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.

Contents

• The National Academies of SCIENCES • ENGINEERING • MEDICINE
• COMMITTEE ON MEDICATION-ASSISTED TREATMENT FOR OPIOID USE DISORDER
• Reviewers
• Preface
• Acronyms and Abbreviations
• Summary
  • OPIOID USE DISORDER IS A TREATABLE CHRONIC BRAIN DISEASE
  • MEDICATIONS FOR OPIOID USE DISORDER SAVE LIVES
  • MEDICATIONS ARE NOT AVAILABLE TO MANY PEOPLE WHO NEED THEM
  • STATEMENT OF TASK AND STUDY METHODOLOGY
• 1. Introduction
  • CHARGE TO THE COMMITTEE AND STUDY SCOPE
  • CONCEPTUAL FRAMEWORK AND KEY TERMS
  • STUDY METHODOLOGY
  • ORGANIZATION OF THE CONSENSUS STUDY REPORT
  • REFERENCES
• 2. The Effectiveness of Medication-Based Treatment for Opioid Use Disorder
  • METHADONE
  • BUPRENORPHINE
  • EXTENDED-RELEASE NALTREXONE
  • NALOXONE
  • EVIDENCE ON THE EFFECTIVENESS OF FDA-APPROVED MEDICATIONS IN TREATING OUD
  • KNOWLEDGE GAPS AND FUTURE DIRECTIONS FOR RESEARCH ON MEDICATIONS FOR OUD
  • BEHAVIORAL THERAPY IN CONJUNCTION WITH MEDICATIONS
  • KNOWLEDGE GAPS AND ADDITIONAL RESEARCH NEEDED ON THE ROLE OF BEHAVIORAL INTERVENTIONS WITH MEDICATIONS IN TREATMENT FOR OUD
  • REFERENCES
• 3. Treatment with Medications for Opioid Use Disorder in Different Populations
  • MEDICATION-BASED TREATMENT FOR OUD ACROSS THE LIFE COURSE
  • SEX-RELATED DIFFERENCES IN MEDICATION-BASED TREATMENT FOR OUD
  • PREGNANT WOMEN
  • SEXUAL MINORITIES
  • INDIVIDUALS WITH OUD AND OTHER MORBIDITIES
  • RACIAL AND ETHNIC MINORITY POPULATIONS
  • LOW SOCIOECONOMIC STATUS AND HOMELESS POPULATIONS
  • RURAL AND URBAN POPULATIONS
  • REFERENCES
• 4. Medications for Opioid Use Disorder in Various Treatment Settings
  • OPIOID TREATMENT PROGRAMS
  • OFFICE-BASED OPIOID TREATMENT
  • ACUTE CARE SETTINGS
  • OTHER CARE SETTINGS
  • CRIMINAL JUSTICE SETTINGS
  • INNOVATIVE SETTINGS FOR OUD TREATMENT
  • REFERENCES
• 5. Barriers to Broader Use of Medications to Treat Opioid Use Disorder
  • STIGMA
  • CONCERNS ABOUT DIVERSION OF MEDICATIONS FOR OUD
  • INADEQUATE PROFESSIONAL EDUCATION AND TRAINING
  • SYSTEM FRAGMENTATION
  • LEGAL AND REGULATORY BARRIERS
  • PUBLIC AND PRIVATE INSURANCE BARRIERS
  • REFERENCES
• Appendix A. Study Approach and Methods
• Appendix B. Public Workshop Agenda
• Appendix C. Biographical Sketches of Committee Members

Suggested citation:

National Academies of Sciences, Engineering, and Medicine. 2019. Medications for opioid use disorder save lives. Washington, DC: The National Academies Press. doi: https://doi.org/10.17226/25310.

Digital Object Identifier: https://doi.org/10.17226/25310

Library of Congress Control Number: 2019939384

Additional copies of this publication are available from the National Academies Press, 500 Fifth Street, NW, Keck 360, Washington, DC 20001; (800) 624-6242 or (202) 334-3313; http://www.nap.edu.

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