The case for a medication first approach to the treatment of opioid use disorder

Abstract

Background: The opioid addiction and overdose crisis continues to ravage communities across the U.S. Maintenance pharmacotherapy using buprenorphine or methadone is the most effective intervention for Opioid Use Disorder (OUD), yet few have immediate and sustained access to these medications. Objectives: To address lack of medication access for people with OUD, the Missouri Department of Mental Health began implementing a Medication First (Med First) treatment approach in its publicly-funded system of comprehensive substance use disorder treatment programs. Methods: This Perspective describes the four principles of Med First, which are based on evidence-based guidelines. It draws conceptual comparisons between the Housing First approach to chronic homelessness and the Med First approach to pharmacotherapy for OUD, and compares state certification standards for substance use disorder (SUD) treatment (the traditional approach) to Med First guidelines for OUD treatment. Finally, the Perspective details how Med First principles have been practically implemented. Results: Med First principles emphasize timely access to maintenance pharmacotherapy without requiring psychosocial services or discontinuation for any reason other than harm to the client. Early results regarding medication utilization and treatment retention are promising. Feedback from providers has been largely favorable, though clinical-and system-level obstacles to effective OUD treatment remain. Conclusion: Like the Housing First model, Medication First is designed to decrease human suffering and activate the strengths and capacities of people in need. It draws on decades of research and facilitates partnerships between psychosocial and medical treatment providers to offer effective and lifesaving care to persons with OUD.

Determination of Common Pharmaceutical Adulterants in Herbal Medicinal Products Used in the Treatment of Opioid Addiction

“…Opioid abuse/addiction is a chronic and recurring disorder, whose recurrence is the most important problem in the treatment of this disease. Nowadays, maintenance pharmacotherapy using opioid agonist agents such as buprenorphine or methadone is considered the most effective intervention for opioid abuse/addiction treatment in many countries [23]. However, OAT is related Vanillin and capsaicin 5.9…”

Expanding Access to Medications for Opioid Use Disorder: Program and Policy Approaches from Outside the Veterans Health Administration

“… 9 Unfortunately, most MOUD-treatment delivery systems and policies are not grounded in person-centered approaches. We highlight two exceptions, which reflect patient centered philosophies or tactics: the Medication First (Med First) Model 10 and culturally specific MOUD delivery design for Black patients with OUD. 11…”

“…The Missouri Med First program, modeled on the low-barrier Housing First approach, 12 follows four key principles: (1) patients receive MOUD as quickly as possible; (2) MOUD is available without arbitrary tapering or time limits; (3) individualized psychosocial services are offered but not required; and (4) MOUD is only discontinued if the patient’s clinical condition deteriorates. 10 The Missouri State Targeted Response (STR) implementation team conditioned STR funding on organizational capacity and willingness to deliver MOUD using Med First principles. 10 Preliminary findings are promising.…”

“… 10 The Missouri State Targeted Response (STR) implementation team conditioned STR funding on organizational capacity and willingness to deliver MOUD using Med First principles. 10 Preliminary findings are promising. In the 38 sites using the Med First model, MOUD use increased from 45 to 85% of site participants, the timeliness of MOUD receipt improved (median of 0 days waiting vs. 8 days), treatment retention improved, and the median treatment cost per month declined 21% from the prior year.…”

“…Address culturally specific needs for marginalized populations with intersecting risks due structural and interpersonal oppression (e.g., racism). • Med First Model 10 • Bellevue Hospital holistic addiction clinic 11 2. Recognize and address delivery gaps in MOUD Identify local system gaps with the intention of developing a high-touch service delivery system that ensures rapid and low-barrier access to MOUD within all care delivery environments.…”