmann PD, Kinlock TW, Nunes EV, Boney TY, Hoskinson RA, et al. Extended-release naltrexone to prevent opioid relapse in criminal justice offenders. N Engl J Med. 2016;374:1232-42. [PMID: 27028913] doi:10.1056/NEJMoa1505409 CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAffiliations: National Institute on Drug Abuse, Bethesda, Maryland (N.D.V., E.M.W.)Disclosures: Authors have disclosed no conflicts of interest. Forms can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M18-1397.Corresponding Author: Nora D. Volkow, MD, National Institute on Drug Abuse, 6001 Executive Boulevard, Bethesda, MD 20892; e-mail, [email protected]nih.gov.Current Author Addresses: Drs. Volkow and Wargo: National Institute on Drug Abuse, 6001 Executive Boulevard, Bethesda, MD 20892.This article was published at Annals.org on 19 June 2018. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoMedication for Opioid Use Disorder After Nonfatal Opioid Overdose and Association With Mortality Marc R. Larochelle , Dana Bernson , Thomas Land , Thomas J. Stopka , Na Wang , Ziming Xuan , Sarah M. Bagley , Jane M. Liebschutz , and Alexander Y. 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Examining facility acceptance levels for serving individuals using medications for opioid used disorderFentanyl shock: The changing geography of overdose in the United StatesSystematic Analysis of the Service Process and the Legislative and Regulatory Environment for a Pharmacist-Provided Naltrexone Injection Service in WisconsinU.S. Emergency Department Visits Resulting From Nonmedical Use of Pharmaceuticals, 2016Prevention of Prescription Opioid Misuse and Projected Overdose Deaths in the United States 7 August 2018Volume 169, Issue 3Page: 190-192KeywordsDrug abuseEmergency departmentHealth careHealth care policyMortalityOpioid addictionOpioid use disorderOpioidsPsychiatry and mental healthSubstance abuse ePublished: 19 June 2018 Issue Published: 7 August 2018 PDF downloadLoading ...