Preventing and Treating Narcotic Addiction — A Century of Federal Drug Control

Courtwright, David T.

doi:10.1056/nejmp1508818

Cited by 34 publications

(28 citation statements)

References 3 publications

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“…UDT has been described as a component of adherence monitoring programs; however, it also has been met with multiple controversies due to the explosive use of frequent UDT and genetic testing, as well as a multitude of abusive patterns. In fact, some practices have generated 80% of their revenues from UDT despite their multidisciplinary and large practice settings (12,42,109,161,390,(395)(396)(397)(398)410,(453)(454)(455)(456)(457). Even then, multiple benefits of UDT have been described (456,457).…”

Section: Adherence Monitoring Strategiesmentioning

confidence: 99%

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Responsible, Safe, and Effective Prescription of Opioids for Chronic Non-Cancer Pain: American Society of Interventional Pain Physicians (ASIPP) Guidelines

Kaye²,

et al. 2017

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Background: Opioid use, abuse, and adverse consequences, including death, have escalated at an alarming rate since the 1990s. In an attempt to control opioid abuse, numerous regulations and guidelines for responsible opioid prescribing have been developed by various organizations. However, the US opioid epidemic is continuing and drug dose deaths tripled during 1999 to 2015. Recent data show a continuing increase in deaths due to natural and semisynthetic opioids, a decline in methadone deaths, and an explosive increase in the rates of deaths involving other opioids, specifically heroin and illicit synthetic fentanyl. Contrary to scientific evidence of efficacy and negative recommendations, a significant proportion of physicians and patients (92%) believe that opioids reduce pain and a smaller proportion (57%) report better quality of life. In preparation of the current guidelines, we have focused on the means to reduce the abuse and diversion of opioids without jeopardizing access for those patients suffering from non-cancer pain who have an appropriate medical indication for opioid use. Objectives: To provide guidance for the prescription of opioids for the management of chronic non-cancer pain, to develop a consistent philosophy among the many diverse groups with an interest in opioid use as to how appropriately prescribe opioids, to improve the treatment of chronic non-cancer pain and to reduce the likelihood of drug abuse and diversion. These guidelines are intended to provide a systematic and standardized approach to this complex and difficult arena of practice, while recognizing that every clinical situation is unique. Methods: The methodology utilized included the development of objectives and key questions. The methodology also utilized trustworthy standards, appropriate disclosures of conflicts of interest, as well as a panel of experts from various specialties and groups. The literature pertaining to opioid use, abuse, effectiveness, and adverse consequences was reviewed, with a best evidence synthesis of the available literature, and utilized grading for recommendation as described by the Agency for Healthcare Research and Quality (AHRQ).

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Section: Adherence Monitoring Strategiesmentioning

confidence: 99%

“…Even then, multiple benefits of UDT have been described (456,457). Similarly, treatment agreements also have been criticized and their efficacy continue to be debated (12,42,109,161,390,396,397,453,454).…”

Section: Adherence Monitoring Strategiesmentioning

confidence: 99%

Responsible, Safe, and Effective Prescription of Opioids for Chronic Non-Cancer Pain: American Society of Interventional Pain Physicians (ASIPP) Guidelines

Kaye²,

et al. 2017

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“…Methadone dosing must be adjusted based on clinical signs and symptoms, and patients differ greatly in their dose requirements. Despite the clinical challenges posed by methadone administration, and resistance to MMT for social and cultural reasons, 9, 10 MMT remains a vitally important treatment strategy for hundreds of thousands of patients in the United States. 11 …”

Section: Introductionmentioning

confidence: 99%

Genome-wide association study of therapeutic opioid dosing identifies a novel locus upstream of OPRM1

