Opioid Use Disorder, Stigma, and Transplantation: A Call to Action
Authors: Sarah E. Wakeman, Keren Ladin, Tim Brennan, Raymond T. Chung
Journal: Annals of Internal Medicine (2018)

Ideas and Opinions7 August 2018Opioid Use Disorder, Stigma, and Transplantation: A Call to ActionSarah E. Wakeman, MD, Keren Ladin, PhD, MSc, Tim Brennan, MD, and Raymond T. Chung, MDSarah E. Wakeman, MDMassachusetts General Hospital, Boston, Massachusetts (S.E.W., R.T.C.), Keren Ladin, PhD, MScTufts University, Medford, Massachusetts (K.L.), Tim Brennan, MDIcahn School of Medicine at Mount Sinai, New York, New York (T.B.), and Raymond T. Chung, MDMassachusetts General Hospital, Boston, Massachusetts (S.E.W., R.T.C.)Author, Article, and Disclosure Informationhttps://doi.org/10.7326/M18-1099 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail More than 2 million Americans have an opioid use disorder (OUD). Although untreated OUD is devastating, most persons who are treated achieve remission, particularly with opioid agonist therapy (OAT), which includes such medications as methadone and buprenorphine. Each year, 12.5 million buprenorphine prescriptions are filled in the United States and 350 000 persons receive methadone (1, 2). This growing population has unique health needs, with higher prevalence of conditions that may require organ transplant, such as hepatitis C. Yet, persons with OUD may be deemed ineligible for transplant, even when they are successfully treated with OAT (3, 4). Excluding OAT recipients ...References1. Clemans-Cope L, Lynch V, Epstein M, Kenney G. Medicaid Coverage of Effective Treatment for Opioid Use Disorder: Trends in State Buprenorphine Prescriptions and Spending since 2011. Urban Institute Health Policy Center. June 2017. Accessed at www.urban.org/sites/default/files/publication/90461/2001287_medicaid_coverage_of_effective_treatment_for_opioid_use_disorder.pdf on 16 May 2018. Google Scholar2. Alderks CE. Trends in the Use of Methadone, Buprenorphine, and Extended-Release Naltrexone at Substance Abuse Treatment Facilities: 2003–2015 (Update). The CBHSQ Report. Rockville, MD: Substance Abuse and Mental Health Services Administration; 22 August 2017. Google Scholar3. Koch M, Banys P. Liver transplantation and opioid dependence. JAMA. 2001;285:1056-8. [PMID: 11209177] CrossrefMedlineGoogle Scholar4. Fleming JN, Lai JC, Te HS, Said A, Spengler EK, Rogal SS. Opioid and opioid substitution therapy in liver transplant candidates: a survey of center policies and practices. Clin Transplant. 2017;31. [PMID: 28941292] doi:10.1111/ctr.13119 CrossrefMedlineGoogle Scholar5. Sordo L, Barrio G, Bravo MJ, Indave BI, Degenhardt L, Wiessing L, et al. Mortality risk during and after opioid substitution treatment: systematic review and meta-analysis of cohort studies. BMJ. 2017;357:j1550. [PMID: 28446428] doi:10.1136/bmj.j1550 CrossrefMedlineGoogle Scholar6. Rodgman C, Pletsch G. Double successful buprenorphine/naloxone induction to facilitate cardiac transplantation in an iatrogenically opiate-dependent patient. J Addict Med. 2012;6:177-8. [PMID: 22456493] doi:10.1097/ADM.0b013e3182486e44 CrossrefMedlineGoogle Scholar7. Aldemir E, Coskunol H, Kilic M, Sert I. Treatment of opioid dependence with buprenorphine/naloxone after liver transplantation: report of two cases. Transplant Proc. 2016;48:2769-72. [PMID: 27788815] doi:10.1016/j.transproceed.2016.08.005 CrossrefMedlineGoogle Scholar8. Liu LU, Schiano TD, Lau N, O'Rourke M, Min AD, Sigal SH, et al. Survival and risk of recidivism in methadone-dependent patients undergoing liver transplantation. Am J Transplant. 2003;3:1273-7. [PMID: 14510701] CrossrefMedlineGoogle Scholar9. Durand CM, Bowring MG, Thomas AG, Kucirka LM, Massie AB, Cameron A, et al. The drug overdose epidemic and deceased-donor transplantation in the United States: a national registry study. Ann Intern Med. 2018. [PMID: 29710288]. doi:10.7326/M17-2451 LinkGoogle Scholar10. Bart G. Maintenance medication for opiate addiction: the foundation of recovery. J Addict Dis. 2012;31:207-25. [PMID: 22873183] doi:10.1080/10550887.2012.694598 CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAffiliations: Massachusetts General Hospital, Boston, Massachusetts (S.E.W., R.T.C.)Tufts University, Medford, Massachusetts (K.L.)Icahn School of Medicine at Mount Sinai, New York, New York (T.B.)Disclosures: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M18-1099.Corresponding Author: Sarah E. Wakeman, MD, Massachusetts General Hospital, 55 Fruit Street, Founders 880, Boston, MA 02114; e-mail, [email protected]org.Current Author Addresses: Dr. Wakeman: Massachusetts General Hospital, 55 Fruit Street, Founders 880, Boston, MA 02114.Dr. Ladin: Departments of Occupational Therapy and Community Health, Tufts University, 574 Boston Avenue, Medford, MA 02155.Dr. Brennan: Icahn School of Medicine at Mount Sinai, 1000 10th Avenue, 8th Floor, New York, NY 10019.Dr. Chung: Massachusetts General Hospital, 55 Fruit Street, Warren 1007, Boston, MA 02114.Author Contributions: Conception and design: S.E. Wakeman, K. Ladin.Analysis and interpretation of the data: K. Ladin.Drafting of the article: S.E. Wakeman, K. Ladin, T. Brennan, R.T. Chung.Critical revision of the article for important intellectual content: S.E. Wakeman, K. Ladin, R.T. Chung.Final approval of the article: S.E. Wakeman, K. Ladin, T. Brennan, R.T. Chung.Collection and assembly of data: K. Ladin.This article was published at Annals.org on 10 July 2018. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics Cited bySubstance use disorders in organ transplantation: perennial challenges and interprofessional opportunitiesCannabis Use and Heart Transplantation: Disparities and Opportunities to Improve OutcomesCAQ Corner: Psychosocial and ethical considerations in patient selection for liver transplantationManagement of Opioid Agonist Treatment for Opioid Use Disorder in the Setting of Solid Organ TransplantAttitudes Toward Organ Donation for Persons Who Have a Substance Use Disorder Relative to Other Health ConditionsStigma as a fundamental hindrance to the United States opioid overdose crisis responseRising Prevalence of Opioid Use Disorder and Predictors for Opioid Use Disorder Among Hospitalized Patients With Chronic PancreatitisAddiction as Disease 7 August 2018Volume 169, Issue 3Page: 188-189KeywordsAntiretroviral therapyDisclosureDrugsHIVLiver transplantationOpioid use disorderOpioidsPrevention, policy, and public healthTransplantationViral load ePublished: 10 July 2018 Issue Published: 7 August 2018 Copyright & PermissionsCopyright © 2018 by American College of Physicians. 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