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The opioid crisis in the United States has come about because of excessive use of these drugs for both legal and illicit purposes and unprecedented levels of consequent opioid use disorder (OUD). More than 2 million people in the United States are estimated to have OUD, which is caused by prolonged use of prescription opioids, heroin, or other illicit opioids. OUD is a life-threatening condition associated with a 20-fold greater risk of early death due to overdose, infectious diseases, trauma, and suicide. Mortality related to OUD continues to escalate as this public health crisis gathers momentum across the country, with opioid overdoses killing more than 47,000 people in 2017 in the United States. Efforts to date have made no real headway in stemming this crisis, in large part because tools that already exist—like evidence-based medications—are not being deployed to maximum impact.

To support the dissemination of accurate patient-focused information about treatments for addiction, and to help provide scientific solutions to the current opioid crisis, this report studies the evidence base on medication assisted treatment (MAT) for OUD. It examines available evidence on the range of parameters and circumstances in which MAT can be effectively delivered and identifies additional research needed.

Product Details

ISBN-13: 9780309486484
Publisher: National Academies Press
Publication date: 06/16/2019
Pages: 174
Sales rank: 1,243,293
Product dimensions: 6.00(w) x 9.00(h) x 0.50(d)

Table of Contents

Acronyms and Abbreviations xvii

Summary 1

1 Introduction 15

Charge to the Committee and Study Scope 20

Conceptual Framework and Key Terms 21

Study Methodology 26

Organization of the Consensus Study Report 27

Conclusion 27

References 28

2 The Effectiveness of Medication-Based Treatment for Opioid Use Disorder 33

Methadone 34

Buprenorphine 35

Extended-Release Naltrexone 37

Naloxone 38

Evidence on the Effectiveness of FDA-Approved Medications in Treating OUD 38

Knowledge Gaps and Future Directions for Research on Medications for OUD 41

Behavioral Therapy in Conjunction with Medications 47

Knowledge Gaps and Additional Research Needed on the Role of Behavioral Interventions with Medications in Treatment for OUD 50

Conclusions 51

References 53

3 Treatment with Medications for Opioid Use Disorder in Different Populations 63

Medication-Based Treatment for OUD Across the Life Course 64

Sex-Related Differences in Medication-Based Treatment for OUD 67

Pregnant Women 69

Sexual Minorities 71

Individuals with OUD and Other Morbidities 71

Racial and Ethnic Minority Populations 76

Low Socioeconomic Status and Homeless Populations 77

Rural and Urban Populations 78

Conclusion 79

References 80

4 Medications for Opioid Use Disorder in Various Treatment Settings 91

Opioid Treatment Programs 92

Office-Based Opioid Treatment 94

Acute Care Settings 97

Other Care Settings 98

Criminal Justice Settings 98

Innovative Settings for OUD Treatment 101

Conclusion 103

References 103

5 Barriers to Broader Use of Medications to Treat Opioid Use Disorder 109

Stigma 110

Concerns About Diversion of Medications for OUD 113

Inadequate Professional Education and Training 115

System Fragmentation 116

Legal and Regulatory Barriers 118

Public and Private Insurance Barriers 122

Conclusion 127

References 127


A Study Approach and Methods 137

B Public Workshop Agenda 141

C Biographical Sketches of Committee Members 149

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