Alternative to ‘revolving door’ of opioid detox and relapse

In a first-ever randomized trial, patients at a short-term inpatient program began long-term outpatient treatment with buprenorphine before discharge, with better outcomes than detox patients.

Three out of four people who complete an inpatient opioid withdrawal management program — commonly known as “detox” — relapse within a month, leading to a “revolving door” effect. Few successfully transition from the inpatient setting to long-term treatment with proven medications such as buprenorphine, methadone, or naltrexone to prevent overdose.

But patients who start long-term buprenorphine treatment at a detox program, instead of going through detox and getting a referral for such treatment at discharge, are less likely to use opioids illicitly over the following six months, and more likely to keep up treatment, according to a first-of-its-kind study led by a Boston University School of Public Health (BUSPH) researcher and published in the journal Addiction.

Full story at Science Daily

Use Of Buprenorphine To Treat Opioid Addiction Proliferates In California

Buprenorphine, a relative newcomer in the treatment of opioid addiction, is growing in popularity among California doctors as regulatory changes, physician training and other initiatives make the medication more widely accessible.

The rate of Medi-Cal enrollees who received buprenorphine nearly quadrupled from the end of 2014 to the third quarter of 2018, according to data released by Medi-Cal, the state’s Medicaid program. The rate for methadone — an older and more commonly used drug — was almost unchanged from the end of 2014 through the last quarter of 2017, the most recent period for which data are available.

Buprenorphine and methadone are both opioids. Both reduce cravings for heroin and synthetic opioids while minimizing withdrawal symptoms. But buprenorphine is less potent and less likely to result in fatal overdoses than methadone. California doctors have more flexibility in prescribing it than with methadone or naltrexone, another medication used to treat addiction.

Full story at Kaiser Health News

Too Few People Who Survive Opioid Overdose Get Medication-Assisted Treatment

A new study concludes too few people who survive an opioid overdose receive medication-assisted treatment that will reduce the chance of another overdose.

The study included more than 17,500 adults who survived an opioid overdose and found only about one-third received either buprenorphine (Suboxone), methadone or naltrexone (Vivitrol), HealthDay reports.

Among people who did receive one of these medications, most did not stay on the drug for a long time, the researchers report in the Annals of Internal Medicine. The researchers found 17 percent used buprenorphine, with a median use of four months; 11 percent used methadone, with a median use of five months; and 6 percent used naltrexone, with a median use of one month.

Full story at drugfree.org

Methadone and buprenorphine reduce risk of death after opioid overdose

A National Institutes of Health-funded study found that treatment of opioid use disorder with either methadone or buprenorphine following a nonfatal opioid overdose is associated with significant reductions in opioid related mortality. The research, published today in the Annals of Internal Medicine, was co-funded by the National Institute on Drug Abuse (NIDA) and the National Center for Advancing Translational Sciences, both parts of NIH.

Study authors analyzed data from 17,568 adults in Massachusetts who survived an opioid overdose between 2012 and 2014. Compared to those not receiving medication assisted treatment, opioid overdose deaths decreased by 59 percent for those receiving methadone and 38 percent for those receiving buprenorphine over the 12 month follow-up period. The authors were unable to draw conclusions about the impact of naltrexone due to small sample size, noting that further work is needed with larger samples. Buprenorphine, methadone, and naltrexone are three FDA-approved medications used to treat opioid use disorder (OUD).

Full story at drugabuse.org

Symptoms of alcoholism make taking medication to treat the disease more difficult

Symptoms of alcoholism make it more difficult for some people to regularly take the prescription drug naltrexone, which could help treat their disease, a researcher at Oregon State University has found.

The finding helps researchers better understand how to intervene with patients to improve the effectiveness of the medication, said Sarah Dermody, an assistant professor in the School of Psychological Science in OSU’s College of Liberal Arts.

“The assumption is the medication is prescribed, so it’s going to work, but the patient has to take the medication in order for it to work,” Dermody said. “This tells us we need to do more than write a prescription. Having some sort of reoccurring contact with the patient is really important.”

Full story at Science Daily