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Weiss RD, Rao V. The Prescription Opioid Addiction Treatment Study: What have we learned. Drug Alcohol Depend 2017; 173 Suppl 1:S48-S54. [PMID: 28363320 PMCID: PMC6866670 DOI: 10.1016/j.drugalcdep.2016.12.001] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2016] [Revised: 12/16/2016] [Accepted: 12/17/2016] [Indexed: 11/20/2022]
Abstract
BACKGROUND The multi-site Prescription Opioid Addiction Treatment Study (POATS), conducted by the National Drug Abuse Treatment Clinical Trials Network, was the largest clinical trial yet conducted with patients dependent upon prescription opioids (N=653). In addition to main trial results, the study yielded numerous secondary analyses, and included a 3.5-year follow-up study, the first of its kind with this population. This paper reviews key findings from POATS and its follow-up study. METHODS The paper summarizes the POATS design, main outcomes, predictors of outcome, subgroup analyses, the predictive power of early treatment response, and the long-term follow-up study. RESULTS POATS examined combinations of buprenorphine-naloxone of varying duration and counseling of varying intensity. The primary outcome analysis showed no overall benefit to adding drug counseling to buprenorphine-naloxone and weekly medical management. Only 7% of patients achieved a successful outcome (abstinence or near-abstinence from opioids) during a 4-week taper and 8-week follow-up; by comparison, 49% of patients achieved success while subsequently stabilized on buprenorphine-naloxone. Long-term follow-up results were more encouraging, with higher abstinence rates than in the main trial. Patients receiving opioid agonist treatment at the time of follow-up were more likely to have better outcomes, though a sizeable number of patients succeeded without agonist treatment. Some patients initiated risky use patterns, including heroin use and drug injection. A limitation of the long-term follow-up study was the low follow-up rate. CONCLUSIONS POATS was the first large-scale study of the treatment of prescription opioid dependence; its findings can influence both treatment guidelines and future studies.
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Affiliation(s)
- Roger D Weiss
- Division of Alcohol and Drug Abuse, McLean Hospital, 115 Mill Street, Belmont, MA 02478, USA; Department of Psychiatry, Harvard Medical School, 25 Shattuck Street, Boston, MA 02115, USA.
| | - Vinod Rao
- Department of Psychiatry, Harvard Medical School, 25 Shattuck Street, Boston, MA 02115, USA; Partners HealthCare Addiction Psychiatry Fellowship, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA.
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Bhatraju EP, Grossman E, Tofighi B, McNeely J, DiRocco D, Flannery M, Garment A, Goldfeld K, Gourevitch MN, Lee JD. Public sector low threshold office-based buprenorphine treatment: outcomes at year 7. Addict Sci Clin Pract 2017; 12:7. [PMID: 28245872 PMCID: PMC5331716 DOI: 10.1186/s13722-017-0072-2] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2016] [Accepted: 02/02/2017] [Indexed: 11/28/2022] Open
Abstract
Background Buprenorphine maintenance for opioid dependence remains of limited availability among underserved populations, despite increases in US opioid misuse and overdose deaths. Low threshold primary care treatment models including the use of unobserved, “home,” buprenorphine induction may simplify initiation of care and improve access. Unobserved induction and long-term treatment outcomes have not been reported recently among large, naturalistic cohorts treated in low threshold safety net primary care settings. Methods This prospective clinical registry cohort design estimated rates of induction-related adverse events, treatment retention, and urine opioid results for opioid dependent adults offered buprenorphine maintenance in a New York City public hospital primary care office-based practice from 2006 to 2013. This clinic relied on typical ambulatory care individual provider-patient visits, prescribed unobserved induction exclusively, saw patients no more than weekly, and did not require additional psychosocial treatment. Unobserved induction consisted of an in-person screening and diagnostic visit followed by a 1-week buprenorphine written prescription, with pamphlet, and telephone support. Primary outcomes analyzed were rates of induction-related adverse events (AE), week 1 drop-out, and long-term treatment retention. Factors associated with treatment retention were examined using a Cox proportional hazard model among inductions and all patients. Secondary outcomes included overall clinic retention, buprenorphine dosages, and urine sample results. Results Of the 485 total patients in our registry, 306 were inducted, and 179 were transfers already on buprenorphine. Post-induction (n = 306), week 1 drop-out was 17%. Rates of any induction-related AE were 12%; serious adverse events, 0%; precipitated withdrawal, 3%; prolonged withdrawal, 4%. Treatment retention was a median 38 weeks (range 0–320) for inductions, compared to 110 (0–354) weeks for transfers and 57 for the entire clinic population. Older age, later years of first clinic visit (vs. 2006–2007), and baseline heroin abstinence were associated with increased treatment retention overall. Conclusions Unobserved “home” buprenorphine induction in a public sector primary care setting appeared a feasible and safe clinical practice. Post-induction treatment retention of a median 38 weeks was in line with previous naturalistic studies of real-world office-based opioid treatment. Low threshold treatment protocols, as compared to national guidelines, may compliment recently increased prescriber patient limits and expand access to buprenorphine among public sector opioid use disorder patients.
