New guideline on the use of prescription medications for treatment of opioid addiction

Medications play an important role in managing patients with opioid use disorders, but there are not enough physicians with the knowledge and ability to use these often-complex treatments. New evidence-based recommendations on the use of prescription medications for the treatment of opioid addiction are published in the October/November Journal of Addiction Medicine, the official journal of the American Society of Addiction Medicine (ASAM). The journal is published by Wolters Kluwer.

Developed by an expert ASAM Guideline Committee, the National Practice Guideline provides guidance on the use of medications to treat addiction involving opioid use, according to a synopsis by Drs. Kyle Kampman of the University of Pennsylvania School of Medicine, Philadelphia, and Margaret Jarvis of Marworth Alcohol and Chemical Dependency Treatment Center, Waverly, Pa. They write, "This Practice Guideline was developed to assist in the evaluation and treatment of opioid use, and in the hope that, using this tool, more physicians will be able to provide effective treatment."

Guidance on Using Medications for Treatment of Opioid Use Disorders
Use and misuse of opioids—morphine and related drugs, including prescription pain medications—has risen rapidly in recent years, leading the Centers for Disease Control and Prevention to declare a nationwide "opioid epidemic." Evidence supports the use of medications, in addition to psychosocial treatments, for people with opioid use disorders.

"Suboptimal treatment has likely contributed to expansion of the epidemic as well as concerns for unethical practices," Drs. Kampman and Jarvis write. "At the same time, access to competent treatment is profoundly restricted because few physicians are willing and able to provide it." The skill and time needed for effective use of medications for opioid use disorders "are not generally available to primary care doctors."

In response, ASAM assembled a multidisciplinary Guideline Committee, consisting of specialists in addiction medicine and other relevant fields. The guideline was developed by a formal process, combining scientific evidence and clinical knowledge. In addition to the synopsis published in the current issue of Journal of Addiction Medicine, the complete guideline can be accessed on the journal website: www.journaladdictionmedicine.com.

The National Practice Guideline provides specific recommendations for assessment, diagnosis, and treatment, including the management of opioid withdrawal. It focuses on specific, evidence-based guidance on the major medications used in treating opioid use disorders.

Medication options include the opioid agonist (same action) medication methadone, the opioid partial agonist buprenorphine, and the opioid antagonist naltrexone. The guideline includes recommendations for appropriate use of these medications through each phase of treatment, as well as for patient monitoring and follow-up.

The guideline also addresses the rapid-acting opioid blocker naloxone, which plays a critical role in reversing opioid overdose. The Guideline Committee recommends that first responders such as emergency medical services, police officers, and firefighters be trained in and authorized to use naloxone.

The guideline also includes recommendations for patient populations with special needs and concerns: pregnant women, people with accompanying psychiatric disorders, people with pain, adolescents, and people involved in the criminal justice system. For each area addressed by the National Practice Guideline, the Committee highlights key areas for further research.

Rather than a set of hard-and-fast rules, the guideline is intended as an aid to clinical decision making for professionals at all levels of experience in treating opioid use disorders. Together with the other members of the Guideline Committee and the ASAM leadership, Drs. Kampman and Jarvis hope the information provided will help to make treatment more readily available for people with addiction involving opioid use, thus stemming the tide of overdose deaths.