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Universal Pharmacotherapy for Opioid Use Disorder

Management of opioid use disorder (OUD) should be transformed through universal treatment with medications such as methadone, buprenorphine, and naltrexone, conclude authors of a Perspective article. Evidence-based medication for opioid use disorder (MOUD) “is one of the most effective interventions available to address the overdose crisis,” they write. “Increasing access to MOUD could help establish the foundation of an addiction-treatment infrastructure. Such a model could address multiple health outcomes by building treatment capacity, enhancing social support, focusing on structural interventions, and promoting equity. “

Because of the legal obstacles to access to methadone and buprenorphine, only a few people with OUD report having received MOUD in the past year. “Patients can obtain methadone only from designated opioid-treatment programs, which are governed by the Controlled Substances Act and jointly regulated by the Substance Abuse and Mental Health Services Administration and the Drug Enforcement Administration,” the authors note. “Although buprenorphine can be administered in medical office settings, providers are required to complete a registration process and obtain an X waiver to prescribe it. These and other barriers have kept a substantial portion of the need for MOUD from being met.”

The authors, from the White House Office of National Drug Control Policy and the Department of Health and Human Services, call for increased education of medical professionals to bolster the addiction-treatment and education infrastructure. Additionally, access to MOUD in clinical and community-based programs should be increased, policymakers should expand access to MOUD, the needs of people who are incarcerated should be addressed, and patient-first terminology should always be used (person with “substance use disorder,” not “addict”).

Source: New England Journal of Medicine