Prescription Opioids & Dependence

A Q&A with Bethany Ranes, PhD, on the Research Update

The exponential increases in the rates of prescription opioid misuse and dependence in the past decade have been staggering. Increases in the rates of prescription, reports of misuse, and opioid-related emergencies and deaths have all acted as catalysts for immediate action by government agencies, scientists, and clinicians.

In this Q&A, Bethany Ranes, PhD, research scientist with the Hazelden Betty Ford Foundation Butler Center for Research, comments on the recent Research Update "Prescription Opioids and Dependence."

Q: What do you hope professionals glean from this Research Update?

A: Research on the current opioid epidemic has shown that prescription opioid misuse is a fatal and growing problem in America. The surge of prescription painkillers made for patients in recent decades has demonstrated a serious need for education among medical providers on the dangers of overprescribing opioid medication. Many prevention and educational programs aimed at increasing the utilization of alternative pain management strategies and regularly assessing patients for signs of prescription opioid misuse or dependence have shown great promise in reducing the dangerous consequences of opioid overprescribing.

It is also important to educate patients on the need to carefully and responsibly use opioid medication only as prescribed and to inform them of the high risk for dependence if the medication is misused. Establishing smooth and effective processes for medical providers to refer patients to substance use treatment is also a phenomenal way to help address any problematic use issues as soon as they are detected.

Q: There has been some recent media attention on the risk of addiction to pharmacological treatment drugs, such as Suboxone®. How does that relate to the research in this issue?

A: The public fear of addiction to opioid substitution medications, such as buprenorphine (which is often marketed under the brand name Suboxone®), often detracts from the scientific evidence that, when used as prescribed, these medications effectively retain patients in addiction treatment programs and reduce illicit opioid use.

A 2014 Cochrane review of 31 randomized controlled trials found support that buprenorphine maintenance therapy was very effective at keeping patients in opioid treatment programs as compared to placebo and was also significantly more effective at reducing opioid use (as measured by urinalysis) in adults. Other comprehensive reviews have found similar positive results for adolescents.

However, this does not mean that the risk of buprenorphine (or other maintenance medication) misuse and dependence should be ignored. Maintenance medications are used for their lower risk of addiction and mortality than prescription opioid painkillers when used as directed. Dependence on maintenance medication is often a sign of misuse. It is critical that these medications only be used as prescribed and as part of a comprehensive opioid treatment program so use (and signs of misuse) can be monitored regularly by professionals and quickly addressed. Recent evaluations of buprenorphine prescriptions within large-scale public health programs have shown that regular patient drug testing, concurrent behavioral health interventions, and monitoring for dangerous concomitant prescriptions (such as other opioids or benzodiazepines) were the exception rather than the rule.

Q: Where can professionals learn more about the opioid epidemic?

A: The severity of the opioid epidemic in the United States has made information related to this issue very accessible. However, as is often the case with a high volume of attention, there is a fair amount of misinformation. It is important for professionals to find objective, unbiased sources of clear information. Reputable, peer-reviewed journals are always a good source, especially those with a medical focus, such as the Journal of Addiction Medicine or Addiction. Publications that focus on meta-analyses and literature reviews (such as The Cochrane Library) are a great way to get information that is purely based on available scientific research. As always, clinical best practices are often available from national organizations such as the National Institute on Drug Abuse (NIDA), which has a wealth of resources related to prescription opioid misuse and treatment options (both pharmacological and behavioral).

Q: What does the future hold for opioid treatment in light of these findings?

A: After observing the consequences of over-reliance on opioid pain medications, many scientists have engaged in a national research focus to better understand pain, physiological responses to opioids and other painkillers, and how these things work together. The goal is to better understand the development of opioid dependence and how to treat it most effectively. A number of findings have already offered early support for alternative methods for pain management, less- or non-addictive pharmacological interventions that can help manage cravings and opioid withdrawal during traditional recovery programs, and a general understanding of how opioids and other drugs impact the brain’s anatomy. Given the immense clinical focus on this issue, there are many positive implications for effective opioid treatment that offer hope for reducing the negative impact of opioid dependence in the future.

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