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Treatment resistant opioid use disorder (TROUD): Definition, rationale, and recommendations
David A Patterson Silver Wolf1, Mark Gold2
1Brown School, Washington University in St. Louis, Campus Box 1196, Goldfarb Hall, Room 351, One Brookings Drive, St. Louis, MO 63130, United States of America.
Journal of the Neurological Sciences
|February 21, 2020
Summary
Opioid use disorder (OUD) affects millions, yet many treatment-resistant cases indicate the brain disorder, not patients, resists standard therapies. This research proposes defining treatment-resistant OUD (TROUD) to improve patient outcomes.
Area of Science:
- Neuroscience
- Psychiatry
- Addiction Research
Background:
- The opioid overdose epidemic is a major public health crisis, with millions affected by opioid use disorder (OUD).
- Decades of research confirm addiction is a brain disorder with lasting changes to dopamine and opioid systems.
- Despite established diagnostic criteria and multifaceted treatments, OUD treatment failures, including relapse and overdose, remain common.
Purpose of the Study:
- To explore treatment failure data in patients with opioid use disorder (OUD).
- To propose the definition of a new category: treatment-resistant opioid use disorder (TROUD).
- To challenge current perspectives on OUD treatment resistance.
Main Methods:
- Review of past treatment attempt data from OUD patients in traditional outpatient settings.
- Analysis of factors contributing to treatment failures.
Main Results:
- A significant subpopulation of OUD patients does not respond to standard treatments, similar to treatment-resistant depression.
- Current approaches often attribute treatment failure to patient non-compliance rather than treatment ineffectiveness.
Conclusions:
- There is a rational basis to categorize non-responsive OUD cases as treatment-resistant opioid use disorder (TROUD).
- Recommendations are made for defining TROUD based on treatment history.
- The field should shift focus from patient resistance to the resistance of the brain disorder to conventional treatments.
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