Long-Term Course of Opioid Addiction

Abstract

Opioid addiction is associated with excess mortality, morbidities, and other adverse conditions. Guided by a life-course framework, we review the literature on the long-term course of opioid addiction in terms of use trajectories, transitions, and turning points, as well as other factors that facilitate recovery from addiction. Most long-term follow-up studies are based on heroin addicts recruited from treatment settings (mostly methadone maintenance treatment), many of whom are referred by the criminal justice system. Cumulative evidence indicates that opioid addiction is a chronic disorder with frequent relapses. Longer treatment retention is associated with a greater likelihood of abstinence, whereas incarceration is negatively related to subsequent abstinence. Over the long term, the mortality rate of opioid addicts (overdose being the most common cause) is about 6 to 20 times greater than that of the general population; among those who remain alive, the prevalence of stable abstinence from opioid use is low (less than 30% after 10-30 years of observation), and many continue to use alcohol and other drugs after ceasing to use opioids. Histories of sexual or physical abuse and comorbid mental disorders are associated with the persistence of opioid use, whereas family and social support, as well as employment, facilitates recovery. Maintaining opioid abstinence for at least five years substantially increases the likelihood of future stable abstinence. Recent advances in pharmacological treatment options (buprenorphine and naltrexone) include depot formulations offering longer duration of medication; their impact on the long-term course of opioid addiction remains to be assessed.

Commentary on Degenhardt et al. (2014): Regional variation in the global burden of disease attributable to opioid dependence—where do the data come from and does population size matter?

“…We agree with Hser et al [1] on the importance of renewed efforts to address the major public health burden of opioid dependence [2]. Opioid dependence made the greatest by far estimated contribution to disease burden via premature death and disability of all illicit drugs considered in the 2010 Global Burden of Disease Study [3].…”

“…Opioid dependence made the greatest by far estimated contribution to disease burden via premature death and disability of all illicit drugs considered in the 2010 Global Burden of Disease Study [3]. The need for a concerted, evidence-based response is heightened by the estimated increase in the burden over the past two decades, due largely to increased prevalence of these disorders [2]. …”

“…2 Opioid dependence contributed to 9 million DALYs globally in 2010, a 73% increase from 1990; and North America, eastern Europe, Australasia and southern sub-Saharan Africa have the highest DALY rates. We recently completed a review paper on the long-term course of opioid addiction [2] in which we examined mortality and opioid abstinence rates reported by long-term follow-up studies (i.e. those with at least 3 years of follow-up) of opioid addicts.…”

Interventions for the management of substance use disorders: an overview

“…In many parts of the world, injection of heroin is the major contributor to the spread of HIV, hepatitis C and other infectious diseases (12,13). Overdose deaths associated with both injecting heroin and taking prescribed opiates are a significant concern (14).…”

The CHANGE Study: Methods and Sample Description for a Cross-Sectional Study of Heroin Cessation in New York City

“…2,[35][36][37] We ascertained whether participants had ever been incarcerated, and for those who had been to jail or prison, we asked about their most recent incarceration. We asked about services offered prior to release from the most recent incarceration such as appointments, referrals, or information for finding a health care provider, information for finding a mental health care provider, discharge planning, aftercare support, medication, assistance or information for applying for public assistance or Medicaid, and case management.…”