Wednesday, December 07, 2022

Opioid use disorder: Medication that lowers the risk of overdose

Researchers at Washington University School of Medicine in St. Louis and St. Louis University have found that less than half of Americans receiving treatment for opioid use disorder over a five-year period were offered a potentially lifesaving drug. And treatment with the drug was even more rare for people with what is known as polysubstance use disorder — when opioid users also abuse other substances, such as alcohol, methamphetamine, benzodiazepines, or cocaine.

The findings are based on the knowledge that drugs are less commonly used to treat those who use opioids.

“This is equivalent to giving less invasive treatments to people with advanced cancer,” said senior investigator Laura J. Beirut, MD, alumnus endowed professor of psychiatry at the University of Washington. “It seems clear to many of us that we should give the most aggressive and effective treatment to those who are most seriously ill.”

The potentially life-saving drug, buprenorphine, has been shown to reduce the risk of overdose – yet an analysis of health insurance data involving nearly 180,000 people treated for opioid use disorder showed that almost all those with the disorder alone The drug was not prescribed to 53% of patients. In people with polysubstance use disorder, the number of buprenorphine prescribed dropped by about 30%.

The study is published on May 10 in the journal jama network open,

“It is concerning that the vast majority of people who abuse multiple substances are not receiving lifesaving medication,” said first author Kevin Xu, MD, a resident physician in the department of psychiatry at the University of Washington. “Even among those who exclusively used opioids, buprenorphine was prescribed only half the time. While the data we analyzed predates COVID-19, the pandemic showed an increase in overdoses, Yet we are still not seeing many eligible patients getting buprenorphine prescriptions.”

Xu and his colleagues – Beirut and Richard A. Gruza, PhD, professor in the Department of Family and Community Medicine at St. Louis University – analyzed data compiled from 2011-2016 by insurance companies for the US IBM MarketScan database. The database includes detailed information about patients treated for opioid use disorder, as well as patients treated for using opioids in combination with other medications.

“The data we analyzed is a few years old,” Beirut said. “But we think this information can be extrapolated to what is happening now because there are even more people using opioids – or using opioids as well as other substances – today in emergency departments.” The problem has only gotten worse during the COVID-19 global pandemic.”

As recently as the 12-month period from early 2021 to early 2022, nearly 107,000 Americans died of drug overdoses. In comparison, in 2017, after years of increases in overdose deaths, the US Centers for Disease Control and Prevention reported 70,237 drug overdose deaths in the United States.

Buprenorphine prescriptions are not stocked as needed. One reason, Xu said, is because buprenorphine itself is an opioid, which results in hesitation to prescribe it to people with opioid use disorder. Unlike methadone, another opioid used to treat heroin addiction, buprenorphine can be taken at home and does not require daily visits to the clinic. But a lack of supervision, as well as a lack of data about the drug’s effectiveness in many substance abusers, means that some doctors are reluctant to prescribe it. Xu said the concerns appeared to be unfounded.

“Buprenorphine appears as a safe opioid,” he said. “It is specifically designed to be different from other opioid medications in that it does not cause the user to stop breathing, which every other type of opioid will do. This means taking it safely at home. can be taken, which is very useful, even necessary, for recovery.”

The study compared the ability of buprenorphine to the drug naltrexone to help prevent future overdoses. Buprenorphine is what is known as a partial opioid agonist, meaning it activates the same receptor that heroin and fentanyl activate. Naltrexone, on the other hand, blocks that receptor on brain cells.

Data from this study indicated that both drugs reduced the risk of future overdoses, but buprenorphine reduced it more than naltrexone.

“For a long time, people thought that blocking the receptor would be just as good as using a drug like buprenorphine to activate the opioid receptor,” Xu said. “But recent data suggest that buprenorphine is significantly more effective. The challenge now will be to persuade more doctors to prescribe this safe and effective drug for patients who need it.”

This work is supported by the National Institute of Mental Health, the National Institute on Drug Abuse, the National Institute of Alcohol Abuse and Alcoholism, the National Center for Advancing Translational Sciences, and the Agency for Healthcare Research and Sciences at the National Institutes of Health. NIH). Grant No. R25 MH112473-01, R21 DA044744, U10 AA008401, R01 DA036583, 12 DA041449, UL1 TR002345, R24 HS19455.


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