Latest news with #OpioidUseDisorder
Medscape
14-07-2025
- Health
- Medscape
Are Opioid Agonist Treatments Effective in the Fentanyl Era?
Opioid agonist treatments (OATs) such as methadone and buprenorphine-naloxone are standard therapy for opioid use disorder, but treatment duration is decreasing as fentanyl becomes more prevalent in the illicit opioid supply. Given that retention in OAT is a core measurement of treatment effectiveness, the finding underscores the urgent need for research and policy changes, according to a population-based, retrospective cohort analysis from Ontario. Illicit opioids in Canada now contain more fentanyl than before. In 2022, almost 70% of opioid samples submitted for analysis in Canada contained fentanyl or fentanyl analogs. 'Fentanyl is substantially more potent than the prescription opioids and heroin that were previously most commonly used, and the fentanyl available today often has other substances mixed in,' study author Robert Kleinman, MD, told Medscape Medical News. 'We were interested in investigating these changes because many patients report that methadone and buprenorphine-naloxone are not as effective for them as they were before the fentanyl era.' Kleinman is a scientist at the Institute for Mental Health Policy Research within the Centre for Addiction and Mental Health and an assistant professor of psychiatry at the University of Toronto, Toronto. The article was published online on July 1 in JAMA Network Open . Differences by Treatment The researchers compared the duration of methadone and buprenorphine-naloxone treatment during 2014-2016 (before fentanyl was common), 2017-2019 (as fentanyl was becoming more common), and 2020-2022 (the 'fentanyl era'). The population included 72,717 patients who were at least 15 years old and who began OAT during those periods. A total of 45,256 (62.2%) participants were men, and the population's median age was 35 years. In all, 34,538 patients (47.5%) received methadone, and 38,179 (52.5%) received buprenorphine-naloxone. Administrative data were obtained from ICES, an independent nonprofit research institute in Ontario. The data contained demographic information, as well as information about outpatient methadone and buprenorphine-naloxone dispensation, including dispensing dates and number of take-home doses supplied. The median duration for methadone use was 193 days in the 2014 to 2016 period, dropping to 86 days in 2020 to 2022. Patients who started methadone in later periods were more likely to stop treatment sooner. The risk for stopping methadone was higher among patients whose treatment was initiated in 2017-2019 (adjusted hazard ratio [aHR], 1.18; P < .001) and yet higher for those who started in 2020-2022 (aHR, 1.45; P < .001). Buprenorphine-naloxone treatment duration decreased from 51 days during 2014-2016 to 38 days during 2020-2022. Patients who initiated buprenorphine-naloxone during 2020-2022 had a higher risk for discontinuation (aHR, 1.11; P < .001). It was unclear why methadone treatment duration decreased more prominently than did buprenorphine-naloxone treatment, according to the researchers. Treatment was more likely to be discontinued early among younger individuals, particularly those aged 15-24 years. Other factors associated with early discontinuation included rurality, lower neighborhood income, and comorbidities. 'Opioid agonist treatments remain the most effective treatments for opioid use disorder, including for people using fentanyl,' Kleinman said. 'However, this study suggests that the effectiveness of the treatments may be lower than they were in the past. There are new approaches to providing these that either have been or are being developed, and research is continuing to evaluate these approaches among patients using fentanyl.' 'Compelling Data' One of the study's limitations was that its source of data does not capture OAT dispensed in hospitals, long-term care homes, or prisons. Also, since the information was obtained through ICES databases, individuals who began OAT outside Ontario were not included in the analysis. Other individuals, such as members of the Indigenous population, may receive OAT through federal benefits and would also be excluded from the analysis. Commenting on the study for Medscape Medical News , addiction medicine specialist Ryan Marino, MD, associate professor at the CWRU School of Medicine at Case Western Reserve University, Cleveland, said, 'These researchers have compelling data to show that there has been a significant decrease in the duration of time people are in treatment. I think the biggest takeaway is that we should really be wondering why. '[This] isn't something that anyone was expecting to see, at least such a dramatic difference. Hopefully this will promote more investigation.' The Centre for Addiction and Mental Health Discovery Fund, the Centre for Addiction and Mental Health Foundation, the Rangerman RAPID Lab, and the University of Toronto Department of Psychiatry Academic Scholar Award funded this study. Kleinman and Marino reported having no relevant financial relationships.
