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ASAM Releases National Practice Guideline for the Use of Medications in the Treatment of Addiction Involving Opioid Use

by ASAM Staff | June 2, 2015

FOR IMMEDIATE RELEASE
Contact: Beth Haynes, 301-547-4123

CHEVY CHASE, MD, June 2, 2015 – ASAM announces the release of its National Practice Guideline for the Use of Medications in the Treatment of Addiction Involving Opioid Use (Practice Guideline). The Practice Guideline will assist clinicians prescribing pharmacotherapies to patients with addiction related to opioid use. It addresses knowledge gaps about the benefits of treatment medications and their role in recovery, while guiding evidence-based coverage standards by payers.

The Practice Guideline is a timely resource as the United States is currently experiencing an opioid epidemic. According to the National Institute on Drug Abuse (NIDA), 2.1 million Americans live with pain reliever opioid addiction disease, while 467,000 Americans live with heroin opioid addiction disease. Overdose deaths are now comparable to the number of deaths caused by motor vehicle crashes, and the societal costs of opioid misuse is estimated to be above $55 billion per year.

Medications are both clinical and cost-effective interventions. While the effectiveness of medications has been researched and documented, their utilization is low and coverage varies dramatically. Less than 30% of treatment programs offer medications and less than half of eligible patients in those programs receive medications.

According to Dr. Jeffrey Goldsmith, ASAM President, “Opioid addiction is a chronic, life-threatening disease with significant medical, emotional, criminal justice and societal costs. This guideline is the first to address all the available medications to treat opioid addiction. It will help save lives.”

ASAM worked with Treatment Research Institute (TRI) to develop the Practice Guideline using the RAND/UCLA Appropriateness Method (RAM), a consensus process that combines scientific evidence with clinical knowledge. A Guideline Committee, made up of experts from multiple disciplines, including addiction medicine, psychiatry, obstetrics/gynecology and internal medicine, participated in the consensus process and helped write the guideline. Dr. Kyle Kampman chaired the Guideline Committee and served as TRI’s Principal Investigator. “The Practice Guideline is the most current document of its kind combining review of existing guidelines, current literature and a systematic process for developing practice recommendations.”

ASAM has been working on a number of quality improvement initiatives. The Practice Guideline builds upon several other recent ASAM clinical documents, including the "Standards of Care: For the Addiction Specialist Physician" and “Performance Measures for the Addiction Specialist Physician.”

According to Dr. Margaret Jarvis, chair of the Quality Improvement Council, ASAM’s guideline oversight committee, “The Practice Guideline is an invaluable document for the addiction medicine field. It will assure a more uniform delivery of quality patient care. We are making a copy of the full guideline available now but are planning publication and a summary article for the Journal of Addiction Medicine and the release of derivative products and educational activities later this summer and fall. We want the Practice Guideline to be widely used and accepted.”

The National Practice Guideline for the Use of Medications in the Treatment of Addiction Involving Opioid Use can be accessed HERE, on ASAM’s website www.asam.org.

Download the full press release 

13 comments

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  1. henry willian Jul 24, 2016 - 02:05 PM
  2. Stone Mar 23, 2016 - 08:20 AM

    Actually the ingredients in Suboxone are buprenorphine and Naloxone not naltrexone. Though these chemicals are similar they are in fact not the same and have different levels of affinity for the opioid receptors. However, DR is wrong in her opinion which is frightful given the abundance of factual resources available on the internet there is no excuse in today's society to be uninformed. I encourage you to use vetted resources as well, not WebMD or some other "this happened to me" website for your information. It should be noted that this article is for use as a "guideline" not as an absolute and each professional is advised to use it to improve their practice. It should also serve as a challenge as to how you currently handle these types of patients at your facility and should you do something different e.g. use buprenorphine in pregnancy instead of methadone.

    My sources: I am a practicing advanced practice pharmacist with a doctorate degree in pharmacy and a board certification in pharmacotherapy from the Board of Pharmacy Specialities.

