Future Directions Incorporating Novel Medications to Reduce Repeat Overdose
- 14 Downloads
Purpose of review
The use of opioids has risen dramatically in the USA and led to an increase in opioid use disorders and deaths due to opioid-related overdoses. Current treatments for opioid use disorder are not without drawbacks, so that new treatments may be helpful in reducing opioid use. This paper reviews current pharmacologic treatments for opioid use disorder as well as emerging novel treatments that may change or improve approaches to treatment.
The current treatments for opioid use disorder are methadone, buprenorphine, and naltrexone. Of the three, methadone has been the most studied and longest treatment used. However, because of limitations with prescribing and safety concerns with methadone, buprenorphine is becoming a widely used pharmacologic treatment alternative. Naltrexone remains less commonly utilized. New treatments such as lorcaserin and medicinal cannabis have potential to make an impact in addressing the opioid epidemic; however, controlled human studies are needed to assess their full potential.
Current treatments for opioid use disorder are beneficial, but have the disadvantage of abuse potential, compliance concerns, and prescribing limitations. Novel pharmacologic treatments may be able to address these concerns. Future research should continue to evaluate the efficacy of novel medications for the treatment of opioid use disorder.
KeywordsOpioid use disorder Opioid epidemic Medication-assisted treatment Novel treatment
Compliance with Ethical Standards
Conflict of Interest
Dr. Moeller has grant support from Indivior pharmaceuticals. Dr. Johns has nothing to disclose.
References and Recommended Reading
Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance
- 1.Substance Abuse and Mental Health Services Administration (SAMHSA). Key substance use and mental health indicators in the United States: results from the 2016 National Survey on Drug Use and Health. HHS Publication No. (SMA) 17–5044. Rockville, MD: Substance Abuse and Mental Health Services Administration, 2017.Google Scholar
- 2.•• Hughes A, Williams MR, Lipari RN, Bose J, Copella EAP, Kroutil LA. Prescription drug use and misuse in the United States: results from the 2015 National Survey on Drug Use and Health. NSDUH Data Review. 2016. Data on prescription drug use and misuse in the United States.Google Scholar
- 3.Rajan S, Ruggles KV, Guarino H, Mateu-Gelabert P. Heroin use and drug injection among youth also misusing prescription drugs. Substance Abuse Treat Prev Policy. 2018;42(1):144–55.Google Scholar
- 5.Park-Lee E, Lipari RN, Hadden SL, Kroutil LA. Receipt of services for substance use and mental health issues among adults: results from the 2016 National Survey on Drug Use and Health. NSDUH Data Review. 2017.Google Scholar
- 6.Center for Disease Control and Prevention. Emergency department data show rapid increases in opioid overdose [Press release]. Retrieved from https://www.cdc.gov/media/releases/2018/p0306-vs-opioids-overdoses.html.
- 7.Fairfax County Opioid Task Force Plan. 2018. https://www.fairfaxcounty.gov/community-services-board/sites/community-services-board/files/assets/documents/pdf/opioid-task-force-plan.pdf. Accessed 23 May 2018.
- 14.Yarborough BJ, Stumbo SP, McCarty D, Mertens J, Weisner C, Green CA. Methadone, buprenorphine and preferences for opioid agonist treatment: a qualitative analysis. Drug Alcohol Depend 2016;160:112–8.Google Scholar
- 17.D’Onofrio G, O’Connor PG, Pantalon MV, Chawarski MC, Busch SH, Owens PH, et al. Emergency department-initiated buprenorphine/naloxone treatment for opioid dependence: a randomized clinical trial. JAMA 2015. 2015;313(16):1636–44.Google Scholar
- 19.•Bisaga A, Mannelli P, Sullivan MA, Vosburg SK, Compton P, Wood GE, et al. Antagonists in the medical management of opioid use disorders: historical and existing treatment strategies. Am J Addict. 2018;27(3):177–87.Addresses practices for managing persons with moderate to severe opioid use disorder.Google Scholar
- 20.Tanum L, Solli KK, Latif ZE, Benth JS, Opheim A, Sharma-Haase K et al. Effectiveness of injectable extended-release naltrexone vs daily buprenorphine-naloxone for opioid dependence: a randomized clinical noninferiority trial. 2017;74(12):1197–1205.Google Scholar
- 21.Bond AJ, Witton J. Perspectives on the pharmacological treatment of heroin addiction. Clin Med Insights: Psychiatr. 2017;8:1–10.Google Scholar
- 22.Shanahan WR, Rose JE, Glicklich A, Stubbe S, Sanchez-Kam M. Lorcaserin for smoking cessation and associated weight gain: a randomized 12-week clinical trial. Nicotine Tob Res 2016;19(8):944–51.Google Scholar
- 24.Lipari RN, Williams M, Van Horn SL. Why do adults misuse prescription drugs? The CBHSQ Report. Rockville MD: Center for Behavioral Health Statistics and Quality, Substance Abuse and Mental health Services, 2017.Google Scholar
- 25.•• Neelakantan H, Holliday ED, Fox RG, Stutz SJ, Comer SD, Haney M, et al. Lorcaserin suppresses oxycodone self-administration and relapse vulnerability in rats. ACS Chem Neurosci. 2017;8(5):1065–73. Evidence of lorcaserin reducing oxycodone self-administrationCrossRefPubMedPubMedCentralGoogle Scholar
- 26.•• Wu X, Pang G, Zhang YM, Li G, Xu S, Don L, et al. Activation of serotonin in 5-HT(2C) receptor suppresses behavioral sensitization and naloxone-precipitated withdrawal symptoms in heroin-treated mice. Neurosci Lett. 2015;607:23–8. Evidence of lorcaserin suppressing behavior sensitization and withdrawal.CrossRefPubMedPubMedCentralGoogle Scholar
- 27.• Baron EPComprehensive review of medical marijuana, cannabinoids, and therapeutic implications in medicine and headache: what a long trip it’s been. Headache 2015;55(6):885–916. A review of medicinal marijuana and headache.Google Scholar
- 29.Gupta S. Why I changed my mind on weed. 2013. https://www.cnn.com/2013/08/08/health/gupta-changed-mind-marijuana/. Accessed 23 May 2018.
- 30.Gupta S. Dr. Sanjay Gupta to Jeff Sessions: medicinal marijuana could save many addicted to opioids. 2018. https://www.cnn.com/2018/04/24/health/medical-marijuana-opioid-epidemic-sanjay-gupta/. Accessed 23 May 2018.
- 31.•• Vigil JM, Stith SS, Adams IM, Reeve AP. Associations between medical cannabis and prescription opioid use in chronic pain patients: a preliminary cohort study. PLoS One. 2017;12(11):e0187795. Evidence of medicinal cannabis reducing prescription opioid use.CrossRefPubMedPubMedCentralGoogle Scholar