New Approaches in Drug Dependence: Opioids

Abstract

Purpose of Review This article aims to provide an overview of standard and adjunctive treatment options in opioid dependence in consideration of therapy-refractory courses. The relevance of oral opioid substitution treatment (OST) and measures of harm reduction as well as heroin-assisted therapies are discussed alongside non-pharmacological approaches. Recent Findings Currently, recommendation can be given for OST with methadone, buprenorphine, slow-release oral morphine (SROM), and levomethadone. Heroin-assisted treatment using diamorphine shall be considered as a cost-effective alternative for individuals not responding to the afore-mentioned opioid agonists in order to increase retention and reduce illicit opioid use. The modalities of application and the additional benefits of long-acting formulations of buprenorphine should be sufficiently transferred to clinicians and the eligible patients; simultaneously methods to improve planning of actions and self- management need to be refined. Regarding common primary outcomes in research on opioid treatment, evidence of the effectiveness of adjunctive psychological interventions is scarce. Summary Maintaining a harm reduction approach in the treatment of opioid addiction, a larger range of formulations is available for the prescribers. Embedding the pharmacological, ideally individualized treatment into a holistic, structure-giving concept also requires a reduction of fragmentation of ancillary services available, drug policies, and treatment philosophies on a global scale.

Rescue Analgesia for Opioid-Dependent Individuals on Opioid Agonist Treatment during Hospitalization: Adherence to Guideline Treatment

“…It was administered at doses between 0.05 and 1 g daily, mostly by mouth alone (26 cases) and predominantly in combination with other opioids (46 cases). This frequency is not surprising as preparations of diacetylmorphine in the tablet form are current practice in Switzerland [43]. Nevertheless, hospital records were mostly unclear in terms of whether the preexisting OAT was continued or not at unchanged doses during hospitalization, as recommended by authorities [23].…”

Exploring Patients’ Perceptions on Injectable Opioid Agonist Treatment: Influences on Treatment Initiation and Implications for Practice

“…A final aspect that has to date not sufficiently been considered is the multifaceted stigmatization of iOAT and the individuals receiving it within populations of those living with OUD, which acts as a substantial barrier to treatment engagement [47]. Participants’ accounts of iOAT as a treatment for “hopeless cases” resonate with medical and policy perspectives of iOAT as an exceptional “last resort” [48] suitable only for a “minority group of patients” meeting strict eligibility criteria [49, 50]. However, this is neither supported by medical evidence nor an established consensus.…”

Pain management for the neurosurgical patient in spinal procedures: overview of historic and new modalities

“…This type of fentanyl injection could help resolve acute short-term pain in patients who undergo spinal surgery, which in turn could decrease the amount of opiates given to these patients [18]. Despite using multiple modalities to help manage pain in neurosurgical patients, it is hard to eliminate opiates due to their ability to help with such acute post-surgical pain [19].…”