Medications for Opioid Use Disorder Save Lives (2019) / Chapter Skim
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Efforts to date have made no real headway in stemming this crisis, in large part because tools that already e xist -- like evidence-based medications -- are not being deployed to maximum impact. To support the dissemination of accurate, patient-focused information about evidence-based treatment for OUD, the National Institute on Drug Abuse and the Substance Abuse and Mental Health Services Administration asked a committee convened by the National Academies of Sciences, Engineering, and Medicine to examine the evidence base for medications to treat OUD and to identify barriers that prevent people from accessing safe, effective, medication-based treatment (see Box S-1)
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However, some addiction treatment facilities that ban medications are still being supported by funding streams that are tied to the criminal justice system or housing authorities, creating strong incentives to steer patients toward non-medication-based treatment approaches. As the number of people with OUD surges, the need for treatment is far outstripping the current capacity to deliver it.
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Making access to medications much broader and more equitable is a high priority for making meaningful progress in saving lives of those with OUD. OPIOID USE DISORDER IS A TREATABLE CHRONIC BRAIN DISEASE Addiction is a chronic disease that involves compulsive or uncontrolled use of one or more substances in the face of negative consequences.
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In fact, people with OUD have a chronic disease that, like many others, warrants long-term medical management beyond episodic acute care incidents. Conclusion 1: Opioid use disorder is a treatable chronic brain disease.
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Patients who receive medication have higher treatment retention rates, better longterm treatment outcomes, and improved social functioning; they are also less likely to inject drugs or transmit infectious diseases. For patients who have gone through withdrawal from opioids for a sufficient time, extendedrelease naltrexone may be used for maintenance treatment.
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Further research is needed to define an optimal treatment regimen for each of the available medications and to directly compare the effects of the three medications' long-term use. Nonetheless, in spite of the need for more research, the body of evidence amassed over the past 50 years underscores the benefits of longterm retention on medication.
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There is insufficient evidence regarding how the medications compare over the long term. Treatment with a combination of medication and evidence-based behavioral interventions (e.g., contingency management approaches, cognitive behavioral therapy, and structured family therapy)
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Some people may do well with medication and medical management alone. However, evidence-based behavioral interventions can be useful in engaging people with OUD in treatment, retaining them in treatment, improv ing their outcomes, and helping them resume a healthy functioning life.
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Conclusion 5: Most people who could benefit from medication-based treatment for opioid use disorder do not receive it, and access is inequitable across subgroups of the population. Available evidence suggests that medication-based treat ment for OUD is highly effective across all subgroups of the population, including adolescents, older persons, preg nant women, individuals with co-occurring disorders (e.g., psychiatric disorders, SUDs, infectious diseases)
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Pharmacies, mobile medication units, community health centers, emergency departments, and other care settings provide opportunities to engage people with OUD and link them to evidence-based care. Expanding medications for OUD into a broader range of care settings would save lives and build the capacity to make real progress against the epidemic.
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Food and Drug Administration–approved classes of medication for the treatment of opioid use disorder in any care or criminal justice setting is denying appropriate medical treatment. Treatment with FDA-approved medications is clearly effec tive in a broader range of care settings (e.g., office-based care setting, acute care, and criminal justice settings)
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Laws and regulatory requirements restrict outpatient methadone treatment to state- and federally certified OTPs, which is detrimental to long-term treatment adherence for many patients. Unlike methadone, buprenorphine is approved to be prescribed in officebased settings, but only by providers who undergo specialized training and obtain a waiver from the Drug Enforcement Administration.
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Almost half of nonelderly adults with OUD are covered by Medicaid, which has been shown to help connect people with medicationbased treatment for OUD and to improve treatment retention. However, Medicaid coverage for OUD medications varies widely by state, with some states excluding methadone and buprenorphine entirely.
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Study activities included a comprehensive literature review of the effectiveness of medications for OUD and the barriers people face in accessing them. The committee held a 1.5-day public workshop in Washington, DC, which was summarized in a Proceedings of a Workshop -- in Brief, as well as two 2-day closed committee meetings.
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