Summary and Analysis…

In this article on the JAMA Network website, Drs. Nora Volkow and Wilson Compton examine the potential value of extended-release buprenorphine implants for those in recovery from opioid addiction compared to daily oral doses of the same drug. The points they make about our staggering losses to opioid overdoses are valid, as is their observation that recovering one’s sobriety after opioid addiction is challenging.

The doctors cite a 2021 study that shows that patients in medicalized treatment for opioid addiction were more satisfied with their treatment with these extended-release implants than were patients receiving daily oral doses. The purpose of this study was to find a treatment modality that resulted in better patient-reported outcomes (PROs). The doctors note: “Using PROs instead of drug abstinence as the primary outcome is innovative…” The original report on this study noted that there were other positive results but did not detail them.

One wonders: Is this the best use of our research dollars and efforts? Many studies are devoted to manipulating the administration of drugs like buprenorphine for medication-assisted treatment or seeking drug-based treatment of addiction to cocaine, methamphetamine or cannabis. But few are devoted to polling faith-based, community-based or alternative drug rehabilitation to look for successful practices. Moreover, the article does not highlight the need to fully inform patients of the long-term effects of buprenorphine or its addictive properties. Overlooking or minimizing opioid addiction helped to bring on the crisis. The role and importance of wrap-around services is also missing.

Focusing exclusively on a medication approach to addiction treatment occurs too often, is problematic and invites under-estimates of how to best respond to the drug crisis.

 

Excerpted from JAMA Network

Medications used for the treatment of opioid use disorder are highly effective not only in preventing relapse to drug taking and facilitating recovery but also in preventing overdoses. As such, expanding treatment with medications for opioid use disorders has become a key strategy for addressing the current US overdose crisis, which in 2019 caused 70 630 deaths.1 However, preventing overdoses requires that patients be retained on medications for opioid use disorder, which has been challenging.

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