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

@article{Connery2015MedicationAssistedTO,
  title={Medication-Assisted Treatment of Opioid Use Disorder: Review of the Evidence and Future Directions},
  author={Hilary S Connery},
  journal={Harvard Review of Psychiatry},
  year={2015},
  volume={23},
  pages={63–75}
}
  • 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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References

SHOWING 1-10 OF 135 REFERENCES
Comparison of pharmacological treatments for opioid-dependent adolescents: a randomized controlled trial.
TLDR
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
TLDR
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.
TLDR
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.
TLDR
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
TLDR
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.
TLDR
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.
TLDR
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.
TLDR
The current state of knowledge regarding the growing problem of opioid abuse and misuse; known risk factors; and methods of predicting, assessing, monitoring, and addressing opioid Abuse and misuse in patients with chronic noncancer pain are reviewed.
Treatment retention among patients randomized to buprenorphine/naloxone compared to methadone in a multi-site trial.
AIMS To examine patient and medication characteristics associated with retention and continued illicit opioid use in methadone (MET) versus buprenorphine/naloxone (BUP) treatment for opioid
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