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Affiliation(s)
- Elenore Patterson Bhatraju
- Department of Population Health, NYU School of Medicine, 227 East 30th St, New York, NY, 10016, USA.,Department of Medicine, Division of General Internal Medicine and Clinical Innovation, NYU School of Medicine, New York, NY, USA
| | - Ellie Grossman
- Department of Medicine, Division of General Internal Medicine and Clinical Innovation, NYU School of Medicine, New York, NY, USA
| | - Babak Tofighi
- Department of Population Health, NYU School of Medicine, 227 East 30th St, New York, NY, 10016, USA.,Department of Medicine, Division of General Internal Medicine and Clinical Innovation, NYU School of Medicine, New York, NY, USA
| | - Jennifer McNeely
- Department of Population Health, NYU School of Medicine, 227 East 30th St, New York, NY, 10016, USA.,Department of Medicine, Division of General Internal Medicine and Clinical Innovation, NYU School of Medicine, New York, NY, USA
| | - Danae DiRocco
- Department of Population Health, NYU School of Medicine, 227 East 30th St, New York, NY, 10016, USA
| | - Mara Flannery
- Department of Population Health, NYU School of Medicine, 227 East 30th St, New York, NY, 10016, USA
| | - Ann Garment
- Department of Medicine, Division of General Internal Medicine and Clinical Innovation, NYU School of Medicine, New York, NY, USA
| | - Keith Goldfeld
- Department of Population Health, NYU School of Medicine, 227 East 30th St, New York, NY, 10016, USA
| | - Marc N Gourevitch
- Department of Population Health, NYU School of Medicine, 227 East 30th St, New York, NY, 10016, USA
| | - Joshua D Lee
- Department of Medicine, Division of General Internal Medicine and Clinical Innovation, NYU School of Medicine, New York, NY, USA. .,Department of Population Health, NYU School of Medicine, 227 East 30th St #712, New York, NY, 10016, USA.
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103
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Rolland B, Bouhassira D, Authier N, Auriacombe M, Martinez V, Polomeni P, Brousse G, Schwan R, Lack P, Bachellier J, Rostaing S, Bendimerad P, Vergne-Salle P, Dematteis M, Perrot S. [Misuse and dependence on prescription opioids: Prevention, identification and treatment]. Rev Med Interne 2017; 38:539-546. [PMID: 28214183 DOI: 10.1016/j.revmed.2016.12.024] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2016] [Revised: 10/23/2016] [Accepted: 12/30/2016] [Indexed: 11/26/2022]
Abstract
Since the 1990s, the use of prescription opioids has largely spread, which has brought a real progress in the treatment of pain. The long-term use of prescription opioid is sometimes required, and may lead to pharmacological tolerance and withdrawal symptoms, i.e. pharmacological dependence on prescription opioids. Occasionally, this may also lead to misuse of prescription opioids (MPO). MPO preferentially occurs in vulnerable individuals, i.e., those with a young age, history of other addictive or psychiatric disorders, especially anxious and depressive disorders. MPO is associated with numerous complications, including an increased risk of fatal overdose. Prevention of MPO begins before the opioid prescription, with the identification of potential vulnerability factors. A planned and personalized monitoring should be systematically implemented. In vulnerable patients, contractualizing the prescription is warranted. During follow-up, the relevance of the prescription should be regularly reconsidered, according to the benefit observed on pain and the potential underlying signs of MPO. Patients with suspected MPO should be referred early to pain or addiction centers. The treatment of MPO should be based on multidisciplinary strategies, involving both the addiction and pain aspects: progressive opioid withdrawal, non-pharmacological measures against pain, or switching to medication-assisted treatment of addiction (i.e., buprenorphine or methadone).
