Opioid Use Disorders and Their Treatment Mark Edlund, MD, PhD RTI International Photo courtesy of The Herb Museum, Vancouver, BC
Acknowledgements Funded by NIDA R01 DA022560-01 NIDA R01 DA034627 NIDA R01 DA030300 HHSD2002013M53964B /200-2016-F-92304 Research Career Development Award No conflicts of interest 2
Among the remedies which it has pleased Almighty God to give to man to relieve his sufferings, none is so universal and so efficacious as opium. Sydenham, 1682 3
Rates of Opioid Overdose Deaths, Sales, and Treatment Admissions, United States, 1999 2010 4 Source: CDC. (2011). Vital signs: Overdoses of prescription opioid pain relievers United States, 1999 2008. Morbidity and Mortality Weekly Report, 60(43),1487-1492. Retrieved from http://www.cdc.gov/mmwr/preview/mmwrhtml/mm60e1101a1.htm?s_cid=mm60e1101a1_w
Drug Overdose Death Rate, 2008, and Opioid Pain Reliever Sales Rate, 2010 National Vital Statistics System, 2008; Automated Reports Consolidated Orders System, 2010. Kg of opioid pain relievers used per 10,000 Age-adjusted rate per 100,000 5
Commonly Used Opioids Prescription opioids, such as oxycodone, hydrocodone, morphine, dilaudad, fentanyl, methadone, buprenorphine Heroin Illicit fentanyl Most initial use is with prescription opioids 1 1 Compton, W. M., Jones, C. M., Baldwin, G. T. (2016). Relationship between nonmedical prescription-opioid use and heroin use. New England Journal of Medicine, 374,154-163. 6
Opioid Use Disorder Criteria Formerly divided into abuse and dependence Combined into Opioid Use Disorders in DSM 5 2 1.9 million people with an opioid use disorder related to prescription opioids 3 586,000 people with an opioid use disorder related to heroin use 3 7 2 American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author. 3 SAMHSA. (2015). Substance use disorders. Retrieved from https://www.samhsa.gov/disorders/substance-use
Opioid Use Disorder Criteria (continued) DSM 5 Criteria requires at least 2 out of 11 1. Taken in larger amounts or for longer periods of time than intended 2. Persistent desire or unsuccessful efforts to cut down or control use 3. Great deal of time is spent in activities necessary to obtain the opioid, use the opioid, or recover from its effects. 4. Craving 5. Recurrent opioid use resulting in a failure to fulfill major role obligations 8 Source: American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author.
Opioid Use Disorder Criteria (continued) 6. Continued opioid use despite persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of opioids 7. Important activities are given up or reduced because of opioid use 8. Recurrent opioid use in situations where it is hazardous 9. Continued opioid use despite knowledge of having a persistent or recurrent physical or psychological problem that is likely caused or exacerbated by opioids 10. Tolerance 9 11. Withdrawal Source: American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author.
Opioid Use Disorder Criteria (continued) One problem with diagnosing opioid use disorders (OUDs) among individuals using chronic opioid therapy for chronic non-cancer pain is that almost all of these individuals will have tolerance and withdrawal. 10
Non-medical Prescription Opioid Use Use of prescription opioids not prescribed for the individual or taken only for the experience or feeling it caused 4 2.5 million people in the United States 5 Many people move from non-medical prescription opioid use to opioid use disorder 6 11 4 Substance Abuse and Mental Health Services Administration 5 Hughes, A., Williams, M. R., Lipari, R. N., Bose, J., Copello, E. A. P., & Kroutil, L. A. (2016). Prescription drug use and misuse in the United States: Results from the 2015 National Survey on Drug Use and Health. NSDUH Data Review. Retrieved from https://www.samhsa.gov/data/sites/default/files/nsduh-ffr2-2015/nsduh-ffr2-2015.htm 6 Compton, W. M., Jones, C. M., Baldwin, G. T. (2016). Relationship between nonmedical prescription-opioid use and heroin use. New England Journal of Medicine, 374,154-163.
Negative Sequalae Crime Mortality from overdose Hepatitis C, HIV Others 12
Treatment 12-step groups Cognitive behavioral therapy (enhance motivation, work towards behavioral change, reward treatment with adherence, teach ways to minimize relapse) Medication-assisted treatment Methadone opioid agonist Buprenorphine opioid partial agonist Naltrexone opioid antagonist 13 Source: Schuckit, M. A. (2016). Treatment of opioid use disorders. New England Journal of Medicine, 375, 357-368.
Thanks! Please email any questions to medlund@rti.org 14