Abstract
Treatment for opioid use disorder in the United States evolved in response to changing federal policy and advances in science. Inpatient care began in 1935 with the US Public Health Hospitals in Lexington, Kentucky, and Fort Worth, Texas. Outpatient clinics emerged in the 1960s to provide aftercare. Research advances led to opioid agonist and opioid antagonist therapies. When patients complete opioid withdrawal, return to use is often rapid and frequently deadly. US and international authorities recommend opioid agonist therapy (i.e., methadone or buprenorphine). Opioid antagonist therapy (i.e., extended-release naltrexone) may also inhibit return to use. Prevention efforts emphasize public and prescriber education, use of prescription drug monitoring programs, and safe medication disposal options. Overdose education and naloxone distribution promote access to rescue medication and reduce opioid overdose fatalities. Opioid use disorder prevention and treatment must embrace evidence-based care and integrate with physical and mental health care.
Highlights
Opioid use is widespread, and treatment access is limited
A physician, lamented that his patient returned to heroin injection despite a prescription for buprenorphine, “I suddenly felt like I was his enabler—and his dealer” (p. 187); after reflection, the physician recognized that the patient had a chronic disease that required long-term medical management and renewed his relationship with the patient [58]
A 1990 review of drug treatment noted that the Public Health Hospitals were significant because they (a) served both inmates and volunteers, (b) were the first allocation of federal funds for specialized drug treatment services, and (c) trained clinicians and investigators to address opioid and other drug use disorders [8, 37]
Summary
Treatment access is limited. Data from the 2015 National Survey on Drug Use and Health suggest that among individuals 12 years of age and older, an estimated 97.5 million individuals (36.4% of the population) used prescription opioids in the past year, 12.5 million (4.7% of the population) misused prescription opioids, 2 million (0.8% of the population) individuals using prescription opioids met the criteria for diagnosis of an opioid use disorder, and 822,000 received treatment [36]. The 2016 Comprehensive Addiction Recovery Act (CARA) expanded the practitioners who are authorized to prescribe buprenorphine to include physician assistants and nurse practitioners upon the completion of opioid use disorder treatment training and DEA and SAMHSA registration.
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