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Medications for Opioid Use Disorder Save Lives (2019)

Chapter: Appendix A: Study Approach and Methods

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Suggested Citation:"Appendix A: Study Approach and Methods." National Academies of Sciences, Engineering, and Medicine. 2019. Medications for Opioid Use Disorder Save Lives. Washington, DC: The National Academies Press. doi: 10.17226/25310.
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Appendix A

Study Approach and Methods

In response to a request by the National Institute on Drug Abuse and the Substance Abuse and Mental Health Services Administration, the National Academies of Sciences, Engineering, and Medicine’s Committee on Medication-Assisted Treatment for Opioid Use Disorder was charged with reviewing and evaluating the evidence base on medication-assisted treatment (MAT) for opioid use disorder (OUD), including the range of parameters for effective delivery of MAT, challenges with implementation and uptake, and additional research needs. The committee’s final report will inform patients, providers, policy makers, and the public on the state of the evidence and knowledge gaps regarding treatment for OUD.

COMMITTEE EXPERTISE

The National Academies convened a 14-member ad hoc committee of experts in the fields of neurobiology, pharmacology, addiction medicine, psychology, social work, nursing, health policy, and epidemiology to respond to the charge by drawing on their experience and knowledge in the treatment of OUD. The committee also included individuals with lived experience, one as a patient and one as a family member of a person with OUD.

MEETINGS AND INFORMATION-GATHERING ACTIVITIES

The committee deliberated from October 2018 to January 2019, during the course of which it held two in-person meetings in October and

Suggested Citation:"Appendix A: Study Approach and Methods." National Academies of Sciences, Engineering, and Medicine. 2019. Medications for Opioid Use Disorder Save Lives. Washington, DC: The National Academies Press. doi: 10.17226/25310.
×

December. The October meeting included portions open to the public. The agenda of the open session appears in Appendix B. The committee meeting in December 2018 was held in closed session. The committee also communicated as needed via email and video conference.

To inform its deliberations the committee gathered information through a variety of mechanisms: (1) one 1.5-day workshop with open public sessions; (2) one open public comment session during its October meeting; (3) literature reviews of the medical, scientific, and policy issues; (4) solicitation and consideration of written statements from stakeholders and members of the public through the committee’s Current Projects System website and by coordinated e-mail outreach; and (5) personal communication among committee members and staff and individuals who have been directly involved in or have special knowledge of the issues under consideration. Comments submitted to the committee can be found in the Public Access File.

LITERATURE AND PRESS REVIEW

The committee and staff conducted a series of literature searches that concentrated on journals found in the following databases: Embase, Medline, Cochrane Database of Systematic Reviews, PubMed, Scopus, and Web of Science. The articles obtained by use of the search terms were reviewed for their relevance to the committee’s charge. Search terms for the committee’s literature searches are detailed below. This does not represent an exhaustive list of the research conducted. Other targeted literature reviews were conducted throughout the committee’s deliberations as novel issues arose and research gaps were identified.

Search Parameter

  • Date parameters: 1940–current
  • Include international citations—foreign languages

Publication Types

Case studies, clinical trials, cohort studies, grey literature, peer-reviewed literature, randomized clinical trials, randomized controlled trials, systematic reviews.

Agency Reviews

Academy of Managed Care Pharmacy, Addiction Medicine Foundation, Agency for Healthcare Research and Quality, American Psychological

Suggested Citation:"Appendix A: Study Approach and Methods." National Academies of Sciences, Engineering, and Medicine. 2019. Medications for Opioid Use Disorder Save Lives. Washington, DC: The National Academies Press. doi: 10.17226/25310.
×

Association, American Society of Addiction Medicine, Centers for Medicare & Medicaid Services, Drug Enforcement Administration, National Council of State Legislatures, National Institutes of Health, Substance Abuse and Mental Health Services Administration, U.S. Centers for Disease Control and Prevention, U.S. Department of Justice, U.S. Food and Drug Administration.

