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The duration dilemma in opioid agonist therapy
Anjali Dhanda1, Edwin A Salsitz2
1Cornell Scott Hill Health Center, Ansonia, Connecticut.
Journal of Opioid Management
|September 17, 2021
Summary
Long-term opioid agonist therapy (OAT) is more effective for opioid use disorder (OUD) than short-term detoxification. Optimal outcomes depend on adequate treatment duration, suggesting OAT should not have arbitrary time limits.
Area of Science:
- Addiction Medicine
- Pharmacology
- Public Health
Background:
- Opioid use disorder (OUD) is a chronic condition with established effective treatments like methadone and buprenorphine.
- Short-term detoxification has demonstrated high relapse rates compared to maintenance therapies.
- The optimal duration for opioid agonist therapy (OAT) remains a subject of debate.
Purpose of the Study:
- To address the dilemma surrounding the ideal duration of OAT for OUD.
- To explore factors influencing decisions on OAT duration.
Main Methods:
- A review of convenience articles published between 1964 and 2018.
- No a priori inclusion criteria were used; not a structured literature review.
Main Results:
- Sustained OAT significantly outperforms short-term detoxification and time-limited maintenance.
- Adequate treatment duration is crucial for achieving optimal long-term outcomes in OUD management.
Conclusions:
- OUD should be treated as a chronic brain disease, analogous to other chronic medical conditions.
- Long-term or lifelong OAT is associated with optimal outcomes in reducing morbidity and mortality.
- Current evidence does not support arbitrary limitations on the duration of OAT for OUD.
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