This information sheet links to primary sources, secondary sources that report on multiple primary sources, informed commentary, and reports from our own literature reviews. To aid in creating printable copies with sources, we have primarily posted the link rather than linked the text.
- Opioid Use Disorder (OUD) is a chronic condition requiring long-term care.
Source: http://www.sciencedirect.com/science/article/pii/S0955395916302985 - Of pain patients who are prescribed opioids, about 8% develop opioid use disorders. Most people with opioid use disorders began by using opioids obtained from a friend or family member.
Sources: http://www.nejm.org/doi/full/10.1056/NEJMra1507771#t=article
https://blogs.scientificamerican.com/mind-guest-blog/opioid-addiction-is-a-huge-problem-but-pain-prescriptions-are-not-the-cause/
http://www.pbs.org/newshour/rundown/opioid-misuse-starts-friend-family-members-prescription/ - An estimated 80% of people who try abstinence-based behavioral treatment or detoxification relapse.
Source: http://www.tandfonline.com/doi/abs/10.1080/10550887.2012.694598 - Individual counseling and group counseling, by themselves, are not evidence-based treatments for opioid use disorder. Individuals receiving only counseling are at higher risk of death than individuals on opioid maintenance treatment.
Sources: http://www.handshakemediainc.com/2017/02/05/on-counseling-and-medication-assisted-treatment/
http://onlinelibrary.wiley.com/doi/10.1111/add.13193/full - People are more likely to fatally overdose prior to beginning maintenance medication and upon ceasing it than are those with continuous treatment.
Sources: http://www.bmj.com/content/357/bmj.j1550
http://www.sciencedirect.com/science/article/pii/S0740547216304123
https://www.ncbi.nlm.nih.gov/pubmed/20978062 - Only buprenorphine or methadone maintenance treatments are known to cut death rates by half or more.
Sources: https://www.ncbi.nlm.nih.gov/pubmed/20978062
https://www.ncbi.nlm.nih.gov/pubmed/25601365 - While oral naltrexone, and extended-release naltrexone marketed as Vivitrol, may be helpful to some, only buprenorphine and methadone are supported by the data in terms of reducing death rates. Further, naltrexone is associated with depression in some individuals, and the risk of overdose and death is high upon cessation of naltrexone. Overdose is eight times higher, and the death rate is four times higher, in people with OUD who stop taking naltrexone vs. those who stop taking buprenorphine or methadone. Naltrexone can block a sense of social connection, considered fundamental to recovery from addiction. Extended-release naltrexone is more expensive than buprenorphine and methadone, making it a fiscally unsound choice for publicly-funded treatment given its lack of evidential support. The company that manufactures Vivitrol, Alkermes, is marketing the drug directly to court judges and other criminal justice officials. Despite the weak evidence base for Vivitrol, judges in drug courts are now mandating Vivitrol, essentially prescribing without a medical license.
Sources: https://fivethirtyeight.com/features/what-science-says-to-do-if-your-loved-one-has-an-opioid-addiction/
http://onlinelibrary.wiley.com/doi/10.1111/dar.12205/full
https://www.vice.com/en_us/article/7x9ypq/how-safe-is-americas-hottest-heroin-addiction-treatment
https://www.statnews.com/2017/06/29/vivitrol-methadone-opioids/
https://www.ncbi.nlm.nih.gov/pubmed/28274648
http://www.npr.org/sections/health-shots/2017/08/03/540029500/to-grow-market-share-a-drugmaker-pitches-its-product-to-judges
“In the United States, a monthly injectable form of long-acting naltrexone (Vivitrol) was approved in 2010 as a third medication option for opioid addiction treatment. In the United States, opioid substitution therapy and extended release naltrexone are grouped together in the category ‘medication assisted treatment’ (MAT), to distinguish these treatments from abstinence only methods. Less than half a dozen trials of long-acting naltrexone have been published and they show promising results in terms of reducing relapse. There is little long-term data, however, and extended-release naltrexone has not been shown to reduce mortality or disease. It may even increase overdose death risk upon cessation. Vivitrol is not approved in Canada, although it is available under the country’s special access program in reaction to the opioid crisis.”
– The Opioid Crisis in North America, Global Commission on Drug Policy, October, 2017
- Maintenance treatment reduces rates of disease.
Source: http://onlinelibrary.wiley.com/doi/10.1111/add.12682/full - For those with OUD who are part of the criminal justice population, maintenance is known to reduce rates of re-incarceration by 20% or more.
Sources: http://onlinelibrary.wiley.com/doi/10.1111/j.1360-0443.2011.03618.x/full
http://www.tandfonline.com/doi/abs/10.3109/16066359909004372
https://www.drugabuse.gov/publications/principles-drug-abuse-treatment-criminal-justice-populations/principles - A minimum of 12 months is recommended for maintenance to be effective.
Source: https://www.ncbi.nlm.nih.gov/pubmed/20978062 - People must be in remission from illicit opioid use for at least five years before risk of relapse decreases substantially.
Source: http://journals.lww.com/hrpjournal/Abstract/2015/03000/Long_Term_Course_of_Opioid_Addiction.3.aspx - Many individuals need long periods of maintenance on methadone or buprenorphine before they are stable in remission, even 17 years or longer, sometimes lifelong.
Sources: http://www.sciencedirect.com/science/article/pii/S0376871616308675
https://www.karger.com/Article/PDF/468518
http://www.sciencedirect.com/science/article/pii/S0376871617301977
A shortened, printable .pdf of the information sheet is here.
A printable .pdf of the infographic by Laurel Sindewald is here. It is updated from our original post here.
This content is for informational purposes only and is not a substitute for medical or professional advice. Consult a qualified health care professional for personalized medical and professional advice.
Related reports on addictions treatment, addictions recovery, and addictions policy from Handshake Media, Incorporated:
- On Counseling and Medication-Assisted Treatment, February 5, 2017
- Why Opioid Maintenance Does Not Replace One Addiction with Another, October 21, 2016
- Addiction or Dependence: A Life and Death Difference, October 18, 2016
- Understanding Why We Have Wait Lists for Opioid Addictions Treatment, June 2, 2016
- What the Opioid Epidemic Means in Virginia, March 4, 2016
This post was last updated 10/31/17.
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