Abstract
Purpose of ReviewThis article aims to provide an overview of standard and adjunctive treatment options in opioid dependence in consideration of therapy-refractory courses. The relevance of oral opioid substitution treatment (OST) and measures of harm reduction as well as heroin-assisted therapies are discussed alongside non-pharmacological approaches.Recent FindingsCurrently, recommendation can be given for OST with methadone, buprenorphine, slow-release oral morphine (SROM), and levomethadone. Heroin-assisted treatment using diamorphine shall be considered as a cost-effective alternative for individuals not responding to the afore-mentioned opioid agonists in order to increase retention and reduce illicit opioid use. The modalities of application and the additional benefits of long-acting formulations of buprenorphine should be sufficiently transferred to clinicians and the eligible patients; simultaneously methods to improve planning of actions and self- management need to be refined. Regarding common primary outcomes in research on opioid treatment, evidence of the effectiveness of adjunctive psychological interventions is scarce.SummaryMaintaining a harm reduction approach in the treatment of opioid addiction, a larger range of formulations is available for the prescribers. Embedding the pharmacological, ideally individualized treatment into a holistic, structure-giving concept also requires a reduction of fragmentation of ancillary services available, drug policies, and treatment philosophies on a global scale.
Highlights
Purpose of Review This article aims to provide an overview of standard and adjunctive treatment options in opioid dependence in consideration of therapy-refractory courses
The United Nations Office on Drugs and Crime (UNODC) reported a worldwide increase of drug usage of 30% in 2018, compared with 2009, stating that in 2019 thirty-five million people fulfill the criteria of drug use disorders [1]
The harm reduction approach allows for a broad range of treatment results ranging from survival to full recovery and does play a major part in opioid substitution treatment (OST) and in dependence on other legal and illicit substances
Summary
Harm reduction subsumes a variety of compassionate and pragmatic strategies focusing on minimizing substancerelated harm and enhancing quality of life for affected individuals and their communities without requiring abstinence or reduction of consumption quantities [26]. The harm reduction approach allows for a broad range of treatment results ranging from survival to full recovery and does play a major part in OST and in dependence on other legal and illicit substances. In reaction to an increase of opioid-related overdose deaths, North Carolina legalized syringe exchange programs in 2016 and distributed naloxone, a non-addictive medication, which reverses opioid overdose, into the community [30]. This may underline the importance of the harm reduction debate for opioid dependence treatment, this article does not intend to give a complete review on this subject
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