Opioid treatment medications roundup

e1drugThe New England Journal of Medicine posted an opinion piece calling for expanding use of medications to treat opioid addiction

These alarming trends led the Department of Health and Human Services (HHS) to deem prescription-opioid overdose deaths an epidemic and prompted multiple federal, state, and local actions.2 The HHS efforts aim to simultaneously reduce opioid abuse and safeguard legitimate and appropriate access to these medications. HHS agencies are implementing a coordinated, comprehensive effort addressing the key risks involved in prescription-drug abuse, particularly opioid-related overdoses and deaths. These efforts focus on four main objectives: providing prescribers with the knowledge to improve their prescribing decisions and the ability to identify patients’ problems related to opioid abuse, reducing inappropriate access to opioids, increasing access to effective overdose treatment, and providing substance-abuse treatment to persons addicted to opioids.

I think there’s little doubt that drugs like buprenorphine and methadone will play a bigger role in the future of opioid addiction treatment. That being the case, let’s hope that these doctors practice and evaluate themselves within Bill White’s model of Recovery Oriented Methadone Maintenance.

Recovery from opioid addiction is also more than remission, with remission defined as the sustained cessation or deceleration of opioid and other drug use/problems to a subclinical level—no longer meeting diagnostic criteria for opioid dependence or another substance use disorder. Remission is about the subtraction of pathology; recovery is ultimately about the achievement of global (physical, emotional, relational, spiritual) health, social functioning, and quality of life in the community.

Let’s also hope they respect the preferences of patients, even if they prefer drug-free recovery, without dismissing these preferences as manifestations of stigma or denial. DJ Mac recently pointed to some research on the topic.

Broadly speaking, the desired goal is abstinence from psychoactive substances. A second tranche of outcomes are about achieving changes that maintain the abstinence goal. A third tranche, and seen rather as a bonus, were the positive benefits of abstinence, for example, improved health. We believe that practitioners will find it helpful to be mindful of the ‘being better’ goals while recognising that the day to day business of therapy often means negotiating small steps along the way to the desired goal.

Along these links, DJ Mac also tweeted a link to a post from RecoverySI asking if we practice sufficient informed consent. If the client really wants drug-free recovery, do we tell them that we don’t know how to get people off these meds without very high rates of relapse?

My biases have been made plain. I have no interest in interfering with a client who wants treatment using these meds. I just also want them to have full informed consent and the opportunity to get the same treatment addicted health professionals receive. That said this will be a good opportunity to see if providers can implement Bill’s vision and how well it works. I wish them the best.

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