  3. Timothy Page Mar 17, 2016 - 07:57 PM
    Dorthy Rose your comment is down right dumb ,naltrexone is one of the ingredients in suboxen ,and suboxen is the correct and only standard of care for opiate withdrawal and addiction
  4. Chris Reveley Jan 11, 2016 - 11:40 AM

    First time on this site.  I'm wondering how DR is suggesting that naltrexone can be used to wean patients off methadone. Weaning is done by slowly  lowering the dose of the opioid medication at a rate that avoids withdrawal symptoms.  Using naltrexone in this context will only precipitate full-blown withdrawal and increase the likelihood of relapse on prescription opioids or heroin.  Maybe I'm misunderstanding what she's saying...?

    Regarding the comments of JW Williams, the pharmaceutical industry and irresponsible prescribing by healthcare providers have helped create the opioid abuse epidemic.  Among those who suffer with the disease of addiction there are those who will be able to stop using their drug of choice through temporary, "bridge" treatment with buprenorphine or methadone along with psychotherapy and group support.  There are also those who demonstrate persistent opioid dependence and continue to relapse after repeated attempts to taper off opioid maintenance treatment.  For them, balancing risks and benefits, ongoing (perhaps lifelong) treatment with methadone or buprenorphine is a reasonable and responsible path to follow.  Also, I'm not quite sure what JWW loves about "the idea of methadone addiction for the unborn".

  5. mary brown Nov 11, 2015 - 08:02 AM
    It is true that there is a consensus among heroin addicts I have met here in the uk that methadone has far worse withdrawal than heroin....and it destroys their teeth!
  6. Karen Sep 24, 2015 - 03:36 PM

    Here is the ASAM link to access the quick-reference pocket cards to support the publication of the full text guideline.

    http://www.asam.org/docs/default-source/publications/asam_opioid-app-pocket-guide.pdf?sfvrsn=0

  7. Dr.Farshid Alishoar Jun 17, 2015 - 02:57 AM

    We have 500000 patient in MMT treatment in Iran in near 6000 clinics. our experience show that Methadone along with psychologic interventions significantly decrease the rate of IV drug users and HIV , Hep B&C and also  improve quality of life of patient compared with not acceptable and poor outcomes in abstinence based models.

  8. Randall Webber Jun 15, 2015 - 12:12 PM
    Actually, long-term studies have found that adding methadone to treatment greatly improves odds of abstinence and recovery. Contact me for specific citations if you would like.
  9. Bashir Adam Yakasai Jun 14, 2015 - 10:01 PM

    I have always been puzzled by the use of addictive substance to treat another substance of addiction in the so call substituition therepy. Could'nt scientists have a better option for the treatment of opiod addiction?

  10. Paul Jun 13, 2015 - 11:46 PM

    JW neonatal abstinence syndrome is a real, but manageable condition. While a fetus can be dependent on methadone, it is impossible for a fetus or new born to be addicted to methadone. Addiction (which involves choosing to take a drug despite negative consequences) and dependence (which is simply physiological habituation and neuro-adaption to the drug) are very different things.

    If a woman is dependent on street opioids and falls pregnant, maintenance on methadone is much more likely to result in a successful pregnancy and birth than repeated attempts to detox followed by relapse. Naltrexone is contraindicated in pregnancy due to potential adverse effects from chronically blocking opioid receptors in the developing brain. Methadone is not contraindicated, and in fact is the recommended by the World Health Organization. 

    Regards,

    Paul.

  11. Dorothy Rose Jun 12, 2015 - 10:26 PM
    If they would use Naltrexone in lieu of Suboxone and assist opiate dependent patients in weaning off  methadone with Naltrexone, they would have a success rate but programs are not open minded about Naltrexone and are not thinking outside the box to help opiate dependent clients fully.
  12. JW Williams Jun 12, 2015 - 06:09 PM

    One of the most ignorant "studies" ever published!  The medical approach to pain management has created and opiod disorder epidemic and the medical approach solution?  More drugs!  

    Addicts report methadone withdrawal to be worse than the original addictive substances.  Detox with buprenorphine or naltrexone is helpful followed by abstinence based psychotherapy and community support.  Unfortunately, long term recovery odds are still short.  I also love the idea of methadone addiction for the unborn?

     

     

  13. Kimberly Wine Jun 03, 2015 - 12:00 PM

    Sure to improve patient care

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