Some Additional Considerations Regarding the American Society of Addiction Medicine National Practice Guideline for the Use of Medications in the Treatment of Addiction Involving Opioid Use

Saxon, Andrew J.; McCance‐Katz, Elinore F.

doi:10.1097/adm.0000000000000219

Cited by 7 publications

(14 citation statements)

References 18 publications

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“…2 Of those who do, many drop out. 3 We believe that patients treated for an overdose should either undergo ODM in the emergency department or be immediately referred to longer-term treatment either in inpatient detoxification services or outpatient services to ensure that they receive adequate long-term ODM, although the suggestion from Desai et al to promote "self-management" is inconsistent with evidence regarding successful remission from opioid use disorders. 3 The emphasis on engagement in treatment after overdose reversal should be established nationwide.…”

Section: Massachusetts Department Of Public Health Findings Of the Op...mentioning

confidence: 99%

“…3 We believe that patients treated for an overdose should either undergo ODM in the emergency department or be immediately referred to longer-term treatment either in inpatient detoxification services or outpatient services to ensure that they receive adequate long-term ODM, although the suggestion from Desai et al to promote "self-management" is inconsistent with evidence regarding successful remission from opioid use disorders. 3 The emphasis on engagement in treatment after overdose reversal should be established nationwide. National efforts should expand the focus on educational campaigns to increase awareness of treatment availability and reduce stigma among the general public, which includes those with an opioid use disorder and their friends and relatives.…”

Section: Massachusetts Department Of Public Health Findings Of the Op...mentioning

confidence: 99%

“…2 One of the primary responses to the opioid crisis was increasing access to opioid-dependency medications, including buprenorphine, by increasing the number of prescribers. 3 To explore the effectiveness of this intervention on ORDs in Massachusetts, we examined the number of buprenorphine prescribers and ORDs from 2010 to 2016.Over this 7-year period, the number of buprenorphine prescribers in Massachusetts increased from 835 to 1990. Of particular interest to us were prescriber numbers after the declared state of emergency in 2014, which prompted targeted efforts at increasing access to opioid-dependency medications in Massachusetts.…”

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confidence: 99%

“…Of particular interest to us were prescriber numbers after the declared state of emergency in 2014, which prompted targeted efforts at increasing access to opioid-dependency medications in Massachusetts. 3 Between 2014 and 2016, prescriber numbers increased by 550, more than any 2-year span during the 7-year period. At no point from 2010 to 2016 was there a decrease in annual ORDs.…”

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Factors to Consider for Reducing US Opioid-Related Deaths: Looking Beyond Access—Reply

2017

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To the Editor We want to thank Martins et al 1 for their direction as we attempt to navigate and remap the current opioid epidemic's vexing domestic landscape. As Martins et al 1 reported, there was a 5-fold increase in heroin use and 3-fold increase in heroin use disorders from 2001 to 2013, which have likely contributed to the rise of US opioidrelated deaths (ORDs) since 2002. 2 One of the primary responses to the opioid crisis was increasing access to opioid-dependency medications, including buprenorphine, by increasing the number of prescribers. 3 To explore the effectiveness of this intervention on ORDs in Massachusetts, we examined the number of buprenorphine prescribers and ORDs from 2010 to 2016.Over this 7-year period, the number of buprenorphine prescribers in Massachusetts increased from 835 to 1990. Of particular interest to us were prescriber numbers after the declared state of emergency in 2014, which prompted targeted efforts at increasing access to opioid-dependency medications in Massachusetts. 3 Between 2014 and 2016, prescriber numbers increased by 550, more than any 2-year span during the 7-year period. At no point from 2010 to 2016 was there a decrease in annual ORDs. On the contrary, nearly a 4-fold increase was observed from 532 deaths in 2010 to an estimated 1979 deaths in 2016. Year-to-year percentage increases in ORDs never fell below 13% and reached 50% between 2013 and 2014. Most concerning, perhaps, is the ratio of ORDs to prescribers, which started at 0.64 in 2010 and slowly climbed to 1 ORD per prescriber in 2016. 4 It is disappointing to see that increased access to buprenorphine in Massachusetts has not lowered the number of ORDs. Besides the recommendation for physicians' role in screening and prescribing practices, opioid use disorder treatment, and improvements in opioid overdose education and use of naloxone, 5 we encourage the continued exploration of other factors, most notably poor patient acceptance of treatment for opioid use disorder, the rise in availability of heroin and synthetic opioids, an emphasis on engagement into treatment after the reversal of overdose, and promotion of integrative medicine (self-management) for sustained recovery. Other approaches, such as decriminalization of opioid abuse and/or supervised injection sites, also seem worthy of consideration.

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Section: Massachusetts Department Of Public Health Findings Of the Op...mentioning

confidence: 99%

Section: Massachusetts Department Of Public Health Findings Of the Op...mentioning

confidence: 99%

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confidence: 99%

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confidence: 99%

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confidence: 99%

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