Prevention and Treatment of Opioid Misuse and Addiction

Abstract

ore than 2 million Americans have an opioid use disorder (OUD), and in 2016, more than 42 000 Americans died of opioid overdoses. 1,2 Although in the first years of the opioid crisis, most overdose-associated deaths were caused by misuse of prescription analgesics, heroin and synthetic opioids (fentanyl and its analogues) currently account for most of the fatalities, a scenario that reflects the changing nature of the opioid crisis (Figure 1). We reviewed the pharmacology of opioids because it is relevant to their rewarding and analgesic effects that lead to their misuse, the epidemiology of the crisis and its transformations in the past 2 decades, and the interventions to treat and prevent OUD that must be implemented to overcome the current crisis and prevent it from happening again. Opioid PharmacologyOpioid drugs-prescription analgesics and illicit drugs-exert their pharmacologic effects by engaging the endogenous opioid system, where they act as agonists at the μ-opioid receptor (MOR). The agonist action at the MOR is responsible for the rewarding effects of opioids and analgesia. In the brain, these receptors are highly concentrated in regions that are part of the pain and reward networks. They are also located in regions that regulate emotions, which is why long-term opioid exposure is frequently associated with depression and anxiety. 4 In addition, MORs are located in brainstem regions that regulate breathing; there, IMPORTANCE More than 42 000 Americans died of opioid overdoses in 2016, and the fatalities continue to increase. This review analyzes the factors that triggered the opioid crisis and its further evolution, along with the interventions to manage and prevent opioid use disorder (OUD), which are fundamental for curtailing the opioid crisis.OBSERVATIONS Opioid drugs are among the most powerful analgesics but also among the most addictive. The current opioid crisis, initially triggered by overprescription of opioid analgesics, which facilitated their diversion and misuse, has now expanded to heroin and illicit synthetic opioids (fentanyl and its analogues), the potency of which further increases their addictiveness and lethality. Although there are effective medications to treat OUD (methadone hydrochloride, buprenorphine, and naltrexone hydrochloride), these medications are underused, and the risk of relapse is still high. Strategies to expand medication use and treatment retention include greater involvement of health care professionals (including psychiatrists) and approaches to address comorbidities. In particular, the high prevalence of depression and suicidality among patients with OUD, if untreated, contributes to relapse and increases the risk of overdose fatalities. Prevention interventions include screening and early detection of psychiatric disorders, which increase the risk of substance use disorders, including OUD. CONCLUSIONS AND RELEVANCEAlthough overprescription of opioid medications triggered the opioid crisis, improving opioid prescription practices for pain management, althoug...

“My life is under control with these medications”: an interpretative phenomenological analysis of managing chronic pain with opioids

“…Of particular note is the opioid crisis in the U.S., where drug overdoses involving opioids resulted in more than 400,000 deaths during the last two decades as a consequence of this opioid epidemic [13,14]. Further, the evidence regarding chronic opioid therapy (COT) (opioid therapy > 90 days) for chronic pain [6,15,16] is increasingly highlighting the risks, e.g., opioid hyperalgesia, opioid use disorder, and loss of beneficial effects over time [7,[17][18][19][20][21][22][23][24][25].…”

Trends in opioid prescribing in Estonia (2011‐2017)

“…Research from the United States, Australia, Canada, and European countries have shown a significant increase in opioid utilization during the past decade to such a scale that several countries (United States, Canada, Australia) have called for an organized response to the opioid crisis . In 2017, the European Monitoring Centre for Drugs and Drug Addiction (EMCDDA) reports that while some parallels exist, the overall European situation remains different to that reported from the United States .…”

Effects of the selective dopamine D3receptor antagonist PG01037 on morphine-induced hyperactivity and antinociception in mice

“…The abuse of prescription and recreational opioids has culminated in a growing national healthcare crisis, with substantial efforts being devoted to the development of novel pharmacotherapeutics that can safely and more effectively reduce opioid misuse and dependence as compared to currently-available medications (Blanco and Volkow 2019;Kreek et al 2019;Volkow et al 2019). It is well-established that the abuse-related effects of opioids are mediated largely via their capacity to increase dopamine (DA) neurotransmission within the mesolimbic reward system (for review, see Di Chiara and North 1992;McBride et al 1999;Pierce and Kumaresan 2006;Reiner et al 2019;Wise 1989), a projection that arises from DAergic cells located in the ventral tegmental area (VTA) and terminates in the nucleus accumbens (NAc) (Bjorklund and Dunnett 2007;Moore and Bloom 1978).…”