Individualizing Opioid Use Disorder (OUD) Treatment: Time to Fully Embrace a Chronic Disease Model

Abstract

The current opioid epidemic in the United States is changing our perceptions of the face of addiction. Opioid Use Disorder (OUD) has become pervasive and is affecting all ethnicities, races, socioeconomic classes, the young and the old. In 2015, 46 people will lose their life each day to a chronic brain disease that is going unnoticed and undertreated. Over the last five decades, numerous scientific and clinical breakthroughs have allowed for a better understanding of the mechanisms underlying addiction, and the development of medications that can help support a patient's long-term recovery. All of those that have contributed to these advancements have aided in redefining addiction as a primary, chronic disease of the brain reward, motivation, memory and related circuitry; however, our treatment strategies have not necessarily advanced to the same extent as our current understanding of the disease. This commentary will explore how personal philosophies can bias treatments strategies and definitions of treatment success, and prevent adoption of chronic disease treatment models that would significantly improve the quality of life of those suffering with OUD. This is a challenge to consider how our views and stigma can impact a patient's recovery. We are currently losing a battle with a disease that is taking the lives of 46 individuals daily; it is time to fully embrace a chronic disease model which comprises an integrated pharmacopsychosocial approach for treating the biopsychosocial disorder that is addiction to reverse these trends.

Do We Really Need to Continue Pharmacotherapy for Opioid Use Disorder (OUD) Indefinitely?

“…a number of variables are known to affect the recovery and ultimately treatment success [15]. In this context we agree with Gustin et al [1] that the treatment protocol should be individualized but the variables that affect the outcome are difficult to quantify. It is difficult to precisely predict the length of treatment a particular individual would need.…”

“…Of course there will be few patients that will never respond. Because a few patients will not respond to any length of treatment does not justify recommending long-term (lifelong) treatment protocol for all patients as suggested by Gustin et al [1].…”

“…Because of limited data and clinical experience, determination of the dose and length of treatment with BUP remains unclear. Gustin et al [1] recommend indefinite continuation of treatment. They argue that the chronic disease model of addiction proposed by american society of addiction Medicine [2] suggests that the addiction treatment should be continued for the rest of life, as is the case with the most chronic diseases like diabetes mellitus and hypertension.…”

Social networking online to recover from opioid use disorder: A study of community interactions

“…Many individuals struggle with overcoming opioid abuse due to the intense withdrawal symptoms that occur when opioid use is discontinued that may include dysphoric mood, nausea or vomiting, fever, insomnia and/or muscle aches among others (American Psychiatric Association, 2013). Accordingly, relapse from opioid abstinence is common and makes the necessity for accessibility to OUD treatment vital for many to experience success in their recovery (Gustin et al, 2015; Martin et al, 2007). …”

Should the United States Government Repeal Restrictions on Buprenorphine/Naloxone Treatment?

“…Most authors have suggested that buprenorphine/naloxone should be utilized as a long-term opioid maintenance therapy based on the chronicity of opioid dependence (Gustin, Nichols, Martin, et al, 2015), while some others do not support this “mainstream” view (Badgaiyan, Sinha, Blum, 2015). …”