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Treatment and Prevention of Opioid Use Disorder: Challenges and Opportunities

Dennis McCarty, Kelsey C. Priest, P. Todd Korthuis

Annual Review of Public Health 2018 39:1

http://www.annualreviews.org/doi/pdf/10.1146/annurev-publhealth-040617-013526

Tramadol for maintenance in opioid dependence: A retrospective chart review.

Sarkar S, Lal R, Varshney M, Balhara YPS.

J Opioid Manag. 2017 Sep/Oct;13(5):329-334. doi: 10.5055/jom.2017.0401.

Abstract

https://www.ncbi.nlm.nih.gov/pubmed/29199398

Medications for opioid use disorder: bridging the gap in care

Volkow, Nora D

The Lancet , Volume 0 , Issue 0 , Published: 14 November 2017

doi.org/10.1016/S0140-6736(17)32893-3

Abstract

http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(17)32893-3/fulltext

Kanada. B.C. pilot project to distribute clean opioids to people at high risk of overdose

Ottawa has approved a pilot project that will allow health officials in B.C. to distribute clean opioids to drug users to use as they please, marking one of the province's most radical efforts to address a fentanyl-saturated drug supply that has killed more than 1,000 people this year. (Globe and Mail, 19.12.2017)

https://www.theglobeandmail.com/news/british-columbia/bc-pilot-project-to-distribute-clean-opioids-to-people-at-high-risk-of-overdose/article37392053

USA. Fact Sheet: Medication-Assisted Treatment Improves Outcomes for Patients With Opioid Use Disorder

Overview 

Opioid overdoses cause one death every 20 minutes. Medication-assisted treatment (MAT)—a combination of psychosocial therapy and U.S. Food and Drug Administration-approved medication—is the most effective intervention to treat opioid use disorder (OUD) and is more effective than either behavioral interventions or medication alone. MAT significantly reduces illicit opioid use compared with nondrug approaches, and increased access to these therapies can reduce overdose fatalities. However, MAT is often unavailable to those in need of it because of inadequate funding for treatment programs and a lack of qualified providers who can deliver these therapies.

(Fact Sheet, Substance Use Prevention and Treatment Initiative, 22.11.2016)

http://www.pewtrusts.org/en/research-and-analysis/fact-sheets/2016/11/medication-assisted-treatment-improves-outcomes-for-patients-with-opioid-use-disorder

Buprenorphine Use, Methadone Dose Affect Neonatal Outcomes

SAN DIEGO, California ― For infants of mothers who were treated for opioid use disorder with buprenorphine, rates of neonatal abstinence syndrome (NAS) were found to be lower compared to infants whose mothers were treated with methadone, new research shows. In addition, use of methadone at doses higher than 50 mg was associated with a significantly higher risk for NAS.

(...) However, Matthew R. Grossman, MD, a senior author of that study, who is assistant professor of pediatrics at Yale School of Medicine, in New Haven, Connecticut, said he has not observed differences associated with the dose of methadone, as reported in the current study.

"If [infants] are exposed to an opioid, particularly methadone, my experience with more than 500 of these infants is that they will all have withdrawal symptoms, regardless of the dose." (Medscape, 18.12.2017)

https://www.medscape.com/viewarticle/890254

Beigebrauchdetektion in der Substitutionstherapie - Speichelproben versus Urinscreening

[Substance abuse detection in substitution therapy : Oral fluid versus urine screening].

Stein J, Geraedts M.

Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz. 2017 Sep 19. doi: 10.1007/s00103-017-2630-x.