Opioid Use Disorder Related Terms

Opioid addiction, opioid-related disorder (MeSH), opioid use disorder, analgesics, opioid (MeSH), opiate, butorphanol, codeine, fentanyl, hydrocodone, levorphanol, meperidine, methodone, morphine, oxycodone, oxymorphone, tapentadol, heroin, fentayl-laced heroin, medication-assisted treatment, opioid substitution treatment, buprenorphinne, methadone, naltrexone, anti-drug vaccines, anti-opioid vaccination, cannabinoids, marijuana, diacetylmorphine, extended-release morphine, hydromorphone, injectable opioid agonist therapy, levo-alpha acetyl, supervised injectable heroin, sustained-release morphine, discontinuation, duration of treatment, medication adherence (MeSH), medication compliance (MeSH), medication counseling, medication non-adherence, medication non-compliance (MeSH), pharmaceutical therapy, tapering, cost effectiveness (MeSH), demographic effectiveness (MeSH), effectiveness treatment (MeSH), medically assisted, medically observed, out-patient treatment, out-patients, program effectiveness (MeSH), treatment effectiveness (MeSH), addiction, behavior, addiction (MeSH), communicable diseases (MeSH), comorbidities, depression, hepatitis (MeSH), infectious diseases, substance abuse, substance-related disorders (MeSH), acceptance and commitment therapy (MeSH), cognitive therapy (MeSH), counseling (MeSH), directive counseling (MeSH), marijuana treatment, addiction centers, delivery of health care (MeSH), drug treatment centers (MeSH), duration of treatment, emergency room, health care delivery (MeSH), health services accessibility, interventions, primary health care (MeSH), adolescent, continental population groups (MeSH), minority health, pregnant women, prisoners/incarcerated, rural populations, urban populations, vulnerable populations (MeSH), health disparities, health care disparities, medically underserved, medically underserved area (MeSH), social determinants of health, socioeconomic factors, crisis intervention, early intervention, infrastructure, physician shortage, regulations, addiction medicine training, clinician training (physician, nurse, physician assistant), education (MeSH), medical school curriculum training and materials, opioid-related education, physician training, social workers, medication availability, medical supply shortage, physician shortage area (MeSH), stigma, social stigma (MeSH), health insurance, insurance, reimbursement, reimbursement mechanisms (MeSH), drug crime

Suggested Citation:"Appendix A: Study Approach and Methods." National Academies of Sciences, Engineering, and Medicine. 2019. Medications for Opioid Use Disorder Save Lives. Washington, DC: The National Academies Press. doi: 10.17226/25310.
×

policy, federal/state funding, law enforcement, regulations, sentencing and corrections legislation, treatment courts, clinical trials—links to clinical trials, future opiate substitution treatment.

Suggested Citation:"Appendix A: Study Approach and Methods." National Academies of Sciences, Engineering, and Medicine. 2019. Medications for Opioid Use Disorder Save Lives. Washington, DC: The National Academies Press. doi: 10.17226/25310.
×
Page 137
Suggested Citation:"Appendix A: Study Approach and Methods." National Academies of Sciences, Engineering, and Medicine. 2019. Medications for Opioid Use Disorder Save Lives. Washington, DC: The National Academies Press. doi: 10.17226/25310.
×
Page 138
Suggested Citation:"Appendix A: Study Approach and Methods." National Academies of Sciences, Engineering, and Medicine. 2019. Medications for Opioid Use Disorder Save Lives. Washington, DC: The National Academies Press. doi: 10.17226/25310.
×
Page 139
Suggested Citation:"Appendix A: Study Approach and Methods." National Academies of Sciences, Engineering, and Medicine. 2019. Medications for Opioid Use Disorder Save Lives. Washington, DC: The National Academies Press. doi: 10.17226/25310.
×
Page 140
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The opioid crisis in the United States has come about because of excessive use of these drugs for both legal and illicit purposes and unprecedented levels of consequent opioid use disorder (OUD). More than 2 million people in the United States are estimated to have OUD, which is caused by prolonged use of prescription opioids, heroin, or other illicit opioids. OUD is a life-threatening condition associated with a 20-fold greater risk of early death due to overdose, infectious diseases, trauma, and suicide. Mortality related to OUD continues to escalate as this public health crisis gathers momentum across the country, with opioid overdoses killing more than 47,000 people in 2017 in the United States. Efforts to date have made no real headway in stemming this crisis, in large part because tools that already exist—like evidence-based medications—are not being deployed to maximum impact.

To support the dissemination of accurate patient-focused information about treatments for addiction, and to help provide scientific solutions to the current opioid crisis, this report studies the evidence base on medication assisted treatment (MAT) for OUD. It examines available evidence on the range of parameters and circumstances in which MAT can be effectively delivered and identifies additional research needed.

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