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4 Medications for Opioid Use Disorder in Various Treatment Settings
Pages 91-108

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From page 91...
... Food and Drug Administration–approved medication for the treatment of opioid use disorder in any care or criminal justice setting is denying appropriate medical treatment.
From page 92...
... OPIOID TREATMENT PROGRAMS The Narcotic Addict Treatment Act of 19742 requires that methadone be administered to patients only through federally certified and regulated opioid treatment programs (OTPs) , commonly referred to as methadone clinics.
From page 93...
... SOURCE: amfAR, 2018. Legend 1 2 3+ FIGURE 4-2 Substance use disorder treatment facilities offering medications for OUD, by county (2018)
From page 94...
... See Chapter 5 for a detailed discussion on how some of the regulations around methadone are a barrier to treatment. OFFICE-BASED OPIOID TREATMENT Expanding the delivery of medications for OUD through medical ­ ffice– o based treatment settings has been a strategy for increasing access to medications for OUD (see Box 4-1)
From page 95...
... . Several different pilot models of office-based methadone treatment soon followed in settings that included opioid treatment programs (OTPs)
From page 96...
... . A systematic review of studies that assessed different primary care and specialty care models for delivering medication-based treatment for OUD did not reach any strong conclusions regarding which specific delivery m ­ odels led to better patient outcomes (Lagisetty et al., 2017)
From page 97...
... Even though most providers in emergency departments and hospitals are not waivered to prescribe buprenorphine, non-waivered providers are permitted to administer buprenorphine or methadone to patients under their care for other medical reasons.5 Various studies indicate that effective medication-based treatment for OUD can be initiated in acute care settings and that patients can be successfully transferred to outpatient medication-based treatment after hospital discharge. The emergency department visit is a chance to treat people with OUD for withdrawal symptoms with medication and to bridge those p ­ atients to longer-term medication-based treatment plans (Chamberlin et al., 2018)
From page 98...
... 7  People with OUD in criminal justice settings often have co-occurring psychiatric disorders, they tend to have high rates of infectious diseases such as HIV and hepatitis C virus, and they often face complex challenges related to emotional, physical, social, and financial issues (Brochu et al., 1999)
From page 99...
... . Randomized trials have also compared the outcomes of people who initiate methadone treatment prior to release from incarceration versus those who were referred to treatment upon release.
From page 100...
... . Like other criminal justice practices involving people with OUD, civil commitment procedures typically do not involve the provision of medication-based treatment, and research demonstrates high rates both of return to use and of overdose postcommitment under these practices.
From page 101...
... . INNOVATIVE SETTINGS FOR OUD TREATMENT Expanding treatment to settings outside of the medical and specialty addiction sectors has the potential to increase treatment access for traditionally hard-to-reach and socially disenfranchised populations.
From page 102...
... . While technology advancements in behavioral health hold promise in the treatment of OUD, these tools need to be underpinned by a sound body of evidence assessing their impact on the access, quality, and cost of OUD treatment services from well-controlled randomized clinical trials (Ramsey, 2015)
From page 103...
... Food and Drug Administration–approved 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 settings, acute care, and criminal justice settings)
From page 104...
... 2016. The SOMATICS collaborative: Intro duction to a National Institute on Drug Abuse cooperative study of pharmacotherapy for opioid treatment in criminal justice settings.
From page 105...
... 2010. Unobserved versus observed office buprenorphine/naloxone induction: A pilot randomized clinical trial.
From page 106...
... 2016. Extended release naltrexone to prevent opioid relapse in criminal justice offenders.
From page 107...
... U.S. hospital discharges documenting patient opioid use disorder without opioid overdose or treatment services, 2011–2015.
From page 108...
... 2011. Interim m ­ ethadone treatment compared to standard methadone treatment: 4-month findings.


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