Yahoo
05-07-2025
- Health
- Yahoo
Housing First intervention associated with reduced opioid overdoses
Opioid use disorder (OUD) has become a mounting public health crisis in the US, often disproportionately affecting individuals in the most vulnerable socioeconomic statuses. The homeless population has recently shown particularly high rates of OUD and opioid addiction, which has provoked debates over the most effective strategies for treating substance abuse while humanely and equitably promoting public safety in afflicted areas. Among the most controversial approaches is the Housing First philosophy, which posits that providing free or low-cost living accommodations for people experiencing homelessness facilitates addiction treatment, especially if accompanied by pharmacotherapy and mental health counselling. In the June 2025 edition of JAMA Network Open, Isabelle Rao and Margaret Brandeau simulated the effects of Housing First interventions on OUD overdoses and mortality under various conditions. The study concludes that a Housing First approach to OUD patients experiencing homelessness, whether accompanied by treatment or not, leads to a reduction in both overdoses and mortality. GlobalData epidemiologists forecast growth in the 12-month diagnosed prevalent cases of opioid addiction with OUD from over 739,000 to approximately 773,000 between 2025 and 2033. Successful implementation of interventions such as Housing First may reduce severe injury or death in this growing patient pool, particularly among those experiencing housing instability or homelessness. Rao and Brandeau modelled various scenarios in which a nationally representative patient population of 1,000 adults with OUD experiencing homelessness were either provided with free or affordable housing or none over five years. Additionally, these populations were simulated to receive methadone therapy under both housing conditions. As displayed in Figure 1, total overdoses over five years were notably lower among individuals provided with housing, at 464 per 1,000 population in those exposed to the Housing First intervention and 533 in the unexposed group over five years. This pattern was found among both fatal and nonfatal overdoses. Similarly, all-cause mortality simulation showed 132 deaths per 1,000 population among housed OUD patients compared to 186 among those without housing (Figure 2). The authors attribute the lower mortality rate to the significant reduction in fatal overdoses in the housed population. In addition to the improvements in health outcomes for OUD patients provided with housing, the cost-effectiveness analysis suggests that a Housing First policy would be more effective when compared to the status quo due to direct and indirect cost benefits from curbing homelessness and OUD overdoses. The work by Rao and Brandeau offers a valuable contribution to the ongoing polemical debates over homelessness and opioid addiction in the US. As officials seek solutions for the treatment and rehabilitation of individuals suffering from these social and medical conditions, data such as that of the authors is critical in order to guide or refine policy solutions. However, Housing First should be only one component of a wider suite of actions to curb opioid addiction, including education of healthcare providers and patients, enforcement of limitations on irresponsible prescribing habits among physicians, and increasing the availability of life-saving treatments such as naloxone. In the absence of such comprehensive, concerted effort, the opioid crisis will continue to have a sizable impact on countless American communities. "Housing First intervention associated with reduced opioid overdoses" was originally created and published by Clinical Trials Arena, a GlobalData owned brand. The information on this site has been included in good faith for general informational purposes only. It is not intended to amount to advice on which you should rely, and we give no representation, warranty or guarantee, whether express or implied as to its accuracy or completeness. You must obtain professional or specialist advice before taking, or refraining from, any action on the basis of the content on our site. Error in retrieving data Sign in to access your portfolio Error in retrieving data Error in retrieving data Error in retrieving data Error in retrieving data
Yahoo
03-07-2025
- Health
- Yahoo
Housing First intervention associated with reduced opioid overdoses
Opioid use disorder (OUD) has become a mounting public health crisis in the US, often disproportionately affecting individuals in the most vulnerable socioeconomic statuses. The homeless population has recently shown particularly high rates of OUD and opioid addiction, which has provoked debates over the most effective strategies for treating substance abuse while humanely and equitably promoting public safety in afflicted areas. Among the most controversial approaches is the Housing First philosophy, which posits that providing free or low-cost living accommodations for people experiencing homelessness facilitates addiction treatment, especially if accompanied by pharmacotherapy and mental health counselling. In the June 2025 edition of JAMA Network Open, Isabelle Rao and Margaret Brandeau simulated the effects of Housing First interventions on OUD overdoses and mortality under various conditions. The study concludes that a Housing First approach to OUD patients experiencing homelessness, whether accompanied by treatment or not, leads to a reduction in both overdoses and mortality. GlobalData epidemiologists forecast growth in the 12-month diagnosed prevalent cases of opioid addiction with OUD from over 739,000 to approximately 773,000 between 2025 and 2033. Successful implementation of interventions such as Housing First may reduce severe injury or death in this growing patient pool, particularly among those experiencing housing instability or homelessness. Rao and Brandeau modelled various scenarios in which a nationally representative patient population of 1,000 adults with OUD experiencing homelessness were either provided with free or affordable housing or none over five years. Additionally, these populations were simulated to receive methadone therapy under both housing conditions. As displayed in Figure 1, total overdoses over five years were notably lower among individuals provided with housing, at 464 per 1,000 population in those exposed to the Housing First intervention and 533 in the unexposed group over five years. This pattern was found among both fatal and nonfatal overdoses. Similarly, all-cause mortality simulation showed 132 deaths per 1,000 population among housed OUD patients compared to 186 among those without housing (Figure 2). The authors attribute the lower mortality rate to the significant reduction