National strategy to reduce opioid epidemic, an urgent public health priority

Years of sustained and coordinated efforts will be required to contain and reverse the harmful societal effects of the prescription and illicit opioid epidemics, which are intertwined and getting worse, says a new report from the National Academies of Sciences, Engineering, and Medicine. The report, requested by the U.S. Food and Drug Administration (FDA), says it is possible to stem the still-escalating prevalence of opioid use disorder and other opioid-related harms without foreclosing access to opioids for patients suffering from pain whose providers have prescribed these drugs responsibly. The committee that conducted the study and wrote the report recommended actions the FDA, other federal agencies, state and local governments, and health-related organizations should take — which include promoting more judicious prescribing of opioids, expanding access to treatment for opioid use disorder, preventing more overdose deaths, weighing societal impacts in opioid-related regulatory decisions, and investing in research to better understand the nature of pain and develop non-addictive alternatives.

“The broad reach of the epidemic has blurred the formerly distinct social boundary between prescribed opioids and illegally manufactured ones, such as heroin,” said committee chair Richard J. Bonnie, Harrison Foundation Professor of Medicine and Law and director of the Institute of Law, Psychiatry, and Public Policy at the University of Virginia in Charlottesville. “This report provides an action plan directed particularly at the health professions and government agencies responsible for regulating them. This plan aims to help the millions of people who suffer from chronic pain while reducing unnecessary opioid prescribing. We also wanted to convey a clear message about the magnitude of the challenge. This epidemic took nearly two decades to develop, and it will take years to unravel.”

Full story of national strategy to reduce the opioid epidemic at Science Daily

Clinical trial looks at tramadol for opioid withdrawal

A randomized clinical trial published by JAMA Psychiatry compared tramadol extended-release with clonidine and buprenorphine for the management of opioid withdrawal symptoms in patients with opioid use disorder in a residential research setting.

Opioid use disorder is a public health problem that has contributed to unprecedented levels of overdose deaths. Detoxification – or medically supervised withdrawal – is a widely used treatment for opioid use disorder. However, failing to adequately manage opioid withdrawal symptoms can contribute to people leaving treatment.

Clonidine and buprenorphine are two medications widely used to manage opioid withdrawal. Tramadol hydrochloride is a promising alternative option for effective opioid use disorder treatment, according to the article.

Full story of tramadol and opioid withdrawal at Science Daily

People With Anxiety and Depression Have High Rate of Prescription Opioid Use

People with anxiety and depression have a high rate of prescription opioid use, a new study finds.

Almost 19 percent of the estimated 38.6 million people diagnosed with anxiety and depression received at least two prescriptions for opioids in one year, the study found. More than half of opioid prescriptions went to people with these mental health disorders, according to The Washington Post.

People with anxiety and depression may feel pain more acutely, or may be less able to cope with the pain, leading to increased requests for opioids, said lead researcher Brian Sites of Dartmouth’s Geisel School of Medicine.

Full story of depression and high prescribed opioids at drugfree.org

Medications underutilized when treating young people with opioid use disorder

Only one in four young adults and teens with opioid use disorder (OUD) are receiving potentially life-saving medications for addiction treatment, according to a new Boston Medical Center (BMC) study published online in JAMA Pediatrics.

Buprenorphine and naltrexone are medications used to treat OUD that help prevent relapse and overdose when used appropriately. In late 2016, the American Academy of Pediatrics recommended, for the first time, that providers offer medication treatment to adolescents with OUD.

Prior studies have shown that among all adults in treatment for opioids, one-third started using opioids before age 18, and two-thirds started before age 25. Unlike methadone, buprenorphine and naltrexone can be offered in the primary care setting. However, few teens receive medication due, in part, to a widespread shortage of physicians who have received a waiver certification required to prescribe buprenorphine. And, as researchers note, of all of the physicians who are certified in the United States, only one-percent are pediatricians.

Full story of treating young people with opioid use disorder at drugfree.org

The cost of opioid use during pregnancy

A new study published today by the scientific journal Addiction reveals that the incidence of neonatal abstinence syndrome — often caused by mothers using opioids during pregnancy — is increasing in the United States, and carries an enormous burden in terms of hospital days and costs. The number of US hospital admissions involving neonatal abstinence syndrome increased more than fourfold between the years 2003 and 2012. In 2012, neonatal abstinence syndrome cost nearly $316 million in the United States.

Neonatal abstinence syndrome (NAS) is a constellation of symptoms that occur in newborn infants exposed to addictive illegal or prescription drugs in utero. Infants affected by NAS typically show a number of neurological symptoms and behaviors (e.g., tremors, seizures) as well as poor feeding and gastrointestinal dysfunction. Standard management of NAS involves the administration of opioids for opioid withdrawal, with additional medications for stubborn cases or instances of multi-drug exposure. This drug administration has been performed traditionally in the hospital setting, consuming valuable and finite hospital resources.

Full story of opioid use during pregnancy at Science Daily