Executive Summary of the Focused Update of the ASAM National Practice Guideline for the Treatment of Opioid Use Disorder

Abstract

A Focused Update of the ASAM National Practice Guideline for the Treatment of Opioid Use Disorder is published in the current issue of the Journal of Addiction Medicine. The focused update included a search of Medline's PubMed database from January 1, 2014 to September 27, 2018, as well as a search of the grey literature (archives of the Clinical Guideline Clearinghouse, and key agency and society websites) for new practice guidelines and relevant systematic reviews addressing the use of medications and psychosocial treatments in the treatment of opioid use disorder, including within special populations. The search identified 11 practice guidelines and 35 systematic reviews that informed the subsequent RAND/UCLA Appropriateness Method (RAM) process employed to facilitate the focused update by a National Guideline Committee of addiction experts. New and updated recommendations were included if they were considered: (a) clinically meaningful and applicable to a broad range of clinicians treating addiction involving opioid use; and (b) urgently needed to ensure the Practice Guideline reflects the current state of the science for the existing recommendations, aligns with other relevant practice guidelines, and reflects newly approved medications and formulations.

Ethical Imperatives to Overcome Stigma Against People With Substance Use Disorders

“…For decades, the addiction treatment system in the United States has been largely separate from the rest of health care, and this reality both stems from and feeds stigma. Although MOUD is now recognized as the gold standard in the treatment of OUD, 15 opioid treatment programs, which have offered methadone to people with OUD for decades, remain the only source of this effective medication. 16 Unfortunately, they are often viewed by communities as potential settings of drug-related crime.…”

Opportunities to Offer Harm Reduction to People who Inject Drugs During Infectious Disease Encounters: Narrative Review

“…Beyond harm reduction is treatment with pharmacotherapy of an underlying SUD if one exists. For MOUD, there are 3 FDA-approved medications including opioid agonist treatment options, methadone, and buprenorphine, in addition to an opioid antagonist treatment option, extended-release naltrexone [ 80 ]. Methadone and buprenorphine have been associated with significant reductions in OD and emergency department utilization or hospitalization related to opioids and are considered first-line agents [ 81–83 ].…”

“…Methadone and buprenorphine have been associated with significant reductions in OD and emergency department utilization or hospitalization related to opioids and are considered first-line agents [ 81–83 ]. Despite this, methadone and buprenorphine remain underutilized given significant treatment access limitations [ 80 ]. Methadone access is restricted due to prescribing limitations for OUD outside of a certified opioid treatment program, which preclude low-threshold access from an ID setting.…”

“…Buprenorphine, on the other hand, can be prescribed and managed in outpatient settings, though obtaining a Drug Addiction Treatment Act (DATA) waiver to prescribe is required first. As such, access is largely restricted by the limited number of clinicians who have obtained the DATA waiver to prescribe buprenorphine [ 80 ]. However, access could be readily expanded if ID clinicians obtained the DATA waiver and offered this as a treatment option to PWID alongside harm reduction during ID encounters.…”

Relative Cost Differences of Initial Treatment Strategies for Newly Diagnosed Opioid Use Disorder

“… 8 , 9 The Centers for Disease Control and Prevention Guideline for Prescribing Opioids for Chronic Pain and American Society of Addiction Medicine (ASAM) recommend buprenorphine or methadone for individuals with OUD. 10 , 11 Psychosocial interventions are available in a range of settings including outpatient counseling, intensive outpatient (IOP) or partial hospitalization programs, or intensive inpatient detoxification or rehabilitation. Given increasing expense and limited capacity with inpatient settings, guidelines have been developed by ASAM to match patients to the least intensive setting needed based on patient presentation across several domains.…”