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Addiction psychopharmacology improves opioid misuse treatment

Adding addiction psychopharmacology to other interventions can improve treatment outcomes for patients with opioid use disorder, study findings indicated.

“The literature regarding treatment outcomes for opioid use disorder without addiction psychopharmacology is discouraging,” Michael D. McGee, MD, chief medical officer of The Haven at Pismo, wrote in Psychiatric Annals. “Clinical evidence indicates that any patient with moderate to severe opioid use disorder should be assessed for addiction psychopharmacology.”

Prior research has shown that opioid agonist therapy, a subset of addiction psychopharmacology, is more effective than abstinence-based group treatment; however, this is not currently the standard of care for opioid detoxification treatment after discharge at many hospitals and programs nationwide. According to McGee, this means patients are often discharged while going through protracted withdrawal. Many patients leave detoxification with a very high probability of relapse, he wrote.

“Without additional treatment interventions, it can be close to impossible for many recovering patients to withstand their discomfort and cravings and stay sober,” McGee explained.

The availability of addiction psychopharmacology treatment with methadone, buprenorphine and extended-release injectable naltrexone, along with adjunct clonidine, prazosin, topiramate and baclofen, is on the rise. However, lack of education and experience in addiction psychiatry, shortages of outpatient providers who offer this psychopharmacology, and legislative and regulatory barriers hinder the delivery of addiction psychopharmacology in inpatient or residential settings, according to McGee.

“People vary in the severity of their compulsions and cravings, as well as in their recovery skills and in the availability of recovery supports. It is simply not realistic to cling to an arbitrary ideology that claims that those taking medications are not really in recovery,” he wrote. “We need to embrace whatever works, including medications, in the treatment of addiction.”

Most clinicians refer to addiction psychopharmacology as medication-assisted treatment, but McGee believes this term should be abandoned because it implies that medications are secondary to the main treatment for addiction. Although it has the potential to benefit those suffering from addiction, if not used right, addiction pharmacology could be harmful to patients, he warns.

“Medications are not a substitute for recovery work. Good treatment for addiction encourages patients to work on the three pillars of recovery — abstinence, well-being, and citizenship — while simultaneously taking medications,” McGee cautions. “As with all medications, the medications for the treatment of addiction have risks and side effects. Both the prescriber and the patient must balance the benefits against the risks and costs.”

Although it is common for intensive treatment settings to prohibit the use of addiction psychopharmacology due to ideological reasons, it is necessary to look at the clinical evidence that supports the use of this treatment for opioid use disorder, he writes.

McGee recommends intensive treatment programs discuss changing their internal policies and procedures for patients interested in addiction psychopharmacology after discharge. Administrators should also prompt physicians who treat patients with opioid use disorder to become certified to prescribe buprenorphine. In addition, treatment programs may consider short-term solutions to enhance outcomes, such as a co-management model or transitioning patients who need addiction psychopharmacology to a prescriber who can provide this treatment, he advises.

“We need to evolve our standard of care for the management of opioid use disorder. Providers should offer addiction psychopharmacology routinely to all patients with opioid use disorder,” McGee concluded. “Although challenging, discharge planners/case managers need to aggressively search for and obtain addiction psychopharmacology treatment providers for patients who find it beneficial.” – by Savannah Demko

Disclosures: McGee reports no relevant financial disclosures.