what is the gold standard treatment for opiate addiction

What is the best treatment for opioid addiction?

Methadone maintenance is currently the gold standard of treatments as it is associated with reductions in intravenous drug use, crime, HIV risk behaviors and mortality, and is well-established in community treatment programs around the world. New and evolving opioid treatments are held to this standard.

Is methadone maintenance the best treatment for opioid addiction?

CONCLUSION. Methadone maintenance is currently the gold standard of treatments as it is associated with reductions in intravenous drug use, crime, HIV risk behaviors and mortality, and is well-established in community treatment programs around the world. New and evolving opioid treatments are held to this standard.

What are the different types of Pharmacotherapies for opioid addiction?

Pharmacotherapies for opioid addiction include opioid agonists, partial agonists, opioid antagonists, and alpha-2-adrenergic agonists, which are targeted toward either detoxification or long-term agonist maintenance.

Which medications are used in the outpatient treatment of heroin withdrawal?

Kleber HD, Topazian M, Gaspari J, Riordan CE, Kosten T. Clonidine and naltrexone in the outpatient treatment of heroin withdrawal. The American journal of drug and alcohol abuse. 1987;13(1–2):1–17. [PubMed] [Google Scholar] 128. Gowing L, Ali R, White J. Opioid antagonists and adrenergic agonists for the management of opioid withdrawal.

What is considered the gold standard for opioid treatment?

A regimen of therapy plus methadone—or one of two other Food and Drug Administration-approved medications, buprenorphine and naltrexone—is considered the gold standard for opioid addiction treatment.

What is the most common form of treatment for opioid dependence?

The most common medications used in the treatment of opioid addiction are methadone, buprenorphine and naltrexone. Counseling is recommended with the use of each of these medications. Each medication works in a different way and has its own risks and benefits.

What is the gold standard of addiction?

The randomized control trial (RCT) is commonly celebrated as the "Gold Standard" of research designs. However, such evidentiary distinctions contain serious implications for the scientific acceptance, funding, and public perception of various treatments for substance abuse.

What is the first line of treatment for opioid use disorder?

Medication for OUD (MOUD) consists of treatment with an opioid agonist or antagonist and is first-line treatment for most patients with an OUD. MOUD appears to reinforce abstinence and improve treatment retention [1-4].

Which medication is frequently used to treat opioid addiction is?

The most common medications used in treatment of opioid addiction are methadone and buprenorphine. Sometimes another medication, called naltrexone, is used.

What are 3 options for drug abuse treatment?

There are many options that have been successful in treating drug addiction, including:behavioral counseling.medication.medical devices and applications used to treat withdrawal symptoms or deliver skills training.evaluation and treatment for co-occurring mental health issues such as depression and anxiety.More items...•

What is Mat used for?

MAT is primarily used for the treatment of addiction to opioids such as heroin and prescription pain relievers that contain opiates.

Which of the following is a pharmacological treatment for opioid use disorder oud )?

Effective medications exist to treat opioid use disorder: methadone, buprenorphine, and naltrexone. These medications could help many people recover from opioid use disorder, but they remain highly underutilized.

What is Sublocade?

SUBLOCADE® (buprenorphine extended-release) injection, for subcutaneous use (CIII) is a prescription medicine used to treat adults with moderate to severe addiction (dependence) to opioid drugs (prescription or illegal) who have received an oral transmucosal (used under the tongue or inside the cheek) buprenorphine- ...

What are the two drugs that are used to treat opioid addiction?

The two drugs, methadone, and buprenorphine, are opioids that can wean addicts off of their dependency.

How can we reduce opioid addiction?

We can do better. The CDC has published clear guidelines for reducing the opioid addiction death toll. Those include: 1 Avoiding opioids whenever possible, and recommending other treatments. 2 Prescribing the lowest effective dose of opioids, and increasing the dosage only as necessary. 3 Monitoring patients for signs of opioid dependency before, during, and after treatment.

How many people died from opioid overdoses in 2016?

