Medications for Opioid Use Disorder Save Lives (2019) / Chapter Skim
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1 Introduction
1 Introduction
Pages 15-32
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1 Introduction Opioid use disorder is a treatable chronic brain disease.
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. Heroin overdoses began to escalate rapidly in 2010, followed by a wave of overdose deaths due to synthetic opioids that began in 2013 and continues to rise each year as the illicitly manufactured, synthetic opioid fentanyl floods street-drug markets (Seth et al., 2018)
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and non-medication-based models. This Consensus Study Report focuses on medication-based treatment for OUD; other treatment approaches were not reviewed in detail because that would have been outside the scope of the committee's task.
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Medication is also a core component of medically supervised withdrawal from opioids, as it can alleviate acute withdrawal symptoms and reduce cravings. Each medication has its own treatment characteristics -- and can affect individuals in different ways -- so the treatment regimen needs to be tailored to patients' specific conditions and needs.
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As an opioid-agonist medication, methadone fully activates the brain's opioid receptors through the same mechanism as prescription or illicit opioids, but it is safer and less addictive because its uptake is slower and its effects less euphoric. Methadone is typically taken orally once daily and administered in person at opioid treatment programs.
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. Chapter 4 describes evidence for implementing medication-based treatment for OUD in different care settings, including opioid treatment programs (OTPs)
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. As with other chronic medical conditions, a confluence of genetic, BOX 1-3 Statement of Task To support the dissemination of accurate patient-focused information about treatments for addiction and to help provide scientific solutions to the current o pioid crisis, an ad hoc committee under the auspices of the National Academies of Sciences, Engineering, and Medicine will conduct a study of the evidence base on medication-assisted treatment (MAT)
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. Addiction to opioids or OUD results from changes in the brain caused by prolonged opioid use, which should be treated with individualized, multidisciplinary care similarly to how other chronic diseases, such as diabetes or asthma, are treated.
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. Escalating tolerance due to chronic opioid use causes acute physical and psychological withdrawal symptoms that can develop within hours of discontinuation (Schuckit, 2016)
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. Ultimately, the committee contends, framing OUD as a chronic disease that is responsive to treatment broadly available through the health care delivery system through a chronic disease management approach will help to decrease the stigma around OUD and allow more individuals to receive high-quality, long-term care.
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Behavioral interventions -- Interventions (e.g., cognitive behavioral therapy, con tingency management, structured family therapy) designed to engage people in opioid use disorder treatment, provide incentives to not use illicit opioids, modify attitudes and behaviors related to the use of opioids, and increase life skills to handle stressful circumstances and environmental cues that may trigger intense craving for opioids.
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-- The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, defines OUD as a problematic pattern of opioid use lead ing to clinically significant impairment or distress, as manifested by at least 2 out of 11 criteria within a 12-month period. See Box 1-4 for the full list of diagnostic criteria for OUD.
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Chapter 3, Treatment with Medications for Opioid Use Disorder in Different Populations, surveys existing evidence and knowledge gaps related to the treatment of OUD across different subpopulations in the United States, including adolescents, older adults, pregnant women, persons with co-occurring conditions, racial and ethnic minorities, and people with low socioeconomic status. Chapter 4, Medications for Opioid Use Disorder in Various Treatment Settings, reviews the evidence concerning differences in medication access and use in different treatment settings including OTPs, office-based care, acute care settings, criminal justice, and other care settings.
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U.S. drug overdose deaths continue to rise; increase fueled by synthetic opioids.
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2018. Drug overdose deaths in the United States, 1999–2017.
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2009. Methadone maintenance therapy versus no opioid replacement therapy for opioid dependence.
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2013. Opioid agonist treatments and heroin overdose deaths in Baltimore, Maryland, 1995–2009.
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2015. Rates of opioid misuse, abuse, and addiction in chronic pain: A systematic review and data synthesis.
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