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The problem is that only a small fraction of persons with opioid use disorder who should be receiving medication-assisted treatment (MAT) are getting it.
So, please remember the following rule of thumb and tell others about it too:
All persons with opioid use disorder should be offered medication-assisted treatment (MAT)
Medication-assisted treatment (MAT) has convincingly been shown to be a very effective intervention that reduces both morbidity and mortality in persons with opioid use disorder.
Note: The treatment approach is called “medication-assisted” treatment because medications are used along with psychosocial treatments.
Which medications are we talking about? As of July 2022, the medications used in MAT are (alphabetically):
1. Buprenorphine-containing products
3. Naltrexone-containing products.
Here is the menu of options:
– Buprenorphine sublingual tablet (generic only; previously available as brand name Subutex®), which has an FDA indication for the “treatment of opioid dependence and is preferred for induction” (Prescribing Information). It is recommended for induction only. By that, they mean that, usually, after 2 days on buprenorphine sublingual tablets, patients are started on buprenorphine and naloxone sublingual tablets or film (see below).
– Buprenorphine and naloxone sublingual film, for sublingual or buccal use (generic only; previously available as brand name Suboxone® sublingual film), which has an FDA indication for the “treatment of opioid dependence” (Prescribing Information).
– Buprenorphine and naloxone sublingual tablet (generic only; previously available as brand name Suboxone® sublingual tablet), which has an FDA indication for “the maintenance treatment of opioid dependence” (Prescribing Information).
– Buprenorphine extended-release injection, for subcutaneous use (Sublocade®; no generic is available as of July 2022), which has an FDA indication for “the treatment of moderate to severe opioid use disorder
in patients who have initiated treatment with a buprenorphine-containing product, followed by dose adjustment for a minimum of 7 days” (Prescribing Information).
– Naltrexone for extended-release injectable suspension, for intramuscular use (Vivitrol®; no generic is available as of July 2022), which has an FDA indication for the “prevention of relapse to opioid dependence, following opioid detoxification” (Prescribing Information). Note: Naltrexone for extended-release (Vivitrol®) also has another FDA indication—”for the treatment of alcohol dependence in patients who are able to abstain from alcohol in an outpatient setting prior to initiation of treatment with VIVITROL” (Prescribing Information).
Since there are limits to how much buprenorphine can be prescribed by one clinician, there is an urgent need for more clinicians to become certified to prescribe buprenorphine
Opioid use disorder
Opioid use disorder—Management
Substance use disorders
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