Medication-Assisted Treatment With Buprenorphine: Assessing the Evidence

Thomas, Cindy Parks; Fullerton, Catherine A.; Kim, Meelee; Montejano, Leslie; Lyman, D. Russell; Dougherty, Richard H.; Daniels, Allen S.; Ghose, Sushmita Shoma; Delphin-Rittmon, Miriam E.

doi:10.1176/appi.ps.201300256

Cited by 183 publications

(93 citation statements)

References 52 publications

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“…Growing knowledge around the neurobiology [5], genetic predisposition [6][7][8], and efficacy studies related to medication assisted treatment [9] provide an evidence-base which, in turn, has aided in the development of treatment guidelines; however, these effective treatment approaches have not been adopted as mainstream treatment options and are not offered to the majority of patients. There are currently greater than 2.5 million people suffering with OUD, with less than half of this population on medication assisted treatment [10].…”

Section: Individualizing Opioid Use Disorder (Oud) Treatment: Time Tomentioning

confidence: 99%

Individualizing Opioid Use Disorder (OUD) Treatment: Time to Fully Embrace a Chronic Disease Model

Gustin¹,

Nichols²,

Martin³

2015

J Reward Defic Syndr

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The current opioid epidemic in the United States is changing our perceptions of the face of addiction. Opioid Use Disorder (OUD) has become pervasive and is affecting all ethnicities, races, socioeconomic classes, the young and the old. In 2015, 46 people will lose their life each day to a chronic brain disease that is going unnoticed and undertreated. Over the last five decades, numerous scientific and clinical breakthroughs have allowed for a better understanding of the mechanisms underlying addiction, and the development of medications that can help support a patient's long-term recovery. All of those that have contributed to these advancements have aided in redefining addiction as a primary, chronic disease of the brain reward, motivation, memory and related circuitry; however, our treatment strategies have not necessarily advanced to the same extent as our current understanding of the disease. This commentary will explore how personal philosophies can bias treatments strategies and definitions of treatment success, and prevent adoption of chronic disease treatment models that would significantly improve the quality of life of those suffering with OUD. This is a challenge to consider how our views and stigma can impact a patient's recovery. We are currently losing a battle with a disease that is taking the lives of 46 individuals daily; it is time to fully embrace a chronic disease model which comprises an integrated pharmacopsychosocial approach for treating the biopsychosocial disorder that is addiction to reverse these trends.

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Section: Individualizing Opioid Use Disorder (Oud) Treatment: Time Tomentioning

confidence: 99%

Individualizing Opioid Use Disorder (OUD) Treatment: Time to Fully Embrace a Chronic Disease Model

Gustin¹,

Nichols²,

Martin³

2015

J Reward Defic Syndr

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“…Opioid maintenance therapy (OMT) with methadone or buprenorphine is an efficacious treatment for opioid use disorders (Mattick, Breen, Kimber, & Davoli, 2009; Mattick, Kimber, Breen, & Davoli, 2008; Thomas et al, 2014). OMT reduces illicit opioid use (Mattick et al, 2008; 2009), mortality (Clausen, Anchersen, & Waal, 2008; Degenhardt et al, 2011), criminal activity (Bates & Pemberton, 1996; Dolan et al, 2005; Mattick et al, 2009), healthcare costs (Tkacz, Volpicelli, Un, & Ruetsch, 2014), and high-risk behaviors associated with transmission of Human Immunodeficiency Virus (HIV) (Gowing, Farrell, Bornemann, Sullivan, & Ali, 2011).…”

Section: Introductionmentioning

confidence: 99%

Patient Perspectives Associated with Intended Duration of Buprenorphine Maintenance Therapy

