2 days ago
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.