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Affiliation(s)
- B Rolland
- Service d'addictologie, hôpital Fontan 2, CHRU de Lille, CS 70001, 59037 Lille cedex, France.
| | - D Bouhassira
- Inserm U-987, centre d'évaluation et de traitement de la douleur, hôpital Ambroise-Paré, 92100 Boulogne-Billancourt, France
| | - N Authier
- UMR Inserm 1107, faculté de médecine, pharmacologie médicale, CRPV/CEIP/CETD, centre d'évaluation et de traitement de la douleur/institut Analgesia, CHU de Clermont-Ferrand, F-63000 Clermont-Ferrand, France
| | - M Auriacombe
- Université de Bordeaux et CNRS USR 3413 (sanpsy), pôle addictologie, CH Ch. Perrens et CHU de Bordeaux, 33076 Bordeaux, France
| | - V Martinez
- Service d'anesthésie, hôpital Raymond-Poincaré, 92380 Garches, France
| | - P Polomeni
- Service d'addictologie, hôpital René-Muret, hôpitaux universitaires Paris Seine-Saint-Denis, 93270 Sevran, France
| | - G Brousse
- Service de psychiatrie B, CHU, hôpital Gabriel-Montpied, F-63003 Clermont-Ferrand, France
| | - R Schwan
- Pôle hospitalo-universitaire de psychiatrie d'adultes du Nancy, centre psychothérapique de Nancy, 54520 Laxou, France
| | - P Lack
- CSAPA, hôpital de la Croix-Rousse, hospices civils de Lyon, 69004 Lyon, France
| | - J Bachellier
- CSAPA centre Port-Bretagne, CHU de Tours, 37000 Tours, France
| | - S Rostaing
- Hôpital Saint-Antoine, centre d'évaluation et de traitement de la douleur, 75012 Paris, France
| | - P Bendimerad
- Service de psychiatrie, secteur 2, CH de La Rochelle, 17019 La Rochelle, France
| | - P Vergne-Salle
- Service de rhumatologie et centre de la douleur, CHU de Limoges, 87042 Limoges, France
| | - M Dematteis
- Service d'addictologie, CHU de Grenoble-Alpes, université Grenoble-Alpes, 38700 La Tronche, France
| | - S Perrot
- Inserm U-987, centre de la douleur, hôpital Hôtel-Dieu, université Paris-Descartes, 75014 Paris, France
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104
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Abstract
This paper is the thirty-eighth consecutive installment of the annual review of research concerning the endogenous opioid system. It summarizes papers published during 2015 that studied the behavioral effects of molecular, pharmacological and genetic manipulation of opioid peptides, opioid receptors, opioid agonists and opioid antagonists. The particular topics that continue to be covered include the molecular-biochemical effects and neurochemical localization studies of endogenous opioids and their receptors related to behavior, and the roles of these opioid peptides and receptors in pain and analgesia, stress and social status, tolerance and dependence, learning and memory, eating and drinking, drug abuse and alcohol, sexual activity and hormones, pregnancy, development and endocrinology, mental illness and mood, seizures and neurologic disorders, electrical-related activity and neurophysiology, general activity and locomotion, gastrointestinal, renal and hepatic functions, cardiovascular responses, respiration and thermoregulation, and immunological responses.
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Affiliation(s)
- Richard J Bodnar
- Department of Psychology and Neuropsychology Doctoral Sub-Program, Queens College, City University of New York, Flushing, NY 11367, United States.
