The U.S. Opioid Epidemic: Clinical, Research, and Public Policy Perspectives
Saturday, April 7, 2018
5:00 – 6:15 pm
Moderator:
Kathryn McHugh, PhD
Associate Psychologist
McLean Hospital
Presenters:
Carlos Blanco, MD, PhD
Director
Division of Epidemiology, Services, and Prevention Research: National Institute on Drug Abuse
Robert P. Schwartz, MD
Medical Director/Senior Research Scientist
Friends Research Institute
Session Description and Objectives:
The non-medical use of prescription opioids (i.e., medications not used as prescribed or by people to whom they were not prescribed) is a major public health problem in the United States. Inappropriate use of opioids leads to death and disease, as well as increased family instability, risk of violence, legal problems, unemployment, financial hardship, and decreased social support. Large epidemiological studies of nationally representative samples indicate that, from 1991 to 2013, the prevalence of non-medical use of prescription opioids increased almost three-fold, from 1.5% to 4.1%, and the prevalence of addiction to prescription opioids tripled, from 0.3% to 0.9%.
This presentation has two interrelated parts. The first part will offer an overview of the prevalence, comorbidity patterns and risk factors for non-medical use of opioids and for opioid use disorder. The second part will focus on treatment of opioid use disorder, with a focus on pharmacological treatment.
There are three FDA-approved medications that are safe and effective for the treatment of opioid use disorder. These include the opioid agonist methadone, the partial opioid agonist buprenorphine, and the opioid antagonist naltrexone. There is an injectable naltrexone formulation that lasts for one month. In addition to the sublingual formulations of buprenorphine, there is a newly-approved buprenorphine implant that is effective for six months. This presentation will provide an overview of the evidence of the efficacy of these medications, their pharmacology, and their side effect profiles. Important clinical issues in the provision of these medications will be reviewed including the appropriate length of treatment, the relationship between dose and outcomes, and the potential roles of combining adjunctive behavioral treatments with pharmacotherapy.
At the conclusion of the presentation, attendees will:
- Know the prevalence, comorbidity and main risk factors for non-medical use of opioids and for opioid addiction.
- Be able to state the primary mechanism by which opioid agonist and opioid antagonist therapies suppress illicit opioid use.
- Be able to state the appropriate length of pharmacotherapy for opioid use disorder
