TY - JOUR
KW - Buprenorphine/therapeutic use
KW - Female
KW - Forecasting
KW - Humans
KW - Male
KW - Methadone/therapeutic use
KW - Naltrexone/therapeutic use
KW - Narcotic Antagonists/therapeutic use
KW - Opiate Substitution Treatment
KW - Opioid-Related Disorders/drug therapy
KW - Pregnancy
KW - Randomized Controlled Trials as Topic
KW - Risk Factors
KW - United States
AU - H. S. Connery
A1 - 
AB - Medication-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 article reviews the current evidence for medication-assisted treatment of opioid use disorder and also presents clinical practice imperatives for preventing opioid overdose and the transmission of infectious disease. The evidence strongly supports the use of agonist therapies to reduce opioid use and to retain patients in treatment, with methadone maintenance remaining the gold standard of care. Combined buprenorphine/naloxone, however, also demonstrates significant efficacy and favorable safety and tolerability in multiple populations, including youth and prescription opioid-dependent individuals, as does buprenorphine monotherapy in pregnant women. The evidence for antagonist therapies is weak. Oral naltrexone demonstrates poor adherence and increased mortality rates, although the early evidence looks more favorable for extended-release naltrexone, which has the advantages that it is not subject to misuse or diversion and that it does not present a risk of overdose on its own. Two perspectives-individualized treatment and population management-are presented for selecting among the three available Food and Drug Administration-approved maintenance therapies for opioid use disorder. The currently unmet challenges in treating opioid use disorder are discussed, as are the directions for future research.
BT - Harvard review of psychiatry
C5 - Opioids & Substance Use
CP - 2
CY - United States
DO - 10.1097/HRP.0000000000000075
IS - 2
JF - Harvard review of psychiatry
N2 - Medication-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 article reviews the current evidence for medication-assisted treatment of opioid use disorder and also presents clinical practice imperatives for preventing opioid overdose and the transmission of infectious disease. The evidence strongly supports the use of agonist therapies to reduce opioid use and to retain patients in treatment, with methadone maintenance remaining the gold standard of care. Combined buprenorphine/naloxone, however, also demonstrates significant efficacy and favorable safety and tolerability in multiple populations, including youth and prescription opioid-dependent individuals, as does buprenorphine monotherapy in pregnant women. The evidence for antagonist therapies is weak. Oral naltrexone demonstrates poor adherence and increased mortality rates, although the early evidence looks more favorable for extended-release naltrexone, which has the advantages that it is not subject to misuse or diversion and that it does not present a risk of overdose on its own. Two perspectives-individualized treatment and population management-are presented for selecting among the three available Food and Drug Administration-approved maintenance therapies for opioid use disorder. The currently unmet challenges in treating opioid use disorder are discussed, as are the directions for future research.
PP - United States
PY - 2015
SN - 1465-7309; 1067-3229
SP - 63
EP - 75
EP - 
T1 - Medication-assisted treatment of opioid use disorder: Review of the evidence and future directions
T2 - Harvard review of psychiatry
TI - Medication-assisted treatment of opioid use disorder: Review of the evidence and future directions
U1 - Opioids & Substance Use
U2 - 25747920
U3 - 10.1097/HRP.0000000000000075
VL - 23
VO - 1465-7309; 1067-3229
Y1 - 2015
ER -