Comment; Great review of options with excellent recommendations to assist in choosing among buprenorphine, methadone
The United States is in the midst of a national opioid epidemic. Physicians are encouraged both to prevent and treat opioid-use disorders (OUDs). Although there are 3 Food and Drug Administration-approved medications to treat OUD (methadone, buprenorphine, and naltrexone) and there is ample evidence of their efficacy, they are not used as often as they should. We provide a brief review of the 3 primary medications used in the treatment of OUD. Using data from available medical literature, we synthesize existing knowledge and provide a framework for how to determine the optimal approach for outpatient management of OUD with medication-assisted treatments.
We are currently in the midst of an opioid epidemic caused by many factors including overzealous use of medications, availability of potent opioids (both legal and illegal), and pervasive social expectations that all pain can be eliminated. We clearly cannot medicate our way out of the problem, but we have the opportunity to mediate the problem through more judicious use of prescription opioids. For those patients who develop OUDs, the research shows that MAT can help, but it is currently underused. Along with drug counseling, naltrexone, buprenorphine, and methadone all have a place in the treatment armamentarium for opioid addiction. The current opioid crisis is an opportunity to change the way we think and do things, moving beyond a medication-only approach to a future when we will establish a generalizable framework that uses the full repertoire of responses and resources we have at our disposal.