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105
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Addiction-25 Years Later. Harv Rev Psychiatry 2017; 25:97-100. [PMID: 28475500 PMCID: PMC5501178 DOI: 10.1097/hrp.0000000000000159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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106
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Weinstein ZM, Kim HW, Cheng DM, Quinn E, Hui D, Labelle CT, Drainoni ML, Bachman SS, Samet JH. Long-term retention in Office Based Opioid Treatment with buprenorphine. J Subst Abuse Treat 2016; 74:65-70. [PMID: 28132702 DOI: 10.1016/j.jsat.2016.12.010] [Citation(s) in RCA: 145] [Impact Index Per Article: 18.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2016] [Revised: 12/11/2016] [Accepted: 12/28/2016] [Indexed: 10/20/2022]
Abstract
BACKGROUND Guidelines recommend long-term treatment for opioid use disorder with buprenorphine; however, little is known about patients in long-term treatment. The aim of this study is to examine the prevalence and patient characteristics of long-term treatment retention (≥1year) in an Office Based Opioid Treatment (OBOT) program with buprenorphine. METHODS This is a retrospective cohort study of adults on buprenorphine from January 2002 to February 2014 in a large urban safety-net primary care OBOT program. The primary outcome was retention in OBOT for at least one continuous year. Potential predictors included age, race, psychiatric diagnoses, hepatitis C, employment, prior buprenorphine, ever heroin use, current cocaine, benzodiazepine and alcohol use on enrollment. Factors associated with ≥1year OBOT retention were identified using generalized estimating equation logistic regression models. Patients who re-enrolled in the program contributed repeated observations. RESULTS There were 1605 OBOT treatment periods among 1237 patients in this study. Almost half, 45% (717/1605), of all treatment periods were ≥1year and a majority, 53.7% (664/1237), of patients had at least one ≥1year period. In adjusted analyses, female gender (Adjusted Odds Ratio [AOR] 1.55, 95% CI [1.20, 2.00]) psychiatric diagnosis (AOR 1.75 [1.35, 2.27]) and age (AOR 1.19 per 10year increase [1.05, 1.34]) were associated with greater odds of ≥1year retention. Unemployment (AOR 0.72 [0.56, 0.92]), Hepatitis C (AOR 0.59 [0.45, 0.76]), black race/ethnicity (AOR 0.53 [0.36, 0.78]) and Hispanic race/ethnicity (AOR 0.66 [0.48, 0.92]) were associated with lower odds of ≥1year retention. CONCLUSIONS Over half of patients who presented to Office Based Opioid Treatment with buprenorphine were ultimately successfully retained for ≥1year. However, significant disparities in one-year treatment retention were observed, including poorer retention for patients who were younger, black, Hispanic, unemployed, or with hepatitis C.
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Affiliation(s)
- Zoe M Weinstein
- Boston University School of Medicine/Boston Medical Center, Department of Medicine, Section of General Internal Medicine, Clinical Addiction Research and Education (CARE) Unit, 801 Massachusetts Avenue, 2nd Floor, Boston, MA 02118, United States.
