Medication-Assisted Treatment of Opioid Use Disorder: Review of the Evidence and Future Directions

  title={Medication-Assisted Treatment of Opioid Use Disorder: Review of the Evidence and Future Directions},
  author={Hilary S Connery},
  journal={Harvard Review of Psychiatry},
  • H. Connery
  • Published 1 March 2015
  • Medicine, Psychology
  • Harvard Review of Psychiatry
Learning ObjectiveAfter participating in this activity, learners should be better able to: Evaluate the rationale for and current evidence supporting medication-assisted treatment of opioid use disorder. AbstractMedication-assisted treatment of opioid use disorder with physiological dependence at least doubles rates of opioid-abstinence outcomes in randomized, controlled trials comparing psychosocial treatment of opioid use disorder with medication versus with placebo or no medication. This… 
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Long-acting implantable drug formulations that offer consistent drug delivery and lower risk of misuse, diversion, or accidental pediatric exposure over traditional formulations represent a promising development for the effective treatment of opioid use disorder.
Review of medication-assisted treatment for opioid use disorder
This review will define the components of MAT, consider the impact of MAT in the primary care setting, and identify barriers to effective MAT.
Opioid Use Disorder: Medical Treatment Options.
Family physicians are ideally positioned to diagnose opioid use disorder, provide evidence-based treatment with buprenorphine or naltrexone, refer patients for methadone as appropriate, and lead the response to the current opioid crisis.
Treatment Approaches for Opioid Use Disorders in Late Life
In order to optimally address OUD in older adults, a multi-dimensional approach involving pharmacotherapy in combination with psychosocial treatments is recommended.
Management of Opioid Misuse and Opioid Use Disorders Among Youth
Growing evidence supports the need for integration of OUD treatment into primary care, and research and expert consensus suggest the use of brief interventions focused on reducing risks associated with ongoing opioid use and using motivational interviewing strategies to engage youth in treatment.
Emerging Evidence for Cannabis' Role in Opioid Use Disorder
Emerging evidence that suggests that cannabis may play a role in ameliorating the impact of OUD is reviewed and the compelling nature of these data and the relative safety profile of cannabis warrant further exploration of cannabis as an adjunct or alternative treatment for OUD.
Managing Acute Pain in Patients Taking Medication for Opioid Use Disorder: a Rapid Review
Evidence supports the practice of continuing methadone or buprenorphine for most patients during acute pain episodes, but well-described, prospective studies of adjuvant pain management strategies when OUD medications are continued would add to the existing literature base.
Opioid Misuse as a Predictor of Alcohol Treatment Outcomes in the COMBINE Study: Mediation by Medication Adherence
Medication adherence partially mediated the association between opioid misuse, cannabis use, other drug use, and treatment outcomes, which was partially mediated by medication adherence.


Comparison of pharmacological treatments for opioid-dependent adolescents: a randomized controlled trial.
Combining buprenorphine with behavioral interventions is significantly more efficacious in the treatment of opioid-dependent adolescents relative to combining clonidine and behavioral interventions.
Maintenance Medication for Opiate Addiction: The Foundation of Recovery
  • G. Bart
  • Medicine, Psychology
    Journal of addictive diseases
  • 2012
Results indicate that maintenance medication provides the best opportunity for patients to achieve recovery from opiate addiction, and selection of medication should be based on informed choice following a discussion of outcomes, risks, and benefits of each medication.
Buprenorphine implants for treatment of opioid dependence: a randomized controlled trial.
Among persons with opioid dependence, the use of buprenorphine implants compared with placebo resulted in less opioid use over 16 weeks as assessed by urine samples and a greater change on clinician global ratings of severity of opioid dependence.
Adjunctive counseling during brief and extended buprenorphine-naloxone treatment for prescription opioid dependence: a 2-phase randomized controlled trial.
Prescription opioid-dependent patients are most likely to reduce opioid use during buprenorphine-naloxone treatment; if tapered off bupreliminary treatment, even after 12 weeks of treatment, the likelihood of an unsuccessful outcome is high, even in patients receiving counseling in addition to SMM.
Opioid Detoxification and Naltrexone Induction Strategies: Recommendations for Clinical Practice
Among the current detoxification regimens, the available clinical and scientific data suggest that the best approach may be using an initial 2–4 mg dose of buprenorphine combined with clonidine, other ancillary medications, and progressively increasing doses of oral naltrexone over 3–5 days up to the target dose of nalt Rexone.
Psychosocial treatment for opiate abuse and dependence.
Both Enhanced Outreach Counselling and Brief Reinforcement Based Intensive Outpatient Therapy coupled with Contingency Management had significantly better outcomes than standard therapy within treatment, regarding relapse to opioid use, re-enrollment in treatment and retention in treatment.
Methadone maintenance therapy versus no opioid replacement therapy for opioid dependence.
Methadone is an effective maintenance therapy intervention for the treatment of heroin dependence as it retains patients in treatment and decreases heroin use better than treatments that do not utilise opioid replacement therapy, and does not show a statistically significant superior effect on criminal activity.
Prescription opioid abuse in chronic pain: a review of opioid abuse predictors and strategies to curb opioid abuse.
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Treatment retention among patients randomized to buprenorphine/naloxone compared to methadone in a multi-site trial.
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