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J Med Toxicol. 2018 Dec;14(4):306-322. doi: 10.1007/s13181-018-0685-1. Epub 2018 Oct 30.

Pharmacologic Treatment of Opioid Use Disorder: a Review of Pharmacotherapy, Adjuncts, and Toxicity.

Toce MS1,2, Chai PR3,4, Burns MM3,5, Boyer EW3,5,4.

Author information

1
Harvard Medical Toxicology Program, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA, 02115, USA. Michael.toce@childrens.harvard.edu.
2
Division of Emergency Medicine, Department of Medicine, Boston Children's Hospital, Boston, MA, USA. Michael.toce@childrens.harvard.edu.
3
Harvard Medical Toxicology Program, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA, 02115, USA.
4
Division of Medical Toxicology, Department of Emergency Medicine, Brigham and Women's Hospital, Boston, MA, USA.
5
Division of Emergency Medicine, Department of Medicine, Boston Children's Hospital, Boston, MA, USA.

Abstract

Opioid use disorder continues to be a significant source of morbidity and mortality in the USA and the world. Pharmacologic treatment with methadone and buprenorphine has been shown to be effective at retaining people in treatment programs, decreasing illicit opioid use, decreasing rates of hepatitis B, and reducing all cause and overdose mortality. Unfortunately, barriers exist in accessing these lifesaving medications: users wishing to start buprenorphine therapy require a waivered provider to prescribe the medication, while some states have no methadone clinics. As such, users looking to wean themselves from opioids or treat their opioid dependence will turn to alternative agents. These agents include using prescription medications, like clonidine or gabapentin, off-label, or over the counter drugs, like loperamide, in supratherapeutic doses. This review provides information on the pharmacology and the toxic effects of pharmacologic agents that are used to treat opioid use disorder. The xenobiotics reviewed in depth include buprenorphine, clonidine, kratom, loperamide, and methadone, with additional information provided on lofexidine, akuamma seeds, kava, and gabapentin.

KEYWORDS:

Buprenorphine; Clonidine; Heroin; Kratom; Loperamide; Methadone; Opioid; Opioid use disorder; Withdrawal

PMID:
30377951
PMCID:
PMC6242798
[Available on 2019-12-01]
DOI:
10.1007/s13181-018-0685-1

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