| | - Hyunjoong W Kim
- Boston University School of Medicine, 72 East Concord St, Boston, MA 02118, United States
| | - Debbie M Cheng
- Boston University School of Public Health, Department of Biostatistics, 801 Massachusetts Avenue, 3rd Floor, Boston, MA 02118, United States
| | - Emily Quinn
- Boston University School of Public Health, Data Coordinating Center, 85 East Newton St, M921, Boston, MA 02118, United States
| | - David Hui
- Boston University School of Medicine, 72 East Concord St, Boston, MA 02118, United States
| | - Colleen T Labelle
- Boston University School of Medicine/Boston Medical Center, Department of Medicine, Section of General Internal Medicine, Clinical Addiction Research and Education (CARE) Unit, 801 Massachusetts Avenue, 2nd Floor, Boston, MA 02118, United States
| | - Mari-Lynn Drainoni
- Boston University School of Public Health, Department of Health Law, Policy & Management, 715 Albany Street, Talbot Building, T2W, Boston, MA 02118, United States; Boston University School of Medicine, Section of Infectious Diseases, 801 Massachusetts Avenue, 2nd Floor, Boston, MA 02118, United States; Center for Healthcare Organization and Implementation Research, Edith Nourse Rogers Memorial VA Hospital, 200 Springs Rd, Bedford, MA 01730, United States
| | - Sara S Bachman
- Boston University School of Public Health, Department of Health Law, Policy & Management, 715 Albany Street, Talbot Building, T2W, Boston, MA 02118, United States; Boston University School of Social Work, Department of Social Research, 264 Bay State Rd, Boston, MA 02215, United States
| | - Jeffrey H Samet
- Boston University School of Medicine/Boston Medical Center, Department of Medicine, Section of General Internal Medicine, Clinical Addiction Research and Education (CARE) Unit, 801 Massachusetts Avenue, 2nd Floor, Boston, MA 02118, United States; Boston University School of Public Health, Department of Community Health Sciences, 801 Massachusetts Avenue, 4th Floor, Boston, MA 02118, United States
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107
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Nunes EV, Lee JD, Sisti D, Segal A, Caplan A, Fishman M, Bailey G, Brigham G, Novo P, Farkas S, Rotrosen J. Ethical and clinical safety considerations in the design of an effectiveness trial: A comparison of buprenorphine versus naltrexone treatment for opioid dependence. Contemp Clin Trials 2016; 51:34-43. [PMID: 27687743 PMCID: PMC5466164 DOI: 10.1016/j.cct.2016.09.006] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2016] [Revised: 09/12/2016] [Accepted: 09/25/2016] [Indexed: 10/20/2022]
Abstract
We examine ethical challenges encountered in the design of an effectiveness trial (CTN-0051; X:BOT), comparing sublingual buprenorphine-naloxone (BUP-NX), an established treatment for opioid dependence, to the newer extended-release injectable naltrexone (XR-NTX). Ethical issues surrounded: 1) known poor effectiveness of one possible, commonly used treatment as usual control condition-detoxification followed by counseling without medication; 2) the role of patients' preferences for treatments, given that treatments were clinically approved and available to the population; 3) differences between the optimal "usual treatment" clinical settings for different treatments making it challenging to design a fair comparison; 4) vested interest groups favoring different treatments exerting potential influence on the design process; 5) potentially vulnerable populations of substance users and prisoners; 6) potential therapeutic misconception in the implementation of safety procedures; and 7) high cost of a large trial limiting questions that could be addressed. We examine how the design features underlying these ethical issues are characteristic of effectiveness trials, which are often large trials that compare treatments with varying degrees of existing effectiveness data and familiarity to patients and clinicians, in community-based treatment settings, with minimal exclusion criteria that could involve vulnerable populations. Hence, investigators designing effectiveness trials may wish to remain alert to the possibility of similar ethical issues.
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Affiliation(s)
- Edward V Nunes
- Columbia University Medical Center, New York State Psychiatric Institute, United States.
| | - Joshua D Lee
- NYU School of Medicine, Department of Population Health, United States
| | - Dominic Sisti
- Perelman School of Medicine, University of Pennsylvania, United States
| | - Andrea Segal
- Perelman School of Medicine, University of Pennsylvania, United States
| | - Arthur Caplan
- NYU School of Medicine, Division of Medical Ethics, United States
| | - Marc Fishman
- Johns Hopkins University School of Medicine, Mountain Manor Treatment Program, United States
| | - Genie Bailey
- Warren Alpert Medical School of Brown University, Stanley Street Treatment and Resources, United States
| | | | - Patricia Novo
- NYU School of Medicine, Department of Psychiatry, United States
| | - Sarah Farkas
- NYU School of Medicine, Department of Psychiatry, United States
| | - John Rotrosen
- NYU School of Medicine, Department of Psychiatry, United States
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Eibl JK, Morin-Taus KA, Marsh DC. Too much or never enough: a response to Treatment of opioid disorders in Canada: looking at the 'other epidemic'. SUBSTANCE ABUSE TREATMENT PREVENTION AND POLICY 2016; 11:33. [PMID: 27646674 PMCID: PMC5029095 DOI: 10.1186/s13011-016-0076-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/18/2016] [Accepted: 09/08/2016] [Indexed: 11/30/2022]
Abstract
Prescription opioid (PO) misuse is a major health concern across North America, and it is the primary cause of preventable death for the 18–35 year old demographic. Medication assisted therapy including methadone and buprenorphine, is the standard of care for patients with opioid-dependence. Moreover, both of these medications are recognized as essential medicines by World Health Organization. In Ontario Canada, the availability of medication assisted therapy has expanded substantially, with almost a ten-fold increase number of patients accessing methadone in Ontario in the past decade. In their manuscript, Fischer et. al. (2016), present a view that expansion of opioid maintenance therapy (OMT) has outpaced true patient need and alternate strategies should be considered as first-line treatments. Here, we present a countering perspective-that medication assisted therapy, along with other harm reduction strategies, should be widely available to all opioid-dependent people as first-line treatments.
