Being Explicit About Decisions: Prescribe Medications for Opioid Use Disorder on the Basis of Proven Effectiveness, Not Beliefs
Authors: Joshua A. Barocas, Richard Saitz
Journal: Annals of Internal Medicine (2018)

Editorials15 January 2019Being Explicit About Decisions: Prescribe Medications for Opioid Use Disorder on the Basis of Proven Effectiveness, Not BeliefsJoshua A. Barocas, MD and Richard Saitz, MD, MPHJoshua A. Barocas, MDBoston Medical Center and Boston University School of Medicine, Boston, Massachusetts (J.A.B.)Search for more papers by this author and Richard Saitz, MD, MPHBoston University School of Public Health, Boston University School of Medicine, and Boston Medical Center, Boston, Massachusetts (R.S.)Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/M18-3293 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Most of the more than 2.1 million persons with opioid use disorder (OUD) do not receive treatment (1, 2). Medical care for other chronic conditions often is fragmented and, in some cases, characterized by poor quality. However, few other conditions for which medical care is as poor or nonexistent are responsible for such a large number of deaths as OUD (49 000 from opioid overdose in the United States in 2017) (3).Although some patients are not ready for treatment, major barriers to high-quality care are squarely in the realm of the health care delivery system. Again, unlike for other chronic ...References1. Substance Abuse and Mental Health Services Administration. Key substance use and mental health indicators in the United States: Results from the 2017 National Survey on Drug Use and Health. Rockville, MD: Center for Behavioral Health Statistics and Quality, Substance Abuse and Mental Health Services Administration; 2018. Google Scholar2. Larochelle MR, Bernson D, Land T, Stopka TJ, Wang N, Xuan Z, et al. Medication for opioid use disorder after nonfatal opioid overdose and association with mortality: a cohort study. Ann Intern Med. 2018;169:137-145. [PMID: 29913516] LinkGoogle Scholar3. National Institute on Drug Abuse. Overdose death rates. 2018. Accessed at www.drugabuse.gov/related-topics/trends-statistics/overdose-death-rates on 31 October 2018. Google Scholar4. 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] CrossrefMedlineGoogle Scholar5. Congressional Research Service. Opioid treatment programs and related federal regulations. 2018. Accessed at https://fas.org/sgp/crs/misc/IF10219.pdf on 1 November 2018. Google Scholar6. Nunn A, Zaller N, Dickman S, Trimbur C, Nijhawan A, Rich JD. Methadone and buprenorphine prescribing and referral practices in US prison systems: results from a nationwide survey. Drug Alcohol Depend. 2009;105:83-8. [PMID: 19625142] CrossrefMedlineGoogle Scholar7. American Society of Addiction Medicine. Terminology related to addiction, treatment, and recovery. Accessed at www.asam.org/docs/default-source/public-policy-statements/1-terminology-atr-7-135f81099472bc604ca5b7ff000030b21a.pdf?sfvrsn=0 on 1 November 2018. Google Scholar8. Murphy SM, McCollister KE, Leff JA, Yang X, Jeng PJ, Lee JD, et al. Cost-effectiveness of buprenorphine-naloxone versus extended-release naltrexone to prevent opioid relapse. Ann Intern Med. 2019;170:90-8. doi:10.7326/M18-0227 LinkGoogle Scholar9. Morgan JR, Schackman BR, Leff JA, Linas BP, Walley AY. Injectable naltrexone, oral naltrexone, and buprenorphine utilization and discontinuation among individuals treated for opioid use disorder in a United States commercially insured population. J Subst Abuse Treat. 2018;85:90-96. [PMID: 28733097] CrossrefMedlineGoogle Scholar10. Hadland SE, Bagley SM, Rodean J, Silverstein M, Levy S, Larochelle MR, et al. Receipt of timely addiction treatment and association of early medication treatment with retention in care among youths with opioid use disorder. JAMA Pediatr. 2018;172:1029-1037. [PMID: 30208470] CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAffiliations: Boston Medical Center and Boston University School of Medicine, Boston, Massachusetts (J.A.B.)Boston University School of Public Health, Boston University School of Medicine, and Boston Medical Center, Boston, Massachusetts (R.S.)Disclosures: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M18-3293.Corresponding Author: Joshua A. Barocas, MD, Boston Medical Center, 801 Massachusetts Avenue, 2nd Floor, Boston, MA 02118; e-mail, joshua.[email protected]org.Current Author Addresses: Dr. Barocas: Boston Medical Center, 801 Massachusetts Avenue, 2nd Floor, Boston, MA 02118.Dr. Saitz: Boston Medical Center, 801 Massachusetts Avenue, 4th Floor, Boston, MA 02118.This article was published at Annals.org on 18 December 2018. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoCost-Effectiveness of Buprenorphine–Naloxone Versus Extended-Release Naltrexone to Prevent Opioid Relapse Sean M. Murphy , Kathryn E. McCollister , Jared A. Leff , Xuan Yang , Philip J. Jeng , Joshua D. Lee , Edward V. Nunes , Patricia Novo , John Rotrosen , and Bruce R. Schackman Metrics Cited byThe Experience of Implementing a Low-Threshold Buprenorphine Treatment Program in a Non-Urban Medical PracticeThe cascade of care for opioid use disorder: a retrospective study in British Columbia, CanadaBuprenorphine/naloxone cost effective for opioid abuseBuprenorphine/naloxone less costly than naltrexone 15 January 2019Volume 170, Issue 2Page: 127-128KeywordsClinical trialsDisclosureDrug administrationFactor analysisFood and Drug AdministrationOpioid addictionOpioid use disorderOpioidsPatientsSafety ePublished: 18 December 2018 Issue Published: 15 January 2019 Copyright & PermissionsCopyright © 2018 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...