Methadone for Opioid Use Disorder

2020 ◽  
pp. 139-154
Author(s):  
Dennis J. Hand
Keyword(s):  
Addiction Treatment ◽  
Methadone Treatment ◽  
Opioid Use Disorder ◽  
Term Treatment ◽  
Opioid Use ◽  
Opioid Agonist ◽  
Long Term Treatment ◽  
Long Acting ◽  
Practical Factors

Methadone is a long-acting full opioid agonist that has a long history in the treatment of opioid use disorder (OUD). It was the first opioid agonist with OUD as an indication for use. Methadone was developed for OUD during a time of prohibition and criminalization of both addiction and the use of opioid agonists for addiction treatment, which resulted in methadone being heavily regulated at multiple levels. Methadone is frequently used in short-term withdrawal management (i.e., detoxification) and in long-term treatment, with the latter producing better treatment outcomes. This chapter explores the basic pharmacology of methadone and the development of methadone for OUD and its accompanying regulations, discusses the place of methadone in treatment for OUD, reviews the effectiveness of methadone treatment, and visits some practical factors related to methadone as part of treatment for OUD.

scholarly journals Development of an Emergency Department-Based Intervention to Expand Access to Medications for Addiction Treatment for Opioid Use Disorder in Appalachia: Protocol for Engagement and Community Collaboration (Preprint)

2020 ◽  
Author(s):  
Lauren A. Walter ◽  
LI Y. Li ◽  
Joel Rodgers ◽  
Jennifer Hess ◽  
Rachel Skains ◽  
...  
Keyword(s):  
Addiction Treatment ◽  
The United States ◽  
Opioid Use Disorder ◽  
Term Treatment ◽  
Opioid Overdose ◽  
Jefferson County ◽  
Opioid Use ◽  
Resource Limited ◽  
Long Term Treatment

BACKGROUND The opioid epidemic has disproportionately impacted the Appalachian region of the United States (US), a region characterized by higher poverty rates, healthcare access challenges, and higher opioid overdose death rates than other parts of the country. Jefferson County, Alabama, located in Southern Appalachia, has been especially affected, with overdose rates over two times greater than the statewide average (48.8 versus 19.9 overdoses per 10,000 persons). Emergency Departments (EDs) have been recognized as a major source of healthcare for persons with Opioid Use Disorder (OUD). A program to initiate medications for addiction treatment (MAT) for OUD in the ED has been shown to be effective. Likewise, continued patient engagement in a recovery or treatment program after ED discharge has been shown to be efficacious and impactful for long-term treatment success. OBJECTIVE This protocol outlines a framework for ED-initiated MAT for OUD in a resource-limited region of the US, made possible through community partnerships with referral resources for definitive OUD care. METHODS When a patient presents to the ED with symptoms of opioid withdrawal, non-fatal opioid overdose, or requesting opioid detoxification, clinicians will screen for OUD using the Diagnostic and Statistical Manual of Mental Disorders-5 diagnosis. All patients who screen positive for OUD will be further engaged and assessed for study eligibility. Recruited subjects will be evaluated for signs and symptoms of withdrawal, treated with buprenorphine/naloxone as appropriate, and given a prescription for take-home induction along with an intranasal naloxone kit. At the time of ED discharge, a peer navigator from a local substance use coordinating center will be engaged to facilitate patient referral to a regional substance abuse coordinating center for longitudinal addiction treatment. RESULTS This project is currently ongoing. It was funded in February, 2019, and approved by the University of Alabama at Birmingham IRB in June, 2019. Data collection began on July 7th, 2019 with projected end date February, 2022. Seventy-nine subjects have been enrolled to date. Results to be published in summer 2022. CONCLUSIONS ED recognition of OUD accompanied by buprenorphine/naloxone induction and referral for subsequent long-term treatment engagement have been shown to be one component of an effective strategy for addressing the ongoing opioid crisis. Establishing community and local partnerships, particularly in resource limited areas such as Appalachia, are crucial for the continuity of addiction care and rehabilitation outcomes.