Smith

Jensen

et al. 2017

Mol Psychiatry

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Opioids are very effective analgesics, but they are also highly addictive. Methadone is used to treat opioid dependence (OD), acting as a selective agonist at the μ-opioid receptor encoded by the gene OPRM1. Determining the optimal methadone maintenance dose is time-consuming; currently, no biomarkers are available to guide treatment. In methadone-treated OD subjects drawn from a case and control sample, we conducted a genome-wide association study (GWAS) of usual daily methadone dose. In African-American (AA) OD subjects (n = 383), we identified a genome-wide significant association between therapeutic methadone dose (mean = 68.0 mg, standard deviation (SD) = 30.1 mg) and rs73568641 (P = 2.8 × 10−8), the nearest gene (306 kilobases) being OPRM1. Each minor (C) allele corresponded to an additional ~20 mg/day of oral methadone, an effect specific to AAs. In European-Americans (EAs) (n = 1,027), no genome-wide significant associations with methadone dose (mean = 77.8 mg, SD = 33.9 mg) were observed. In an independent set of opioid-naïve AA children being treated for surgical pain, rs73568641-C was associated with a higher required dose of morphine (n = 241, P = 3.9 × 10−2). Similarly, independent genomic loci previously shown to associate with higher opioid analgesic dose were associated with higher methadone dose in the OD sample (AA and EA: n = 1,410, genetic score P = 1.3 × 10−3). The present results in AAs indicate that genetic variants influencing opioid sensitivity across different clinical settings could contribute to precision pharmacotherapy for pain and addiction.

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“…1–6 For overdose prevention and response research a broad assessment capable of capturing behavioral risks in populations with varying substance choices and use patterns is critically important, particularly as we seek to understand the precipitants of changes in overdose risk behaviors among at-risk populations.…”

Section: Introductionmentioning

confidence: 99%

Development of an Opioid-Related Overdose Risk Behavior Scale (ORBS)

et al. 2017

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Background Drug overdose has emerged as the leading cause of injury-related death in the U.S., driven by prescription opioid (PO) misuse, polysubstance use and use of heroin. To better understand opioid-related overdose risks that may change over time and across populations there is a need for a more comprehensive assessment of related risk behaviors. We developed the opioid-related Overdose Risk Behavior Scale (ORBS), drawing on existing research, formative interviews, and discussions with community and scientific advisors. Methods We enrolled military veterans reporting any use of heroin or POs in the past month using venue-based and chain referral recruitment. The final scale consisted of 25 items grouped into 5 subscales eliciting the number of days in the past 30 during which the participant engaged in each behavior. We assessed internal reliability using Cronbach’s alpha; test-retest reliability using intraclass correlation coefficients (ICCs); and criterion validity using Pearson’s correlations with indicators of having overdosed during the past 30 days. Results Data for 220 veterans were analyzed. The 5 subscales---A. Adherence to Opioid Dosage and Therapeutic Purposes, B. Alternative Methods of Opioid Administration, C. Solitary Opioid Use; D. Use of Non-prescribed Overdose-associated Drugs and E. Concurrent Use of POs, Other Psychoactive Drugs and Alcohol---generally showed good internal reliability (alpha range = 0.61 to 0.88), test-retest reliability (ICC range = 0.81 to 0.90), and criterion validity (r range = 0.22 to 0.66). The subscales were internally consistent with each other (alpha = 0.84). The scale mean had an ICC value of 0.99, and correlations with validators ranged from 0.44 to 0.56. Conclusions These results constitute preliminary evidence for the reliability and validity of the new scale. If further validated, it could help improve overdose prevention and response research, and could help improve the precision of overdose education and prevention efforts.

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Preventing and Treating Narcotic Addiction — A Century of Federal Drug Control

Cited by 34 publications

References 3 publications

Responsible, Safe, and Effective Prescription of Opioids for Chronic Non-Cancer Pain: American Society of Interventional Pain Physicians (ASIPP) Guidelines

Responsible, Safe, and Effective Prescription of Opioids for Chronic Non-Cancer Pain: American Society of Interventional Pain Physicians (ASIPP) Guidelines

Genome-wide association study of therapeutic opioid dosing identifies a novel locus upstream of OPRM1

Development of an Opioid-Related Overdose Risk Behavior Scale (ORBS)

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