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Affiliation(s)
- Joseph K Eibl
- Northern Ontario School of Medicine, 935 Ramsey Lake Rd, Sudbury, Ontario, P3E 2C6, Canada
| | - Kristen A Morin-Taus
- Northern Ontario School of Medicine, 935 Ramsey Lake Rd, Sudbury, Ontario, P3E 2C6, Canada
| | - David C Marsh
- Northern Ontario School of Medicine, 935 Ramsey Lake Rd, Sudbury, Ontario, P3E 2C6, Canada. .,Canadian Addiction Treatment Centers, 13291 Yonge St., Ste. 403, Richmond Hill, Ontario, L4E 4L6, Canada.
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109
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Wakeman SE. Using Science to Battle Stigma in Addressing the Opioid Epidemic: Opioid Agonist Therapy Saves Lives. Am J Med 2016; 129:455-6. [PMID: 26836384 DOI: 10.1016/j.amjmed.2015.12.028] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2015] [Revised: 12/23/2015] [Accepted: 12/30/2015] [Indexed: 10/22/2022]
Affiliation(s)
- Sarah E Wakeman
- Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston.
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110
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Affiliation(s)
- Nora D Volkow
- From the National Institute on Drug Abuse, National Institutes of Health, Bethesda, MD (N.D.V.); and the Treatment Research Institute, Philadelphia (A.T.M.)
| | - A Thomas McLellan
- From the National Institute on Drug Abuse, National Institutes of Health, Bethesda, MD (N.D.V.); and the Treatment Research Institute, Philadelphia (A.T.M.)
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111
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Abstract
OBJECTIVE Prescription opioid abuse and dependence have escalated rapidly in the United States over the past 20 years, leading to high rates of overdose deaths and a dramatic increase in the number of people seeking treatment for opioid dependence. The authors review the scope of the abuse and overdose epidemic, prescription practices, and the assessment, treatment, and prevention of prescription opioid misuse and dependence. METHOD The authors provide an overview of the literature from 2006 to the present, with the twin goals of highlighting advances in prevention and treatment and identifying remaining gaps in the science. RESULTS A number of policy and educational initiatives at the state and federal government level have been undertaken in the past 5 years to help providers and consumers, respectively, prescribe and use opioids more responsibly. Initial reports suggest that diversion and abuse levels have begun to plateau, likely as a result of these initiatives. While there is a large body of research suggesting that opioid substitution coupled with psychosocial interventions is the best treatment option for heroin dependence, there is limited research focusing specifically on the treatment of prescription opioid dependence. In particular, the treatment of chronic pain in individuals with prescription opioid use disorders is underexplored. CONCLUSIONS While policy and educational initiatives appear to be effective in decreasing prescription opioid abuse and misuse, research focusing on the development and evaluation of treatments specific to prescription opioid dependence and its common comorbidities (e.g., chronic pain, depression) is critically needed.
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Affiliation(s)
- Kathleen T Brady
- From the Addiction Sciences Division, Institute of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston; and the Ralph H. Johnson Veterans Affairs Medical Center, Charleston
| | - Jenna L McCauley
- From the Addiction Sciences Division, Institute of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston; and the Ralph H. Johnson Veterans Affairs Medical Center, Charleston
| | - Sudie E Back
- From the Addiction Sciences Division, Institute of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston; and the Ralph H. Johnson Veterans Affairs Medical Center, Charleston
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