Pharmacotherapy for substance use disorders within correctional facilities

2015 ◽  
Author(s):  
Sarah E. Wakeman ◽  
Josiah D. Rich
Keyword(s):  
Substance Use ◽  
Substance Use Disorders ◽  
Behavioral Interventions ◽  
Opioid Dependence ◽  
Addiction Treatment ◽  
Term Treatment ◽  
Opiate Dependence ◽  
Opioid Use ◽  
Long Term Treatment

Drug addiction treatment is increasingly complex. Only 5% of prisons and 34% of jails offer any detoxification services, and only 1% of jails offer methadone for opioid withdrawal. Even fewer facilities offer medication assisted therapy (MAT) for alcohol or substance use disorders despite the tremendous evidence base supporting the use of medications to treat addiction. Untreated opioid dependence both within corrections and in the community is associated with HIV, Hepatitis C, crime, and death by overdose. Substantial evidence argues that these risks are reduced through long-term treatment with agonist medications such as methadone and buprenorphine. Only a minority of prisoners receive any addiction treatment while incarcerated. Those that do are usually offered behavioral interventions, which when used alone have extremely poor outcomes. Although there are limited studies on the outcomes of drug treatment during incarceration, there are nearly 50 years of evidence documenting the efficacy of methadone given in the community in reducing opioid use, drug-related health complications, overdose, death, criminal activity, and recidivism. Buprenorphine is similarly an effective, safe, and cost-effective long-term treatment for opioid dependence that reduces other opioid use and improves health and quality of life outcomes. There is a growing role for MAT in jails, and to a lesser degree in prisons for the treatment of alcohol and opiate dependence. This chapter presents the current state of evidence based practice in correctional MAT models.

scholarly journals Long-term treatment outcomes in a First Nations high school population with opioid use disorder

2020 ◽  
Vol 66 (12) ◽  
pp. 907-912
Author(s):  
Anita Srivastava ◽  
Meldon Mayer Kahan ◽  
Mae Katt ◽  
Tammy Patriquin ◽  
Henry Becker ◽  
...  
Keyword(s):  
High School ◽  
Treatment Outcomes ◽  
First Nations ◽  
Opioid Use Disorder ◽  
Term Treatment ◽  
Opioid Use ◽  
School Population ◽  
Long Term Treatment

Opioids

2020 ◽  
pp. 109-148
Author(s):  
Darius A. Rastegar
Keyword(s):  
Respiratory Depression ◽  
Opioid Use Disorder ◽  
Opioid Antagonist ◽  
Opioid Use ◽  
Opioid Agonist ◽  
Level Of Consciousness ◽  
Long Acting ◽  
Self Help Groups ◽  
Prescription Pain Relievers

Opioids are a class of drugs that include heroin and prescription pain relievers that produce analgesia and euphoria. More than 2 million Americans have an opioid use disorder. Acute effects include analgesia, respiratory depression, miosis, and euphoria. Overdose is a serious complication of opioid use, characterized by depressed level of consciousness and respiratory depression. It can be treated with naloxone. Withdrawal symptoms include dysphoria, yawning, tearing, diarrhea, cramps, nausea, and piloerection. Buprenorphine, methadone, clonidine, and lofexidine can be used to ameliorate the symptoms of withdrawal. However, supervised withdrawal alone rarely leads to long-term abstinence. There are a number of psychosocial treatments, including self-help groups, outpatient therapy, and residential treatment; the data on their effectiveness are limited. Pharmacotherapy with an opioid agonist (methadone or buprenorphine) is the most effective treatment. Long-acting injectable naltrexone, an opioid antagonist, is also effective, but it is more difficult to initiate.

Pharmacotherapy for substance use disorders within correctional facilities

2017 ◽  
Author(s):  
Sarah E. Wakeman ◽  
Josiah D. Rich
Keyword(s):  
Substance Use ◽  
Substance Use Disorders ◽  
Behavioral Interventions ◽  
Opioid Dependence ◽  
Addiction Treatment ◽  
Term Treatment ◽  
Opiate Dependence ◽  
Opioid Use ◽  
Long Term Treatment