Abstract

https://link.springer.com/article/10.1007%2Fs00103-017-2630-x

Betäubungsmittel: Arzneimittel zur Substitution – ein Überblick 

Bei der Substitutionstherapie Opioidabhängiger gibt es eine Reihe zusätzlicher Auflagen. Hier sind vor allem die Regelungen des § 5 der Betäubungsmittelverschreibungsverordnung maßgeblich. Unter anderem finden sich dort Vorgaben, welche Arzneimittel beziehungsweise Wirkstoffe überhaupt für eine Substitutionstherapie verschrieben werden können. In der Praxis stehen sowohl Rezepturen als auch Fertigarzneimittel zur Verfügung. (DAZ – Deutsche Apotheker Zeitung, 11.12.2017)

https://www.deutsche-apotheker-zeitung.de/news/artikel/2017/12/11/arzneimittel-zur-substitution-ein-ueberblick/chapter:1

As Francis Collins and I wrote in May, NIH and NIDA are committed to an “all scientific hands on deck” effort to end the opioid crisis in America by halving the time it takes to develop new medications to treat pain and addiction and reverse overdoses. This effort will involve partnerships with pharmaceutical companies and academic institutions, leveraging the diverse benefits that federally funded science, private industry, and academia can bring to bear. Such partnerships have always been important in advancing treatment of addiction, as exemplified by NIDA’s partnership with Lightlake Therapeutics, Inc. (a partner of Adapt Pharma Limited) that led to the approval of nasal Narcan (an intranasal formulation of naloxone) in 2015.

The goals of the new initiative range from innovative and ambitious new treatment approaches that will take some time to develop, such as vaccines or transcranial magnetic stimulation for pain and addiction, to goals that are relatively achievable in the short term, such as improved formulations of existing medications. (NIDA, Nora’s Blog, 22.08.2017)

https://www.drugabuse.gov/about-nida/noras-blog/2017/08/new-medication-formulations-could-quickly-make-difference-treating-opioid-addiction

Opioid Agonist Treatment Reduces Societal Costs of Crime

Patients with opioid use disorder generated crime-related costs to society at a lower rate while they were in treatment compared with after they left treatment.

Patients who initiate time-unlimited opioid-agonist therapy will generate lower average total crime-related costs over the next 6 months than patients who initiate a 21-day detoxification regimen.

Savings in crime-related costs are substantial and warrant inclusion in cost-effectiveness analyses of treatment for opioid addiction. (NIDA Notes, Eric Sarlin, M.Ed., M.A., 23.08.2017)

https://www.drugabuse.gov/news-events/nida-notes/2017/08/opioid-agonist-treatment-reduces-societal-costs-crime

Noch immer ist die Substitutionstherapie Heroinabhängiger auch in Fachkreisen mit Vorurteilen und ­Ängsten verbunden. Zwischenzeitlich jedoch gilt diese als etabliert und kann auch der Kritik anfänglicher Skeptiker standhalten. (Pharmazeutische Zeitung online, Ausgabe 47/2015)

http://www.pharmazeutische-zeitung.de/index.php?id=60811

A systematic review of health economic models of opioid agonist therapies in maintenance treatment of non-prescription opioid dependence.

Chetty M, Kenworthy JJ, Langham S, Walker A, Dunlop WC.

Addict Sci Clin Pract. 2017 Feb 24;12(1):6. doi: 10.1186/s13722-017-0071-3. Review.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5324212/

Feasibility of alcohol screening among patients receiving opioid treatment in primary care.

Henihan AM, McCombe G, Klimas J, Swan D, Leahy D, Anderson R, Bury G, Dunne CP, Keenan E, Lambert JS, Meagher D, O'Gorman C, O'Toole TP, Saunders J, Shorter GW, Smyth BP, Kaner E, Cullen W.

BMC Fam Pract. 2016 Nov 5;17(1):153.

https://bmcfampract.biomedcentral.com/articles/10.1186/s12875-016-0548-2

The impact of cannabis use on patients enrolled in opioid agonist therapy in Ontario, Canada.

Franklyn AM, Eibl JK, Gauthier GJ, Marsh DC (2017)

PLoS ONE12(11): e0187633. doi.org/10.1371/journal.pone.0187633

http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0187633

The makers of Vivitrol have mounted an aggressive campaign to push this narrative to the government and law enforcement. (The Fix, 21.07.2017)

https://www.thefix.com/vivitrol-more-effective-suboxone-and-methadone

Extended-release naltrexone: good but not a panacea

Lott, David C

The Lancet , Volume 0 , Issue 0 , Published: 14 November 2017

dx.doi.org/10.1016/S0140-6736(17)32872-6

Abstract

http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(17)32872-6/fulltext