Skip to main content

Advertisement

Log in

Future Directions Incorporating Novel Medications to Reduce Repeat Overdose

  • Substance Use Disorders (FG Moeller, Section Editor)
  • Published:
Current Treatment Options in Psychiatry Aims and scope Submit manuscript

Abstract

Purpose of review

The use of opioids has risen dramatically in the USA and led to an increase in opioid use disorders and deaths due to opioid-related overdoses. Current treatments for opioid use disorder are not without drawbacks, so that new treatments may be helpful in reducing opioid use. This paper reviews current pharmacologic treatments for opioid use disorder as well as emerging novel treatments that may change or improve approaches to treatment.

Recent findings

The current treatments for opioid use disorder are methadone, buprenorphine, and naltrexone. Of the three, methadone has been the most studied and longest treatment used. However, because of limitations with prescribing and safety concerns with methadone, buprenorphine is becoming a widely used pharmacologic treatment alternative. Naltrexone remains less commonly utilized. New treatments such as lorcaserin and medicinal cannabis have potential to make an impact in addressing the opioid epidemic; however, controlled human studies are needed to assess their full potential.

Summary

Current treatments for opioid use disorder are beneficial, but have the disadvantage of abuse potential, compliance concerns, and prescribing limitations. Novel pharmacologic treatments may be able to address these concerns. Future research should continue to evaluate the efficacy of novel medications for the treatment of opioid use disorder.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References and Recommended Reading

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Substance Abuse and Mental Health Services Administration (SAMHSA). Key substance use and mental health indicators in the United States: results from the 2016 National Survey on Drug Use and Health. HHS Publication No. (SMA) 17–5044. Rockville, MD: Substance Abuse and Mental Health Services Administration, 2017.

  2. •• Hughes A, Williams MR, Lipari RN, Bose J, Copella EAP, Kroutil LA. Prescription drug use and misuse in the United States: results from the 2015 National Survey on Drug Use and Health. NSDUH Data Review. 2016. Data on prescription drug use and misuse in the United States.

  3. Rajan S, Ruggles KV, Guarino H, Mateu-Gelabert P. Heroin use and drug injection among youth also misusing prescription drugs. Substance Abuse Treat Prev Policy. 2018;42(1):144–55.

    Google Scholar 

  4. Seth P, Scholl L, Rudd RA, Bacon S. Overdose deaths involving opioids, cocaine, and psychostimulants—United States, 2015–2016. MMWR Morb Mortal Wkly Rep. 2018;67:349–58.

    Article  PubMed  PubMed Central  Google Scholar 

  5. Park-Lee E, Lipari RN, Hadden SL, Kroutil LA. Receipt of services for substance use and mental health issues among adults: results from the 2016 National Survey on Drug Use and Health. NSDUH Data Review. 2017.

  6. Center for Disease Control and Prevention. Emergency department data show rapid increases in opioid overdose [Press release]. Retrieved from https://www.cdc.gov/media/releases/2018/p0306-vs-opioids-overdoses.html.

  7. Fairfax County Opioid Task Force Plan. 2018. https://www.fairfaxcounty.gov/community-services-board/sites/community-services-board/files/assets/documents/pdf/opioid-task-force-plan.pdf. Accessed 23 May 2018.

  8. •• Sharma A, Kelly SM, Mitchel SG, Gryczynski J, O’Grady KE, Schwartz RP. Update on barriers to pharmacotherapy for opioid use disorder. Curr Psychiatry Rep. 2017;19(6):35. Current barriers to substance abuse treatment medications.

    Article  PubMed  Google Scholar 

  9. • Ling W. A perspective on opioid pharmacotherapy: where we are and how we got here. J Neuroimmune Pharmacol. 2016;11(3):394–00. History of substance abuse and current trends.

    Article  PubMed  Google Scholar 

  10. • Joseph H, Stancliff S, Langrod J. Methadone maintenance treatment (MMT): a review of historical and clinical issues. MT Sinai J Med. 2000;67(5–6):347–64. Methadone treatment history and current trends.

