Medications underused in treating opioid addiction, says Mayo Clinic

While medication-assisted treatment can help people who are addicted to opioids, the three drugs approved by the Food and Drug Administration are underused, according to a review of current medical data on opioid addiction in the U.S. The review appears in the October issue of Mayo Clinic Proceedings.

Along with addiction counseling, the drugs naltrexone, buprenorphine and methadone all have a place in treatment for opioid use disorder, the authors said. Dr. Tyler Oesterle, medical director of Mayo Clinic Health System's Fountain Centers drug and alcohol treatment programs and the lead author, said evidence of the three drugs' effectiveness in treating opioid use disorder is well-established.

The review uses data from available medical literature to provide a framework for determining the optimal approach for medication-assisted treatments.

WHAT'S THE IMPACT

Opioid addiction has long been an epidemic in the U.S., and it's been caused by many factors: the widespread availability of opioid both legal and illegal, the overzealous use of medication, even the expectation that all pain can be eliminated.

A more judicious use of prescription opioids can mediate the problem, said Oesterle. Each drug has strengths and weaknesses, and the appropriate risks and benefits should be discussed with each patient suffering from an opioid use disorder, according to the study.

Naltrexone, which is approved to treat opioid and alcohol dependence, and block the effects of opioids in adults, is longer-acting and ideal as an opioid blocking agent. Patient compliance with buprenorphine is relatively high and associated with improved rates of sobriety and a reduction in accidental overdoses. The principal benefits of methadone are relief of narcotic cravings, the suppression of withdrawal syndrome, and blocking of the euphoric effects associated with heroin.

According to the review, the three drugs may be underused in part because access is limited by some legal requirements regarding who can write prescriptions. The one exception is naltrexone, which can be ordered by any prescriber.

Another challenge in treating opioid use disorder is that it can be slow in developing, making it difficult to identify for primary care providers. Effectively responding to the opioid crisis requires moving beyond a medication-only approach, the authors said.

THE LARGER TREND

The opioid epidemic has long been a challenging issue both for Americans and the healthcare system that treats them, and the mortality statistics are significant. The American Academy of Family Physicians published research this year showing that, if there's no change in the annual incidence of prescription opioid misuse, annual opioid deaths could hit 82,000 by 2025.

From finding new, more cost-effective care delivery models to establishing outpatient addiction treatment programs, there's an opportunity for investors to pump some much needed cash into the efforts to curb opioid misuse. If done correctly, the investors can see a healthy ROI while also helping patients with addiction issues and easing the burden on the healthcare system.
 

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Email the writer: jeff.lagasse@himssmedia.com