Committee on Medication-Assisted Treatment for Opioid Use Disorder
Alan I. Leshner and Michelle Mancher, Editors
Board on Health Sciences Policy
Health and Medicine Division
A Consensus Study Report of
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This activity was supported by a contract between the National Academy of Sciences and the National Institutes of Health (HHSN263201800029I/HHSN26300005) and the Substance Abuse and Mental Health Services Administration. Any opinions, findings, conclusions, or recommendations expressed in this publication do not necessarily reflect the views of any organization or agency that provided support for the project.
International Standard Book Number-13: 978-0-309-48648-4
International Standard Book Number-10: 0-309-48648-3
Digital Object Identifier: https://doi.org/10.17226/25310
Library of Congress Control Number: 2019939384
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Suggested citation: National Academies of Sciences, Engineering, and Medicine. 2019. Medications for opioid use disorder save lives. Washington, DC: The National Academies Press. doi: https://doi.org/10.17226/25310.
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COMMITTEE ON MEDICATION-ASSISTED TREATMENT FOR OPIOID USE DISORDER
ALAN I. LESHNER (Chair), Chief Executive Officer Emeritus, American Association for the Advancement of Science
HUDA AKIL, Co-Director and Research Professor, Molecular & Behavioral Neuroscience Institute; Distinguished University Professor and Quarton Professor of Neurosciences, Department of Psychiatry, University of Michigan
COLLEEN BARRY, Fred & Julie Soper Professor and Chair, Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health
KATHLEEN CARROLL, Albert E. Kent Professor of Psychiatry, Yale School of Medicine
CHINAZO CUNNINGHAM, Professor, Albert Einstein College of Medicine, Montefiore Medical Center
WALTER GINTER, Project Director, Medication Assisted Recovery Support Project
TRACI GREEN, Associate Professor, Emergency Medicine; Associate Director and Senior Scientist, Injury Prevention Research Center, Boston University/Boston Medical Center
YASMIN HURD, Ward Coleman Chair of Translational Neuroscience; Director, Addiction Institute at Mount Sinai, Icahn School of Medicine at Mount Sinai
ALAN JETTE, Professor, MGH Institute of Health Professions
LAURA R. LANDER, Associate Professor and Addiction Therapist, Department of Behavioral Medicine and Psychiatry and Department of Neuroscience, West Virginia University
DAVID PATTERSON SILVER WOLF, Associate Professor, Washington University
SEUN ROSS, Director, Nursing Practice and Work Environment, American Nurses Association
SCOTT STEIGER, Associate Clinical Professor of Medicine and Psychiatry, University of California, San Francisco
DAVID VLAHOV, Associate Dean for Research and Professor, Yale School of Nursing
MICHELLE MANCHER, Study Director
CLARE STROUD, Senior Program Officer
EMILY BUSTA, Associate Program Officer (until September 2018)
BENJAMIN KAHN, Associate Program Officer
DANIEL FLYNN, Research Associate (until December 2018)
MEREDITH HACKMANN, Research Associate (until December 2018)
MICHAEL BERRIOS, Senior Program Assistant
MARIAM SHELTON, Board on Health Sciences Policy Program Coordinator
DANIEL BEARSS, Research Librarian
ANDREW M. POPE, Director, Board on Health Sciences Policy
ANNA NICHOLSON, Science Writer
This Consensus Study Report was reviewed in draft form by individuals chosen for their diverse perspectives and technical expertise. The purpose of this independent review is to provide candid and critical comments that will assist the National Academies of Sciences, Engineering, and Medicine in making each published report as sound as possible and to ensure that it meets the institutional standards for quality, objectivity, evidence, and responsiveness to the study charge. The review comments and draft manuscript remain confidential to protect the integrity of the deliberative process.
