Overdose deaths have hit a record high in the United States with over 100,000 people dying from drug overdoses in the 12-month period ending in October 2021. This rise is largely driven by use of illicit fentanyl and other synthetic opioids. This roundup provides updates on adherence rates for medications for opioid use disorder, a DEA rule allowing practitioners to dispense up to a 3-day supply of medication-assisted treatment (MAT) to patients being referred for opioid use disorder treatment, guidelines on managing substance use disorders, and rising rates of fentanyl-laced illicit drugs.
Methadone Linked to Greater Adherence for Opioid Use Disorder
Methadone was associated with the lowest risk of treatment discontinuation compared with buprenorphine and naltrexone in an analysis of Ohio Medicaid data published in the Journal of Substance Abuse Treatment.1 Concurrent behavioral health therapy was associated with a lower risk of discontinuation of MAT for opioid use disorder for some groups.
“If you want to keep a patient on medication-assisted treatment for a longer period of time, methadone is the best option,” said study co-author Krystel Tossone, PhD, a research assistant professor at the Case Western Reserve University Center on Trauma and Adversity at the Jack, Joseph and Morton Mandel School of Applied Social Sciences.2
Researchers examined the time to discontinuation of MAT using Ohio Medicaid claims data (N=81,752). Compared with methadone, buprenorphine was associated with the highest risk of discontinuation at the time of initiation (adjusted hazard ratios [AHR], 2.41; 95% CI, 2.28-2.55); for naltrexone, the AHR for discontinuation compared with methadone was 1.44 (95% CI, 1.37-1.50). Those differences decreased over 1 year for buprenorphine and increased for naltrexone.
Exposure to behavioral health therapy was associated with a lower risk of MAT discontinuation (AHR, 0.94); however, this association was not found among adolescent/young adults and pregnant women.
Tossone said she hopes the research demonstrates the need to expand access to methadone and buprenorphine treatment, noting that naltrexone (the medication with the poorest continuation rate) is often the only medical option available in some areas.
Up to 3 Day Dispensing of Buprenorphine, Methadone Permitted by DEA
The Drug Enforcement Administration (DEA) announced a new option allowing dispensing of up to a 3-day supply of medication-assisted treatments for opioid use disorder, including buprenorphine and methadone, “to a person for the purpose of relieving acute withdrawal symptoms when necessary while arrangements are being made for referral for treatment.” The dispensing allowance is for DEA-registered practitioners working in hospitals, clinics, or emergency rooms, and for DEA-registered hospitals/clinics that allow practitioners to operate under their registration number. Practitioners must request an exception to the 1-day supply limitation currently imposed.
The DEA also announced that it is working to make permanent the temporary regulations allowing for the initiation of buprenorphine for opioid use disorder by telemedicine that were enacted during the COVID-19 public health emergency.
National Addiction Treatment Guide Released
A national framework for patient-centered, evidence-based addiction care was released by the American Society of Addiction Medicine (ASAM) and the University of California, Los Angeles Integrated Substance Abuse Programs (UCLA ISAP). The ASAM Criteria Assessment Interview Guide is the first publicly available standardized version of The ASAM Criteria assessment.
“ASAM is focused on providing tools to help addiction treatment providers and health plans in states across the country adopt more standardized, evidence-based addiction care,” said R. Corey Waller, MD, MS, FACEP, DFASAM, editor-in-chief for The ASAM Criteria. “This new assessment guide will help support a more consistent application of The ASAM Criteria to improve care delivery and coordination across diverse health care systems.”
VA Guidelines on Management of Substance Use Disorders Released
US Department of Veterans Affairs (VA) and US Department of Defense (DoD) updated key recommendations for the management of alcohol use disorder, use of buprenorphine in opioid use disorder, contingency management, and use of technology and telehealth to manage patients remotely in a clinical practice guideline published in Annals of Internal Medicine.3
Rapid Rise in Pills Adulterated With Fentanyl Found
Law enforcement seizures of pills containing illicit fentanyl increased nearly 50-fold between January 2018 and December 2021, according to a study funded by the National Institute on Drug Abuse (NIDA) published in Drug and Alcohol Dependence.4
“For the first time we can see this rapid rise in pills adulterated with fentanyl, which raises red flags for increasing risk of harm in a population that is possibly less experienced with opioids,” said Dr. Palamar. “We absolutely need more harm reduction strategies, such as naloxone distribution and fentanyl test strips, as well as widespread education about the risk of pills that are not coming from a pharmacy. The immediate message here is that pills illegally obtained can contain fentanyl.”
The number of seizures of pills containing fentanyl increased from 68 to 635 from the first quarter of 2018 to the last quarter of 2021, and the total number of individual pills seized by law enforcement increased from 42,202 to 2,089,186. Seizures of powder containing fentanyl also increased from 424 to 1539, and the total weight of powder seized increased from 298.2 kg to 2416.0 kg.
1. Zhang P, Tossone K, Ashmead R, et al. Examining differences in retention on medication for opioid use disorder: an analysis of Ohio Medicaid data. J Subst Abuse Treat. 2022;136:108686. doi:10.1016/j.jsat.2021.108686
2. Case Western Reserve University. Study: Methadone most effective drug in medication-assisted treatment for opioid-use disorder. March 17, 2022. Accessed April 1, 2022. https://thedaily.case.edu/study-methadone-most-effective-drug-in-medication-assisted-treatment-for-opioid-use-disorder/
3. Perry C, Liberto J, Milliken C, et al; VA/DoD Guideline Development Group. The management of substance use disorders: synopsis of the 2021 US Department of Veterans Affairs and US Department of Defense Clinical Practice Guideline. Ann Intern Med. 2022 Mar 22. doi:10.7326/M21-4011
4. Palamar JJ, Ciccarone D, Rutherforld C, Keyes KM, Carr TH, Cottler LB. Trends in seizures of powders and pills containing illicit fentanyl in the United States, 2018 through 2021. Drug Alcohol Depend. doi:10.1016/j.drugalcdep.2022.109398 (2022).