scholarly journals Patterns of withdrawal in patients with opioid use disorder (OUD) transitioning from untreated OUD or buprenorphine treatment to extended-release naltrexone

2021 ◽  
pp. 1-7
Author(s):  
Paolo Mannelli ◽  
Antoine B. Douaihy ◽  
Abigail Zavod ◽  
Anna Legedza ◽  
Sarah C. Akerman ◽  
...  
Keyword(s):  
Extended Release ◽  
Opioid Use Disorder ◽  
Opioid Use ◽  
Buprenorphine Treatment

scholarly journals A Delta-Opioid Receptor Gene Polymorphism Moderates the Therapeutic Response to Extended-Release Buprenorphine in Opioid Use Disorder

2020 ◽  
Author(s):  
Henry R Kranzler ◽  
Kevin G Lynch ◽  
Richard C Crist ◽  
Emily Hartwell ◽  
Anne Le Moigne ◽  
...  
Keyword(s):  
Placebo Group ◽  
Opioid Receptor ◽  
Odds Ratio ◽  
Extended Release ◽  
Receptor Gene ◽  
Opioid Use Disorder ◽  
Delta Opioid Receptor ◽  
Opioid Use ◽  
Log Odds ◽  
Buprenorphine Treatment

Abstract Background Buprenorphine treatment is not equally effective in all patients with opioid use disorder (OUD). Two retrospective studies showed that, among African Americans (AAs), rs678849, a polymorphism in the delta-opioid receptor gene, moderated the therapeutic effect of sublingual buprenorphine. Methods We examined rs678849 as a moderator of the response to an extended-release subcutaneous buprenorphine formulation (BUP-XR) in a 24-week OUD treatment study of 127 AAs and 327 European Americans (EAs). Participants were randomly assigned to receive: (1) BUP-XR as 2 monthly injections of 300 mg followed by either 300 mg monthly or 100 mg monthly for 4 months, or (2) monthly volume-matched placebo injections. Generalized estimating equations logistic regression analyses tested, per population group, the main and interaction effects of treatment (BUP-XR vs placebo) and genotype group (rs678849*CC vs CT/TT) on weekly urine drug screens (UDS). Results Among AAs, the placebo group had higher rates of opioid-positive UDS than the BUP-XR group (log odds ratio = 1.67, 95% CI = 0.36, 2.98), but no genotype by treatment effect (P = .80). Among EAs, the placebo group also showed higher rates of opioid-positive UDS than the BUP-XR group (log odds ratio = 1.97, 95% CI = 1.14, 2.79) but a significant genotype by treatment interaction (χ 2(1) = 4.33, P = .04). Conclusion We found a moderating effect of rs678849 on the response to buprenorphine treatment of OUD in EAs, but not AAs. These findings require replication in well-powered, prospective studies of both AA and EA OUD patients treated with BUP-XR and stratified on rs678849 genotype.

scholarly journals Prior National Drug Abuse Treatment Clinical Trials Network (CTN) opioid use disorder trials as background and rationale for NIDA CTN-0100 “optimizing retention, duration and discontinuation strategies for opioid use disorder pharmacotherapy (RDD)”

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Matisyahu Shulman ◽  
Roger Weiss ◽  
John Rotrosen ◽  
Patricia Novo ◽  
Elizabeth Costello ◽  
...  
Keyword(s):  
Clinical Trials ◽  
Extended Release ◽  
Primary Outcome ◽  
Opioid Use Disorder ◽  
Drug Abuse Treatment ◽  
Opioid Use ◽  
National Drug ◽  
Retention In Treatment ◽  
Abuse Treatment

AbstractOpioid use disorder continues to be a significant problem in the United States and worldwide. Three medications—methadone, buprenorphine, and extended-release injectable naltrexone,— are efficacious for treating opioid use disorder (OUD). However, the utility of these medications is limited, in part due to poor rates of retention in treatment. In addition, minimum recovery milestones and other factors that influence when and whether individuals can safely discontinue medications are unknown. The National Drug Abuse Treatment Clinical Trials Network (CTN) study “Optimizing Retention, Duration, and Discontinuation Strategies for Opioid Use Disorder Pharmacotherapy” (RDD; CTN-0100) will be among the largest clinical trials on treatment of OUD yet conducted, consisting of two phases, the Retention phase, and the Duration-Discontinuation phase. The Retention phase, open to patients initiating treatment, will test different doses and formulations of buprenorphine (standard dose sublingual, high dose sublingual, or extended-release injection), and a digital therapeutic app delivering contingency management and cognitive behavioral counseling on the primary outcome of retention in treatment. The Discontinuation phase, open to patients in stable remission from OUD and choosing to discontinue medication (including participants from the Retention phase or from the population of patients treated at the clinical site, referred by an outside prescriber or self-referred) will study different tapering strategies for buprenorphine (sublingual taper vs taper with injection buprenorphine), and a digital therapeutic app which provides resources to promote recovery, on the primary outcome of relapse-free discontinuation of medication. This paper describes how the RDD trial derives from two decades of research in the CTN. Initial trials (CTN-0001; CTN-0002; CTN-0003) focused on opioid detoxification, showing buprenorphine-naloxone was effective for detoxification, but that acute detoxification did not appear to be an effective treatment strategy. Trials on comparative effectiveness of medications for opioid use disorder (MOUD) (CTN-0027; CTN-0030; and CTN-0051) highlighted the problem of dropout from treatment and few trials defined retention on MOUD as the primary outcome. Long-term follow-up studies on those patient samples demonstrated the importance of long-term continuation of medication for many patients to sustain remission. Overall, these trials highlight the potential of a stable research infrastructure such as CTN to advance treatment effectiveness through a programmatic succession of large clinical trials.

