Medications for opioid use disorder: bridging the gap in care

Abstract

For the past two decades, the USA has been in the throes of an opioid crisis marked by a rising number of deaths; in 2016, opioids were responsible for most of the nation's estimated 64 000 fatal drug overdoses. 1 US Centers for Disease Control and PreventionNational Center for Health StatisticsNational Vital Statistics SystemProvisional counts of drug overdose deaths, as of 8/6/2017. https://www.cdc.gov/nchs/data/health_policy/monthly-drug-overdose-death-estimates.pdfDate: 2017 Google Scholar The problem began with overprescribing of opioid analgesics in the 1990s, which exposed pain patients to the risks of addiction and produced large surpluses of pain pills that were diverted for misuse by the larger community. Additionally, the escalating numbers of opioid-addicted Americans led to increased HIV and hepatitis C transmission among people who misuse these drugs by injecting them 2 Van Handel MM Rose CE Hallisey EJ et al. County-level vulnerability assessment for rapid dissemination of HIV or HCV infections among persons who inject drugs, United States. J Acquir Immune Defic Syndr. 2016; 73: 323-331 Crossref PubMed Scopus (278) Google Scholar and increased numbers of infants born dependent on opioids as a result of the mother's opioid use (neonatal abstinence syndrome). 3 Brown JD Goodin AJ Talbert JC Rural and Appalachian disparities in neonatal abstinence syndrome incidence and access to opioid abuse treatment. J Rural Health. 2017; (published online July 7.)DOI: 10.1111/jrh.12251 Google Scholar Extended-release naltrexone: good but not a panaceaUnlike other addictions, opioid-use disorder has several highly effective medication treatments available, in particular methadone, buprenorphine, and naltrexone.1–3 Methadone is the least accessible or acceptable of these in many settings, so providers and patients are often faced with a choice between buprenorphine-naloxone (BUP-NX) and extended-release naltrexone injection (XR-NTX). Full-Text PDF Comparative effectiveness of extended-release naltrexone versus buprenorphine-naloxone for opioid relapse prevention (X:BOT): a multicentre, open-label, randomised controlled trialIn this population it is more difficult to initiate patients to XR-NTX than BUP-NX, and this negatively affected overall relapse. However, once initiated, both medications were equally safe and effective. Future work should focus on facilitating induction to XR-NTX and on improving treatment retention for both medications. Full-Text PDF