Opioids Again and Again

The CDC reported today that the opioid crisis is only getting worse: more ED visits, more deaths. More than from car accidents, more than from guns. Unbelievable, but we believe it and we are doing what we can to help.

In the June 5th, 2017 issue of The Medical Letter, we published an article on Drugs for Opioid Use Disorder that reviewed maintenance treatment for opioid addiction and treatment of opioid overdose. Methadone and buprenorphine are the mainstays of maintenance, but buprenorphine is the treatment of choice for most patients. It is safer than methadone and appears to be at least as effective in preventing overdose deaths. Both methadone and buprenorphine are opioids themselves, and in the US there are significant legal restrictions on their use. Naloxone is the drug of choice for emergency treatment of opioid overdose, and in many jurisdictions it can be made available to first responders, relatives, and even close friends of persons using heroin or taking prescription opioids. And that barely scratches the surface of this useful article, which is available free on our website.

The same issue included an article on abuse-deterrent opioid products, which have one or more properties that make their intentional nontherapeutic use (e.g., injecting or snorting pulverized tablets) more difficult, less attractive, or less rewarding. These products are relatively expensive, and they have no generic equivalents. And no opioid formulation prevents consumption of a large number of intact tablets, which is the most common method of abuse.

A coming issue will include an article on Opioid Drugs for Pain, detailing the appropriate use of these agents, which are the most effective treatments we have for severe acute pain and chronic cancer pain. Opioids have no ceiling on their analgesic effect, and patients become tolerant to their side effects (except for constipation) as they become tolerant to their analgesic effects.

Sometime after that, we will publish an article on Management of Opioid Withdrawal. If our readers suggest any other topics that could be helpful in dealing with this terrible epidemic, we will consider pursuing those as well.

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