New Guidance on Treating Opioid Use Disorders

The American Society of Addiction Medicine (ASAM) has released new evidence-based recommendations on the use of prescription medications for the treatment of opioid addiction. Published in the October/November issue of the Journal of Addiction Medicine, the guideline aims to increase physician’s knowledge of and ability to use often-complex treatments for managing patients with opioid use disorders.

The ASAM Guideline Committee writes “This Practice Guideline was developed to assist in the evaluation and treatment of opioid use, and in the hope that, using this tool, more physicians will be able to provide effective treatment.”

The guideline comes at an opportune time, with the Centers for Disease Control and Prevention having recently described opioid use and resultant deaths as an epidemic. Although evidence supports the use of medications and psychological treatments for patients with opioid use disorders, unfortunately, treating this patient population requires skill and time that most primary care providers in most practice models are not afforded.

The suboptimal treatment stemming from this has likely contributed to expansion of the epidemic and concerns for unethical practices. Yet, access to reliable treatment is highly restricted due to many physicians’ unwillingness or inability to provide it.

Guidelines for the treatment of opioid use disorder do already exist, but none have included the whole lot of medications currently used for its treatment. Also, few of these guidelines address the needs of such special population as pregnant women, those with comorbid psychiatric disorders or pain, adolescents, or incarcerated individuals.

In response to all of the above, ASAM assembled a multidisciplinary Guideline Committee, including specialists in addiction medicine and other relevant field, with the hope that, using the recommendations contained within, more physicians will be able to provide effective treatment to this in-need population.

The RAND Corporation/UCLA Appropriateness Method (RAM)—a process that combines scientific evidence and clinical knowledge to determine the appropriateness of a set of clinical procedures—was used to develop the guideline. “The RAM is a deliberate approach encompassing review of existing guidelines, literature reviews, appropriateness ratings, necessity reviews, and document development,” writes the ASAM Guideline Committee.

For the guideline, ASAM chose an independent committee to oversee development and to assist in writing. But ASAM’s Quality Improvement Council oversaw the selection process for the development committee, assuring that recommendations included in the guideline covered such topics as the initial evaluation of patients, medication selection, the use of all approved medications for opioid use disorder, the combination of psychosocial treatment with medications, the treatment of special population. Recommendations also cover diagnosis and opioid withdrawal.

The guideline includes recommendations for the appropriate use of methadone, buprenorphine, and naltrexone through each phase of treatment as well as for patient monitoring and follow-up. Use of naloxone for reversing opioid overdoses is also addressed. ASAM recommends that first responders such as emergency medical services, police officers, and firefighters be trained in and authorized to use naloxone.

ASAM notes that the guideline is meant to aid in clinical decision making for clinicians at all levels of experience in treating opioid use disorders, as opposed to serving as a set of hard-and-fast rules. The Guideline Committee hopes that the information provided in the guideline “will help to make treatment more readily available for people with addiction involving opioid use, thus stemming the tide of overdose deaths.”