Bentzley

Barth

Back

et al. 2015

Journal of Substance Abuse Treatment

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Patients with opioid use disorders frequently discontinue opioid maintenance therapy (OMT) prematurely, reducing retention and possibly limiting the efficacy of OMT. The current study is a cross-sectional survey of patients (N = 69) enrolled in buprenorphine maintenance therapy (BMT). We examined patient demographics, BMT characteristics (e.g., dose, time in BMT), and patient perspectives regarding intended duration of BMT. In addition, patients’ reasons for continuing or discontinuing BMT were investigated. Results revealed that the majority (82%) of participants reported wanting to continue BMT for at least 12 months. Age at first drug use, time in BMT, concern about pain, and concern about relapse were all positively associated with intended duration of BMT. The following were negatively associated with intended duration of BMT: recent discussion with a treatment provider about BMT discontinuation, prior attempt to discontinue BMT, concern about withdrawal symptoms, experiencing pleasurable effects from taking buprenorphine, and perceived conflicts of BMT with life, work, or school obligations. The most common reasons for wanting to continue BMT included concerns about withdrawal symptoms, relapse, and pain. Although preliminary, the findings highlight key issues with regard to patients’ perspectives of BMT. The results of this study provide information that may be useful in improving OMT programs and treatment outcomes.

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“…The finding that youth using heroin were less likely to cease injecting, coupled with the lack of an association of addiction treatment with cessation, suggests that current addiction treatment services may not meet the needs of vulnerable youth [25,26]. It is noteworthy that the majority of cessation events coincided with continued non-injection drug use.…”

Section: Discussionmentioning

confidence: 99%

Cessation of Injecting and Preceding Drug Use Patterns Among a Prospective Cohort of Street-Involved Youth

Hadland

Wood

Nosova

et al. 2017

Journal of Adolescent Health

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Purpose Injection drug use is prevalent among street-involved youth, but patterns of cessation are poorly described. We identified drug use patterns preceding injection cessation among street-involved youth. Methods From September 2005 to May 2015, we collected data from the At-Risk Youth Study, a prospective cohort of street-involved youth in Vancouver, Canada, and limited the sample to actively injecting youth. The primary outcome was cessation of injecting self-reported at semiannual follow-up visits. We used Cox regression to identify drug use patterns preceding cessation. Results Among 383 youth, 65% were male, mean age was 22.3 (SD, 2.5; range, 15–30) years, and 171 (45%) ceased injecting for 6 months or more (crude incidence density 22 per 100 person-years; 95% confidence interval [CI], 19–26). Youth who ceased were less likely to have injected daily (adjusted hazard ratio [AHR], 0.40; 95% CI, 0.28–0.56), injected heroin (AHR, 0.40; 95% CI, 0.29–0.56), or injected crystal methamphetamine (AHR, 0.43; 95% CI, 0.31–0.59) prior to cessation. Non-injection heroin use was positively associated with injection cessation (AHR, 1.52; 95 CI, 1.12–2.08). Addiction treatment was not associated with cessation. At the time of cessation, 101 (59%) youth continued to use ‘hard’ non-injection drugs such as heroin and crystal methamphetamine. Conclusions Periods of injection cessation were common but frequently accompanied by ongoing non-injection drug use. Findings indicate that trajectories of injection drug use among youth are complex and highlight the need to further explore relationships between ongoing non-injection drug use and injection cessation.

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Medication-Assisted Treatment With Buprenorphine: Assessing the Evidence

Abstract: BMT is associated with improved outcomes compared with placebo for individuals and pregnant women with opioid use disorders. BMT should be considered for inclusion as a covered benefit.

Cited by 183 publications

References 52 publications

Individualizing Opioid Use Disorder (OUD) Treatment: Time to Fully Embrace a Chronic Disease Model

Individualizing Opioid Use Disorder (OUD) Treatment: Time to Fully Embrace a Chronic Disease Model

Patient Perspectives Associated with Intended Duration of Buprenorphine Maintenance Therapy

Cessation of Injecting and Preceding Drug Use Patterns Among a Prospective Cohort of Street-Involved Youth

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