Impact of High Deductible Health Plans on Continuous Buprenorphine Treatment for Opioid Use Disorder

2021 ◽  
Author(s):  
Alene Kennedy-Hendricks ◽  
Cameron J. Schilling ◽  
Alisa B. Busch ◽  
Elizabeth A. Stuart ◽  
Haiden A. Huskamp ◽  
...  
Keyword(s):  
Opioid Use Disorder ◽  
Health Plans ◽  
Opioid Use ◽  
Buprenorphine Treatment

scholarly journals Project ECHO and primary care buprenorphine treatment for opioid use disorder: Implementation and clinical outcomes

2021 ◽  
pp. 1-9
Author(s):  
James B. Anderson ◽  
Stephen A. Martin ◽  
Anne Gadomski ◽  
Nicole Krupa ◽  
Daniel Mullin ◽  
...  
Keyword(s):  
Primary Care ◽  
Clinical Outcomes ◽  
Opioid Use Disorder ◽  
Opioid Use ◽  
Project Echo ◽  
Buprenorphine Treatment

scholarly journals Buprenorphine Induction in a Rural Maryland Detention Center During COVID-19: Implementation and Preliminary Outcomes of a Novel Telemedicine Treatment Program for Incarcerated Individuals With Opioid Use Disorder

2021 ◽  
Vol 12 ◽  
Author(s):  
Annabelle M. Belcher ◽  
Kelly Coble ◽  
Thomas O. Cole ◽  
Christopher J. Welsh ◽  
Anna Whitney ◽  
...  
Keyword(s):  
Opioid Use Disorder ◽  
Community Treatment ◽  
Successful Implementation ◽  
Opioid Use ◽  
Screening Process ◽  
Detention Center ◽  
Medication Prescription ◽  
Proven Efficacy ◽  
Pass Through ◽  
Buprenorphine Treatment

Over 10 million individuals pass through U.S. detention centers on an annual basis, with nearly two-thirds meeting criteria for drug dependence/abuse. Despite proven efficacy, treatment with medications for opioid use disorder (MOUD) is underutilized in jail settings—a gap that could be addressed using telemedicine. Here we describe a new program of telemedicine-based clinical provision of new/continuing buprenorphine treatment for individuals detained in a rural jail. Implementation objectives were completed between January and August 2020, and patient encounters were conducted between August 2020 and February 2021. We established (i) telemedicine hardware/software capability; (ii) a screening process; (iii) buprenorphine administration methods; (iv) necessary medical release procedures; (v) telemedicine encounter coordination and medication prescription procedures; and (vi) a research platform. Seven incarcerated patients have been treated, two of whom were referred from community treatment. Patients were mostly male (71%), non-Hispanic White (86%), and averaged 33 years old. All patients tested positive for an opioid upon intake and began/continued buprenorphine treatment in the jail. Average time to first MOUD appointment was 9 days and patients were maintained in treatment an average 21 days. Referrals for continuing community treatment were offered to all patients prior to discharge. We report successful implementation of telemedicine MOUD in a rural detention center, with treatment engagement and initiation occurring prior to the high-risk period of discharge. The fact that this program was launched during the height of the pandemic highlights the flexibility of telemedicine-based buprenorphine treatment. Challenges and obstacles to implementation of buprenorphine treatment in a correctional system are discussed.

scholarly journals Recovery From Opioid Use Disorder (OUD) After Monthly Long-acting Buprenorphine Treatment

2020 ◽  
Vol Publish Ahead of Print ◽  
Author(s):  
Walter Ling ◽  
Vijay R. Nadipelli ◽  
Arnie P. Aldridge ◽  
Naoko A. Ronquest ◽  
Caitlyn T. Solem ◽  
...  
Keyword(s):  
Opioid Use Disorder ◽  
Opioid Use ◽  
Long Acting ◽  
Buprenorphine Treatment

scholarly journals Beyond Antibiotics: A Practical Guide for the Infectious Disease Physician to Treat Opioid Use Disorder in the Setting of Associated Infectious Diseases

2019 ◽  
Vol 7 (1) ◽  
Author(s):  
Nikhil Seval ◽  
Ellen Eaton ◽  
Sandra A Springer
Keyword(s):  
Infectious Disease ◽  
Extended Release ◽  
Hospital Admissions ◽  
Opioid Use Disorder ◽  
Evidence Based ◽  
Opioid Use ◽  
Patient Centered ◽  
Infectious Disease Physician ◽  
Centered Care ◽  
Acute Injection

Abstract Infections are a common cause of hospitalization for patients with opioid use disorder (OUD), and hospital admissions are rising in the context of the worsening US opioid crisis. Infectious disease (ID) physicians are frequently the first point of medical contact for these patients. In this article, we discuss the integration of evidence-based management of OUD and patient-centered care of hospitalized persons with acute injection-related infections. We describe the following components of a comprehensive approach for OUD with inpatient ID consultations: (1) how to screen for OUD; (2) how to initiate the 3 US Food and Drug Administration-approved medications for OUD (buprenorphine, methadone, and extended-release naltrexone); (3) how to manage acute pain and opioid-related conditions; and (4) how to link and integrate ID and OUD treatment after hospital discharge. These strategies reduce unplanned discharges and increase completion of recommended antimicrobial regimens.

Sign in / Sign up

Export Citation Format

Share Document