The American Society of Addiction Medicine (ASAM) has issued its first-ever comprehensive guidelines for using drugs to treat opioid addiction, called the “National Practice Guideline for the Use of Medications in the Treatment of Addiction Involving Opioid Use.” And while other guidelines for health care providers have been released, these have typically addressed treatment for addiction to just one drug, like oxycodone or hydrocodone. The new guidelines from ASAM, though, offer comprehensive practice recommendations for several opioids, including prescription painkillers and heroin, says Kyle Kampman, MD, professor of psychiatry at the Hospital of the University of Pennsylvania and chairman of the ASAM opioid guideline committee.
Equally important, says Dr. Kampman, the new guidelines also drew on the expertise of a variety of specialists — not just addiction medicine physicians — including psychiatrists, to devise appropriate treatment for opioid addicts who may also be dealing with other psychosocial issues, like depression, anxiety, trauma and bipolar disorder. Obstetricians helped write the recommendations for pregnant women who are addicted to opioids, and other groups addressed in the new recommendations include chronic pain patients and adolescents. There’s also guidance on how to treat an overdose from these drugs.
Opioid Use Disorder: A Big and Growing Problem
According to the ASAM, the ongoing epidemic of opioid addiction and overdose in the U.S. has made comprehensive treatment guidelines for medication something that’s sorely needed. The National Institute on Drug Abuse (NIDA) reports that over two million Americans live with a substance use disorder related to prescription opioids, and 467,000 are struggling with heroin addiction. In fact, NIDA says that opioid overdose deaths are now comparable to the number of fatalities from car crashes, and the cost from expenses related to addiction, including lost wages, totals more than $55 billion per year.
The ASAM is hoping that the new guidelines will increase the use of medications to treat opioid addiction. Use of drugs like naltrexone, methadone and buprenorphine remains low even though studies have shown them to be both effective in helping opioid/heroin users recover and cost-effective. For example, addicts who recover are more likely to return to work and to cut down on medical expenses, like emergency room visits.
One roadblock to using these medications, though, is that many health insurers don’t cover the drugs. Another complicating factor: Many doctors continue to believe that addiction is a psychosocial condition that’s best treated by psychotherapy rather than medication. These are beliefs that the new guidelines hope to change, says Dr. Kampman. “Opioid addiction is a chronic, life-threatening disease with significant medical, emotional, criminal justice and societal costs,“ said Jeffrey Goldsmith, MD, president of ASAM, in a press release accompanying the release of the guidelines. “This guideline is the first to address all the available medications to treat opioid addiction. It will help save lives.”
In developing the guidelines, ASAM worked with the Treatment Research Institute, a nonprofit research group based in Philadelphia, with Kampman as the principal investigator. Because there have been few clinical trials testing treatments for opioid addiction, the new guidelines are based both on published studies as well as consensus decisions by the panel of general and specialist physicians who reviewed the data for ASAM. “[This] is the most current document of its kind, combining review of existing guidelines, current literature and a systematic process for developing practice recommendations,” notes Kampman.
Another key goal is to establish a standard of patient care that ensures more patients have access to best practices to treat their opioid addiction. ASAM is publishing the guidelines in the Journal of Addiction Medicine as well as promoting it widely among addiction specialists and other medical specialties. “There is a growing evidence base for what works in treating opioid addiction and more and more research is being done to determine proven treatment for other addictions. As we gather evidence, we need to use it,” says Kampman.
You can read the full ASAM “National Practice Guideline for the Use of Medications in the Treatment of Addiction Involving Opioid Use” here.