Drug addiction treatment is increasingly complex. Only 5% of prisons and 34% of jails offer any detoxification services, and only 1% of jails offer methadone for opioid withdrawal. Even fewer facilities offer medication assisted therapy (MAT) for alcohol or substance use disorders despite the tremendous evidence base supporting the use of medications to treat addiction. Untreated opioid dependence both within corrections and in the community is associated with HIV, Hepatitis C, crime, and death by overdose. Substantial evidence argues that these risks are reduced through long-term treatment with agonist medications such as methadone and buprenorphine. Only a minority of prisoners receive any addiction treatment while incarcerated. Those that do are usually offered behavioral interventions, which when used alone have extremely poor outcomes. Although there are limited studies on the outcomes of drug treatment during incarceration, there are nearly 50 years of evidence documenting the efficacy of methadone given in the community in reducing opioid use, drug-related health complications, overdose, death, criminal activity, and recidivism. Buprenorphine is similarly an effective, safe, and cost-effective long-term treatment for opioid dependence that reduces other opioid use and improves health and quality of life outcomes. There is a growing role for MAT in jails, and to a lesser degree in prisons for the treatment of alcohol and opiate dependence. This chapter presents the current state of evidence based practice in correctional MAT models.

scholarly journals What Differs between Patients under Methadone and under Buprenorphine for Opioid Use Disorder (OUD) in Daily Clinical Practice in France? A Short Report

2021 ◽  
Vol 18 (4) ◽  
pp. 1425
Author(s):  
Morgane Guillou-Landreat ◽  
Antoine Dany ◽  
Gaëlle Challet-Bouju ◽  
Edouard Laforgue ◽  
Juliette Leboucher ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Opioid Use Disorder ◽  
Term Treatment ◽  
Pharmacological Therapy ◽  
Daily Clinical Practice ◽  
Short Report ◽  
Opioid Use ◽  
Cross Sectional ◽  
Long Term Treatment ◽  
Social Profiles

(1) Background: Opioid use disorder (OUD) is a complex condition that can require long-term treatment. Pharmacological therapy for OUD involves treatment with opioid agonists (OMT) tailored to individual profiles. The aim of our study in daily clinical practice was to compare the profiles of patients treated with methadone (MTD) and those using buprenorphine (BHD or BHD-naloxone-NX). (2) Methods: A cross-sectional multicentre study explored the psychological, somatic and social profiles of patients with Opioid Use Disorder (OUD) following Opioid Maintenance Treatment (BHD, BHD/NX, or MTD). Descriptive and comparative analyses were performed (3) Results: 257 patients were included, a majority were men using heroin. 68% (178) were on MTD, 32% (79) were on BHD. Patients with MTD were significantly more likely to report socio-affective damage, and more likely to be younger and not to report oral or sublingual use as the main route for heroin or non-medical opioids (4) Conclusions: In daily clinical practice, regarding OUD damage, only socio-affective damage was significantly more prevalent among patients on MTD than among those on BHD in the multivariate model. Age and route of administration also differed, and our results could raise the issue of the type of OMT prescribed in case of non-medical use of prescribed opioids. These hypothesis should be confirmed in larger studies.

Sustained drug delivery optimizes long-term treatment of patients with schizophrenia

2004 ◽  
Vol 16 (6) ◽  
pp. 319-325 ◽  
Author(s):  
Pierre S. Chue ◽  
Peter D'Hoore ◽  
J. Michael Ramstack
Keyword(s):  
Antipsychotic Agents ◽  
Term Treatment ◽  
Treatment Programs ◽  
Sustained Drug Delivery ◽  
Partial Compliance ◽  
Long Term Treatment ◽  
Optimal Maintenance ◽  
Long Acting ◽  
The Impact

Chronic disorders such as schizophrenia require long-term treatment programs in order to maintain patients at the lowest level of symptomatology, reduce the likelihood of psychotic relapse, and support achievement of remission and recovery. Evidence suggests that treatment with long-acting injectable antipsychotics reduces the impact of partial compliance and provides predictable release of medication, assuring continuous therapeutic coverage. Until recently, only conventional antipsychotic agents were available in long-acting formulations, thereby foregoing the advantages of the atypical class. Atypical agents which are given orally have been shown to provide long-term efficacy and tolerability benefits compared with conventional agents, but are limited by the need for daily administration. The most recent pharmacological strategy to achieve optimal maintenance treatment has been to combine the benefits of an atypical antipsychotic with delivery in a water-based long-acting formulation. The first antipsychotic to achieve this combination – long-acting risperidone – may thus represent an important advance in the optimization of long-term treatment outcomes in patients with schizophrenia.

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