Increases in Drug and Opioid-Involved Overdose Deaths — United States, 2010–2015

Rudd, Rose A.; Seth, Puja; David, Felicita; Scholl, Lawrence

doi:10.15585/mmwr.mm655051e1

Cited by 2,034 publications

(1,479 citation statements)

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“…A drug overdose crisis exists in the United States, with the majority (>60%) of deaths involving an opioid such as heroin, fentanyl, and carfentanil 1. The 2016 National Survey on Drug Use and Health survey indicated that, within the past year, approximately 2 million Americans aged 18 or older had an opioid use disorder (OUD) involving prescription pain relievers or heroin 2.…”

Section: Introductionmentioning

confidence: 99%

Antagonists in the medical management of opioid use disorders: Historical and existing treatment strategies

et al. 2018

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Background and ObjectivesOpioid use disorder (OUD) is a chronic condition with potentially severe health and social consequences. Many who develop moderate to severe OUD will repeatedly seek treatment or interact with medical care via emergency department visits or hospitalizations. Thus, there is an urgent need to develop feasible and effective approaches to help persons with OUD achieve and maintain abstinence from opioids. Treatment that includes one of the three FDA‐approved medications is an evidence‐based strategy to manage OUD. The purpose of this review is to address practices for managing persons with moderate to severe OUD with a focus on opioid withdrawal and naltrexone‐based relapse‐prevention treatment.MethodsLiterature available on PubMed was used to review the evolution of treatment strategies from the 1960s onward to manage opioid withdrawal and initiate treatment with naltrexone.ResultsEmerging practices for extended‐release naltrexone induction include the use of agonist tapers and adjuvant medications. Clinical challenges frequently encountered when initiating this therapy include managing withdrawal and ongoing opioid use during treatment. Clinical factors may inform decisions regarding patient selection and length of naltrexone treatment, such as recent opioid use and patient preferences.Conclusions and Scientific SignificanceTreatment strategies to manage opioid withdrawal have evolved, but many patients with OUD do not receive medication for the prevention of relapse. Clinical strategies for induction onto extended‐release naltrexone are now available and can be safely and effectively implemented in specialty and select primary care settings. (© 2018 The Authors. The American Journal on Addictions Published by Wiley Periodicals, Inc. on behalf of The American Academy of Addiction Psychiatry (AAAP);27:177–187)

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Section: Introductionmentioning

confidence: 99%

Antagonists in the medical management of opioid use disorders: Historical and existing treatment strategies

et al. 2018

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“…In 2015 alone, there were 52,404 drug overdose deaths in the US, 63.1 percent of which involved an opioid [2]. Due to the criminalization of drug use and addiction, the prevalence of opioid use is overrepresented in incarcerated populations.…”

Section: Introductionmentioning

confidence: 99%

Why It's Inappropriate Not to Treat Incarcerated Patients with Opioid Agonist Therapy

Wakeman¹

2017

AMA Journal of Ethics

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Due to the criminalization of drug use and addiction, opioid use disorder is overrepresented in incarcerated populations. Decades of evidence supports opioid agonist therapy as a highly effective treatment that improves clinical outcomes and reduces illicit opioid use, overdose death, and cost. Opioid agonist therapy has been both studied within correctional facilities and initiated prerelease. It has been found to be beneficial, yet few incarcerated persons receive this evidence-based treatment. In addition to not offering treatment initiation for those who need it, most correctional facilities forcibly withdraw stable patients from opioid agonist therapy upon their entry into the criminal justice system. This approach limits their access to evidence-based health care and results in negative outcomes for individuals, communities, and society.

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“…Opportunities and treatment availability are insuffi cient for increased treatment needs. Th is is accompanied by increase in opiate overdoses and deaths, and in the United States data on a tenfold increase since the year 1999 are reported, and epidemic proportions are discussed [3]. By contrast, in Europe, there is a certain decline in the number of opioid addicts, starting from 2011 e.g.…”

Section: Introductionmentioning

confidence: 99%

Recidivism with opiate addicted patients on buprenorphine substitution treatment: Case report

Crnic¹,

Todorovic²

2017

Hosp Pharm Int Multi J

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SUMMARYIntroduction: Opiate dependence is a serious, chronic and recurrent psychiatric disorder, whose prevalence reach epidemic proportions. This also contributes to a signifi cant increase in mortality, associated with overdose with opiates, as well as the rise in other health and social problems of the society. The methods and availability of treatment do not correspond to increased treatment needs, and treatment success is limited by the characteristics of the disorder, or numerous risk factors, which contribute to a high percentage of recidivism. Good clinical practice guidelines have defi ned treatment recommendations that include high and low-demanding programs. The personalized and integrative approaches are emphasized. Case report: The patient aged 41 years, intravenous-use opiate addict from his adolescences, with numerous psychological, health and social complications of addiction, is a participant in institutional treatment, following a court order as a measure of obligatory treatment, due to criminal off enses related to addiction. The history of the disease refers to numerous unsuccessful attempts to heal and short-term abstinence in the past, mainly in penal institutions. The patient meets all the criteria defi ned by the guidelines for inclusion in the buprenorphine maintenance program started in the year 2013. During the four-year treatment, the doses of the drug were adapted as needed; two heroin relapses and many in-risk situations for relapse were registered. The treatment continuated with close monitoring of the patient's condition and, with appropriate psychosocial interventions, contribute to keeping the patient in treatment and preventing the development of new complications of addiction, as well an improving the quality of his life. Discussion: Pharmacological treatment of opioid dependence relies on agents belonging to groups of antagonists, agonists and partial agonists of opiate receptors. The earlier programs with abstinence as a treatment goal have signifi cantly allocated the place to "harm reduction" programs, where the therapeutic goals are less demanding and defi ned as the harm-reduction of opiate dependence on the individual and the society. Treatment guidelines defi ne the principles and types of treatment regimens with agonists and partial agonists of opiate receptors and most commonly used are methadone and buprenorphine. The high risk of relapses despite treatment is defi ned and a comprehensive approaches and inclusion of Cognitive Behavior Therapy /CBT/, family and social therapy are needed.

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Increases in Drug and Opioid-Involved Overdose Deaths — United States, 2010–2015

Cited by 2,034 publications

References 9 publications

Antagonists in the medical management of opioid use disorders: Historical and existing treatment strategies

Antagonists in the medical management of opioid use disorders: Historical and existing treatment strategies

Why It's Inappropriate Not to Treat Incarcerated Patients with Opioid Agonist Therapy

Recidivism with opiate addicted patients on buprenorphine substitution treatment: Case report

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