People considering opioid therapy for chronic pain or any other condition should choose only doctors who diligently follow them. More than 600,000 people died of drug overdoses between 2000-2016. Most overdoses were due to opioids. It’s time to end this epidemic with science-based treatment.

How to avoid opioids?

Avoiding opioids whenever possible, and recommending other treatments. Prescribing the lowest effective dose of opioids, and increasing the dosage only as necessary. Monitoring patients for signs of opioid dependency before, during, and after treatment. These guidelines are potentially life-saving.

Is long term use of a drug considered a gold standard?

Others treat them only as short-term solutions. Addiction researchers, however, increasingly consider long-term use of one of these drugs to be the gold standard in addiction treatment—a gold standard that less than a third of addiction clinics apply.

Is medication based treatment more affordable?

Research also shows that medication-based treatment is significantly more affordable , and results in fewer health expenditures. Available on an outpatient basis, medication-based treatment can help people in recovery avoid paying tens of thousands of dollars for inpatient treatment.

Is addiction a disease?

The Frustrating Reality of Addiction Treatment. At its core, addiction is a chemical dependency. Many rehab facilities treat it as a moral failing—often while simultaneously emphasizing that addiction is a disease.

What is the treatment for opioid addiction?

The development of effective treatments for opioid dependence is of great importance given the devastating consequences of the disease. Pharmacotherapies for opioid addiction include opioid agonists, partial agonists, opioid antagonists, and alpha-2-adrenergic agonists, which are targeted toward either detoxification or long-term agonist ...

When was buprenorphine approved?

Buprenorphine. In October of 2002, sublingual buprenorphine and buprenorphine/naloxone tablets for the management of opiate dependence were approved by the FDA in the US. Prior to this time, buprenorphine has been used successfully in many European countries as well as Australia 20, 21.

How long does naltrexone last?

A daily dose of naltrexone (50 mg) will block the pharmacologic effects of 25 mg IV heroin for as long as 24 hours , and increasing the dose extends its duration of action to 48 hours with 100 mg and 72 hours with 150 mg 96.

What are the two phases of withdrawal?

Two-phases of symptoms were reported: (1) a first withdrawal phase, seen in most patients, characterized by common symptoms and likely naltrexone-induced; and (2) a second phase experienced by fewer patients (aches, insomnia and loss of appetite worsened) and likely attributed to declining methadone concentrations.

Is methadone better than buprenorphine?

Overall, it appears that decreased illicit opiate use and increased retention are seen with both higher doses of methadone (> 60 mg) and higher doses of buprenorphine (> 8mg), although methadone appears superior to buprenorphine in retaining patients when using flexible dosing approaches 30.

Is methadone a 4:1 ratio?

Buprenorphine has also been combined with naloxone at a 4:1 ratio for the purpose of reducing abuse liability.

Is buprenorphine a full agonist?

Unlike methadone and LAAM which are full opioid agonists, buprenorphine is a partial agonist of mu-opioid receptors. It has a slow onset and long duration of action allowing for alternate day dosing 22–24. Its partial agonist properties reduce the risk of unintentional overdose relative to full agonist medications.

Treatment and Doctors

The authors accept that doctors generally come to treatment with more resources than the average patient, but they also point out the hazards that doctors face which potentially increase relapse risk.

Overall Outcomes

Specifically, of the 904 physicians followed, 72% were still licensed and practicing with no indications of substance abuse or malpractice, five to seven years after signing their contracts.

What Does This Mean for Treatment?

If we applied the principles and standard of treatment that doctors get to other patients, would we see improved outcomes overall?

Making All Treatment Gold Standard

The paper has some suggestions to transfer learning and improve addiction treatment outcomes:

Reflections

The fact that only one doctor ended up on opiate replacement is a remarkable finding. Are there double standards inherent here? Why do doctors so readily turn away from an evidence-based intervention, one they are very happy to prescribe for patients?

Opioid Use Disorder Affects Millions

Medications Are Not Widely Used

Addressing Myths About Medications

Additional Information

References