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Chapter 50.Opioid-Related Disorders: Agonist Maintenance Treatment

Edited by:
https://doi.org/10.1176/appi.books.9781585625048.gg50

Sections

Mortality and Natural History of Opioid Use Disorder | Rationale for Opioid Agonist Maintenance Treatment | Effectiveness of Opioid Agonist Maintenance Treatment | Clinical Pharmacology of Methadone and Buprenorphine | Advantages and Disadvantages of Agonist Maintenance Treatment | Safety, Toxicity, and Interactions With Other Systems | Agonist Induction, Dosage, and Treatment Duration | Medication Interactions | Agonist Treatment During Pregnancy | Co-occurring Other Psychiatric or Substance Use Disorders | Co-occurring Medical Disorders and Provision of Medical Care | Pain Management During Opioid Agonist Maintenance Treatment | Drug Counseling and Behavioral Components of Opioid Agonist Maintenance Treatment | Federal Rules Governing Opioid Agonist Maintenance Treatment

Excerpt

Opioid use disorder is chronic and severe and is associated with substantial risk of mortality, morbidity, and adverse social, vocational, familial, and legal consequences. The goals of treatment are to prevent or reduce adverse consequences and to improve the patient’s functioning and quality of life. Opioid agonist maintenance treatment generally refers to a comprehensive approach, including maintenance on an opioid agonist (in the United States, methadone or buprenorphine) in combination with drug counseling; behavioral monitoring; and provision of or referral to psychiatric, medical, or vocational services. Since its development in the 1960s, this approach has proven to be the most effective treatment for opioid dependence. Yet in the United States, of the estimated 1.7 million individuals meeting criteria for opioid use disorder (Substance Abuse and Mental Health Services Administration 2012), only 299,643 patients were treated with methadone maintenance (Substance Abuse and Mental Health Services Administration 2011). More than 650,000 patients were prescribed buprenorphine in the United States in 2009, but it is unclear how many were receiving maintenance treatment. Ensuring adequate funding and effectiveness of services and continuing to expand access through novel settings are critical for improving accessibility and availability of treatment.

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