in fatal overdoses in the housed population. In addition to the improvements in health outcomes for OUD patients provided with housing, the cost-effectiveness analysis suggests that a Housing First policy would be more effective when compared to the status quo due to direct and indirect cost benefits from curbing homelessness and OUD overdoses. The work by Rao and Brandeau offers a valuable contribution to the ongoing polemical debates over homelessness and opioid addiction in the US. As officials seek solutions for the treatment and rehabilitation of individuals suffering from these social and medical conditions, data such as that of the authors is critical in order to guide or refine policy solutions. However, Housing First should be only one component of a wider suite of actions to curb opioid addiction, including education of healthcare providers and patients, enforcement of limitations on irresponsible prescribing habits among physicians, and increasing the availability of life-saving treatments such as naloxone. In the absence of such comprehensive, concerted effort, the opioid crisis will continue to have a sizable impact on countless American communities. "Housing First intervention associated with reduced opioid overdoses" was originally created and published by Clinical Trials Arena, a GlobalData owned brand. The information on this site has been included in good faith for general informational purposes only. It is not intended to amount to advice on which you should rely, and we give no representation, warranty or guarantee, whether express or implied as to its accuracy or completeness. You must obtain professional or specialist advice before taking, or refraining from, any action on the basis of the content on our site. Sign in to access your portfolio
Medscape
12-06-2025
- Health
- Medscape
Fast Five Quiz: Opioid Use Disorder
Opioid use disorder (OUD) currently impacts approximately 16 million people worldwide. It is considered a significant public health issue, with experts noting a 'burden that is increasing' globally. As research into optimal management of OUD evolves, updates to clinical guidelines emphasize a more individualized approach to pharmacologic treatment, psychosocial support, and special considerations for specific patient populations, such as pregnant individuals. However, OUD remains a complex disease that comes with many serious health and legal concerns for both patients and clinicians. What do you know about OUD? Check your knowledge with this quick quiz. Despite pharmacologic treatment being known to be highly effective for treating OUD, a CDC report states that 30% of patients with OUD who require OUD treatment received only nonpharmacologic treatment. Further, 43% of patients did not perceive a need for OUD treatment at all. In this significant report, males aged 35-49 years were most likely to receive OUD treatment with medications, while females and younger and older adults had lower rates of access to pharmacologic interventions. The CDC concluded that engaging patients needing OUD treatment with pharmacologic interventions is 'essential.' Learn more about essential statistics for OUD. Data from a predictive-model study indicate that service setting was the strongest predictor for premature discontinuation of OUD treatment. The strength of this predictor declined with length of stay, becoming negligent after 365 days. Other system-level factors such as geographic region, primary source of payment for treatment, and referral source were also strong predictors of early discontinuation; individual factors such as age of first use, sex, and race were less predictive. Previous research cited by the study has also stressed the importance of reducing system-level barriers to care, and the updated federal guidance for opioid treatment programs have expanded access in several ways. Learn more about OUD guidance. Precipitated withdrawal can occur when transferring a patient from methadone to buprenorphine due to buprenorphine being only a partial opioid agonist; as such, the traditional method of transfer involves putting the patient in a controlled, moderate withdrawal state before initiating buprenorphine therapy. However, a novel dosing strategy called microinduction, which involves starting buprenorphine at submilligram doses (or 'low-dose induction'), and cross-tapering with methadone can prevent precipitated withdrawal. Additionally, this method is ideal for patients who want to switch from methadone to buprenorphine and those with chronic use of intravenous or intranasal fentanyl. A recent systematic review found that microinduction and traditional transfer methods had similar rates of successful induction of buprenorphine at 95.6%. Learn more about safe withdrawal practices for OUD. Both the CDC and the latest American Society of Addiction Medicine (ASAM) guidelines specifically state that pharmacotherapy for OUD should be offered as early as possible in pregnancy to prevent harms to both the patient and the fetus, noting that pharmacotherapy for OUD has been associated with improved maternal outcomes. ASAM specifically states, 'increasing the dose or split dosing is often required, especially in the third trimester.' Federal guidelines emphasize that pregnant individuals seeking treatment for OUD are considered a priority for enrollment in opioid treatment programs. Once receiving treatment, they do not generally recommended medically supervised withdrawal from pharmacotherapy for pregnant patients as it might harm the fetus and patient; further, ASAM guidelines state that patients who undergo medically supervised withdrawal are at an increased risk for 'return to opioid use.' However, if a patient decides to proceed with medically supervised withdrawal, ASAM guidelines suggest physicians provide education and resources regarding associated risks. The CDC also specifically recommends against abruptly discontinuing opioids during pregnancy, citing data and resources from the American College of Obstetricians and Gynecologists and the Substance Abuse and Mental Health Services Administration. Learn more about OUD. Federal guidelines specify that opioid treatment programs must conduct at least eight random drug tests per year on their patients. These tests must use FDA approved products that test for commonly abused substances that might affect patient safety, recovery, or adherence to OUD treatment. ASAM affirms this requirement, noting that many patients might need more frequent testing and that eight tests per year 'should be viewed as a minimum.' Learn more about drug testing in OUD. Editor's Note: This article was created using several editorial tools, including generative AI models, as part of the process. Human review and editing of this content were performed prior to publication.
