Medications for Opioid Use Disorder Improve Patient Outcomes The Pew Charitable Trusts

Neonatal consultation, if available, can be considered prenatally to discuss postdelivery care of the infant. Screening for depression and other behavioral health conditions should be conducted. Opioid cross-tolerance often necessitates higher opioid analgesic doses at shorter intervals. Aversion therapy involves pairing aversive stimuli to cognitive images of opioid use and conversely conjuring images of socially appropriate behaviors such as employment, education, and nondrug behavior.

CDC is planning to enroll over 1,188 patients in approximately 65 sites throughout the country. All sites are outpatient treatment facilities, including opioid treatment programs, hospital and university-based treatment sites, federally qualified health centers, and primary care facilities. Individual treatment site information will not be released to protect patient and staff privacy. In assessing the current research, we note that many of the existing barriers and regulatory hurdles are themselves not evidence-based, and have historical roots in misperceptions and stigma around substance use.

SAMHSA National Hotline

States can also consider expanding the scope of practice for nurse practitioners to expand the pool of potential treatment providers, a strategy that may be especially useful in rural and underserved areas. DEA and SAMHSA can partner to explore methadone delivery models that can increase access to this lifesaving medication. For example, the agencies should approve pilot programs with evaluation that include pharmacy and office-based methadone treatment for patients.

The evidence suggests that low-threshold approaches can increase access to treatment, with outcomes comparable to high-barrier, standard care. Barriers to seeking care may include some of the others discussed in this paper. For example, people may be wary of seeking treatment because of the stigma from their communities, opioid addiction treatment employers, or health care providers. Others may not know where to find treatment, or may be unable to find available treatment slots when they are motivated to seek care. Some may forgo treatment because it is too costly, because it is too far from where they live, or it may interfere with their employment commitments.

Can Anyone Get Methadone or Buprenorphine Treatment?

If the pregnant woman is already receiving therapy with methadone, she should not transition to buprenorphine because of the significant risk of precipitated withdrawal. There is not a similar risk of withdrawal when transitioning from buprenorphine to methadone. The potential risk of unrecognized, adverse long-term outcomes with buprenorphine use, which is inherent with use of any relatively new medications during pregnancy, should always be taken into consideration. The U.S. Food and Drug Administration has recently approved a long-acting buprenorphine implant that provides low-to-moderate doses of buprenorphine for up to 6 months for treatment of opioid use disorder in patients stable on the sublingual form. Trying to quit “cold turkey” is not recommended, ASAM advises, because it can lead to stronger cravings and continued use.

Fear of overregulation by DEA can be a powerful deterrent to providing effective care. Data show that nonprescribers are significantly more likely than other clinicians to cite the potential for DEA intrusion into clinical practice as a barrier to providing MOUD . Finally, payers often introduce policies that limit and delay access to lifesaving treatment.

Federal Laws Limiting Access to Methadone

The development of a public health framework could improve system-level practice and treatment outcomes. For example, the Pennsylvania Department of Human Services recently initiated an example of incentivized reform . Research on the outcomes of this initiative may soon illustrate whether this model is adaptable for other communities. One key challenge is the lack of evidence-based practice in existing substance use treatment facilities.

• Pharmacologic therapy for heroin addiction has focused on ameliorating withdrawal symptoms and reducing cravings.
• One key challenge is the lack of evidence-based practice in existing substance use treatment facilities.
• Initiating buprenorphine treatment for OUD in emergency departments increases treatment engagement .
• Studies should avoid a sole focus on abstinence outcomes, which is inconsistent with the harm reduction principle of low-threshold treatment, and may not reflect patients’ own goals for their treatment.

Screening—A health care professional assesses a patient for risky substance use behaviors using standardized screening tools. Verify methadone and buprenorphine doses with clinics or prescribing physicians, and inform these physicians of any benzodiazepines or opioids given that may be detected on urine drug screening. As more patients with opioid addiction receive OAT, physicians will encounter OAT patients with acute pain syndromes.

What are the symptoms of an opioid overdose?

People usually have to take this medicine in a clinic or other supervised location. The two medicines most often used are methadone and buprenorphine; they are described below. Prescription drug monitoring programs are often among the programmatic strategies that states employ to combat overdose mortality rates . PDMPs help support high-quality care when reliable information and guidance are made readily available to clinicians. However, evidence suggests that these programs show uncertain effectiveness in changing prescribing behavior, reducing misuse and diversion of controlled substances, and reducing opioid-related mortality . This is in part because the programs vary widely across states in their reliability, consistency, ease of use, and utilization .

• As such, diversion may reflect the need to increase, rather than restrict, access to prescribed buprenorphine.
• Prescription drug monitoring programs are often among the programmatic strategies that states employ to combat overdose mortality rates .
• The medication effects—in addition to patient-specific factors, such as response to past treatment—guide medication treatment selection.
• Like other diseases, opioid use disorder has specific symptoms and a pattern of progression , and treatments may help bring it under control.
• Before initiating opioid therapy for chronic pain for reproductive-aged women, clinicians should discuss family planning and how long-term opioid use might affect care during a future pregnancy.
• According to the World Health Organization , naloxone is one of a number of medications considered essential to a functioning health care system.