We thank the following individuals for their review of this report:
JAN M. BROWN, SpiritWorks Foundation Center for the Soul
H. WESTLEY CLARK, Santa Clara University
KELLY J. CLARK, American Society of Addiction Medicine
BRANDEE IZQUIERDO, SAFE Project
CHRISTOPHER M. JONES, U.S. Centers for Disease Control and Prevention
PAULA J. LUM, University of California, San Francisco
SANDRA A. SPRINGER, Yale School of Medicine
JOYCELYN SUE WOODS, National Alliance for Medication Assisted Recovery
Although the reviewers listed above provided many constructive comments and suggestions, they were not asked to endorse the conclusions or recommendations of this report, nor did they see the final draft before its release. The review of this report was overseen by JOHN H. KRYSTAL, Yale
School of Medicine, and KRISTINE GEBBIE, Flinders University School of Nursing and Midwifery. They were responsible for making certain that an independent examination of this report was carried out in accordance with the standards of the National Academies and that all review comments were carefully considered. Responsibility for the final content rests entirely with the authoring committee and the National Academies.
The United States is experiencing a public health crisis of almost unprecedented scale: an epidemic of opioid use disorder (OUD) and related overdose deaths. It is not wholly new, as opioid addiction and the resulting societal disruption have been major problems in many countries for hundreds of years, but its magnitude has increased exponentially in the past decades.
As this Consensus Study Report articulates, modern medicine and the science that underpins it have developed and provided a set of highly effective tools that can help address the opioid epidemic—specifically, three U.S. Food and Drug Administration–approved medications—that have been severely underused, even in the health care sector. Their effectiveness and why they are not more widely used are the subjects of this report. Most of the factors impeding their full use can and must be dealt with if real progress is to be made. These factors include the misunderstandings and stigma surrounding both addiction and the medications used to treat it, as well as counterproductive ideologies that consider addiction simply a failure of will or a moral weakness, as opposed to understanding OUD as a chronic disease of the brain that requires medical treatment. This misunderstanding and stigma must be addressed; they have resulted in hundreds of thousands of patients being denied access to life-saving medications on non-medical, non-scientific grounds, which our committee considers to be unethical.
As with all such studies, the committee developed its conclusions based on a review of the scientific literature as it stands at the point in time of the committee’s work. Fortunately, there is a robust research enterprise that is continuing to work on OUD and its treatment. We are confident that these
efforts will yield results that will continue to increase understanding of OUD and the most effective ways to prevent and treat it. Knowledge needs include refining in detail the most effective protocols for administering medications to specific individuals and subpopulations and the identification of additional molecular targets and approaches to enable the development of new and even more effective medications. Other research needs are discussed throughout the report.
The committee would like to express its great appreciation to the study director, Michelle Mancher, and her colleagues on the National Academies staff whose dedication, competence, and hard work have greatly improved the quality of this report. We also greatly appreciate the insight and support of our sponsors, the National Institute on Drug Abuse of the National Institutes of Health and the Substance Abuse and Mental Health Services Administration.
Alan I. Leshner, Chair
Committee on Medication-Assisted Treatment for Opioid Use Disorder
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Boxes and Figures
|AAP||American Academy of Pediatrics|
|ACA||Patient Protection and Affordable Care Act|
|CARA||Comprehensive Addiction and Recovery Act|
|CDC||U.S. Centers for Disease Control and Prevention|
|CFR||Code of Federal Regulations|
|CHC||community health center|
|DATA||Drug Addiction Treatment Act|
|DEA||Drug Enforcement Administration|
|EHR||electronic health record|
|FDA||U.S. Food and Drug Administration|
|HCV||hepatitis C virus|
|HIV||human immunodeficiency virus|
|MHPA||Mental Health Parity Act|
|NSDUH||National Survey on Drug Use and Health|
|OTP||opioid treatment program|
|OUD||opioid use disorder|
|PDMP||Prescription Drug Monitoring Program|
|QTc||corrected QT interval|
|SAMHSA||Substance Abuse and Mental Health Services Administration|
|siOAT||supervised injectable opioid agonist treatment|
|SROM||slow-release oral morphine|
|SUD||substance use disorder|