Globe and Mail
31-03-2025
- Health
- Globe and Mail
New Developments in Opioid Use Disorder Research Highlighting the Need for Integrated Care Approaches
Chicago, IL - A new study titled 'Predictors of Mortality Among Patients With Opioid Use Disorder: Insights From the Healthcare Cost and Utilization Project (HCUP) Nationwide Readmission Database' has uncovered critical factors influencing mortality among patients with Opioid Use Disorder. The research, led by Naga Venkata Satish Babu Bodapati, Sandipkumar Patel, Rana Veer Samara Sihman Bharattej Rupavath, Omkar Reddy Polu, Balaiah Chamarthi, and Chrishanti Anna Joseph, provides valuable insights that could improve survival outcomes for this vulnerable population. The study found that mortality among patients with Opioid Use Disorder is significantly influenced by factors such as age, comorbidities, hospital characteristics, and healthcare disparities. These findings emphasize the urgent need for integrated care approaches that address both the medical and psychiatric conditions associated with Opioid Use Disorder. The research highlights the importance of providing holistic treatment strategies to improve patient outcomes and reduce mortality rates. Ms. Emily Clark, Senior Journalist at Alpine Vision Media, stated, 'This study offers vital insights into the complex factors that contribute to mortality among patients with Opioid Use Disorder. By recognizing the role of comorbidities and healthcare disparities, we can develop more targeted interventions that address the multifaceted needs of this population. In the United States, the opioid crisis continues to claim thousands of lives each year, with opioid-related deaths exceeding 100,000 annually. The findings from this research suggest that a more integrated care model, which includes coordinated medical and psychiatric treatment, could lead to improved survival rates". These strategies, combined with harm reduction approaches, could significantly reduce the mortality rate among individuals struggling with Opioid Use Disorder. Leading experts from around the world are already recognizing the importance of these findings. Dr. Eduardo J. Gómez, a prominent addiction specialist from Colombia, and Dr. Nasser Al-Ghanim, a leader in public health from Kuwait, both of whom have dedicated their careers to improving healthcare outcomes in underserved regions, acknowledge the value of integrated care in improving survival outcomes for patients with Opioid Use Disorder. Their work, alongside the insights from this study, could influence the global approach to addressing opioid addiction and its associated risks. The study's implications are far-reaching. "With over 16 million people suffering from opioid use disorder worldwide, these findings highlight the need for more comprehensive, patient-centered care strategies that focus on both physical and mental health. In addition to the health benefits, this research is poised to result in significant financial savings. The cost of opioid-related healthcare in the U.S. is astronomical, with opioid overdoses and related conditions contributing to over $78 billion annually in medical, lost productivity, and criminal justice costs. By reducing mortality rates and improving patient care through more targeted and integrated interventions, this research could save billions in healthcare expenditures. Optimizing the treatment approach for those with Opioid Use Disorder not only improves lives but also holds the potential to significantly alleviate the financial burden on healthcare systems worldwide," stated Ms. Clark. Targeted interventions to mitigate high-risk factors and enhance harm reduction strategies will be essential for improving survival rates and reducing the burden of opioid-related mortality globally. Citation: Bodapati N, Patel S, Sihman Bharattej Rupavath R, et al. (March 29, 2025) Predictors of Mortality Among Patients With Opioid Use Disorder: Insights From the Healthcare Cost and Utilization Project (HCUP) Nationwide Readmission Database. Cureus 17(3): e81405. DOI 10.7759/cureus.81405