    PubMed  CAS  Google Scholar 

  11. Itzoe M, Guarnieri M. New developments in managing opioid addiction: impact of a subdermal buprenorphine implant. Drug Des Devel Ther. 2017;11:1429–37.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  12. • Sunilkumar MM, Lockman K. Practical pharmacology of methadone: a long-acting opioid. Indian J Palliat Care. 2018;24(Suppl 1):S10–4. Pharmacology and current use of methadone in substance abuse.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  13. Leahy LG. The opioid epidemic: what does it mean for nurses? J Psychosoc Nurs Ment Health Serv. 2017;55(1):18–23.

    Article  PubMed  Google Scholar 

  14. Yarborough BJ, Stumbo SP, McCarty D, Mertens J, Weisner C, Green CA. Methadone, buprenorphine and preferences for opioid agonist treatment: a qualitative analysis. Drug Alcohol Depend 2016;160:112–8.

  15. Srivastava A, Kahan M, Nader M. Primary care management of opioid use disorders: abstinence, methadone, or buprenorphine-naloxone? Can Fam Physician. 2017;63(3):200–5.

    PubMed  PubMed Central  Google Scholar 

  16. Rosenthal RN, Goradia W. Advances in the delivery of buprenorphine for opioid dependence. Drug Des Devel Ther. 2017;11:2493–505.

    Article  PubMed  PubMed Central  Google Scholar 

  17. D’Onofrio G, O’Connor PG, Pantalon MV, Chawarski MC, Busch SH, Owens PH, et al. Emergency department-initiated buprenorphine/naloxone treatment for opioid dependence: a randomized clinical trial. JAMA 2015. 2015;313(16):1636–44.

    Google Scholar 

  18. Jackson H, Mandell K, Johnson K, Chatterjee D, Vanness DJ. Cost-effectiveness of injectable extended-release naltrexone compared to methadone maintenance and buprenorphine maintenance treatment for opioid dependence. Subst Abus. 2015;36(2):226–31.

    Article  PubMed  PubMed Central  Google Scholar 

  19. •Bisaga A, Mannelli P, Sullivan MA, Vosburg SK, Compton P, Wood GE, et al. Antagonists in the medical management of opioid use disorders: historical and existing treatment strategies. Am J Addict. 2018;27(3):177–87.Addresses practices for managing persons with moderate to severe opioid use disorder.

  20. Tanum L, Solli KK, Latif ZE, Benth JS, Opheim A, Sharma-Haase K et al. Effectiveness of injectable extended-release naltrexone vs daily buprenorphine-naloxone for opioid dependence: a randomized clinical noninferiority trial. 2017;74(12):1197–1205.

  21. Bond AJ, Witton J. Perspectives on the pharmacological treatment of heroin addiction. Clin Med Insights: Psychiatr. 2017;8:1–10.

    Google Scholar 

  22. Shanahan WR, Rose JE, Glicklich A, Stubbe S, Sanchez-Kam M. Lorcaserin for smoking cessation and associated weight gain: a randomized 12-week clinical trial. Nicotine Tob Res 2016;19(8):944–51.

  23. Gannon BM, Sulima A, Rice KC, Collins GT. Inhibition of cocaine and 3,4-methylenedioxypyrovalerone (MDPV) self-administration by lorcaserin is mediated by 5-HT2C receptors in rats. J Pharmacol Exp Ther. 2018;364(2):359–66.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  24. Lipari RN, Williams M, Van Horn SL. Why do adults misuse prescription drugs? The CBHSQ Report. Rockville MD: Center for Behavioral Health Statistics and Quality, Substance Abuse and Mental health Services, 2017.

  25. •• Neelakantan H, Holliday ED, Fox RG, Stutz SJ, Comer SD, Haney M, et al. Lorcaserin suppresses oxycodone self-administration and relapse vulnerability in rats. ACS Chem Neurosci. 2017;8(5):1065–73. Evidence of lorcaserin reducing oxycodone self-administration

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  26. •• Wu X, Pang G, Zhang YM, Li G, Xu S, Don L, et al. Activation of serotonin in 5-HT(2C) receptor suppresses behavioral sensitization and naloxone-precipitated withdrawal symptoms in heroin-treated mice. Neurosci Lett. 2015;607:23–8. Evidence of lorcaserin suppressing behavior sensitization and withdrawal.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  27. • Baron EPComprehensive review of medical marijuana, cannabinoids, and therapeutic implications in medicine and headache: what a long trip it’s been. Headache 2015;55(6):885–916. A review of medicinal marijuana and headache.

  28. • Owens B. Drug development: the treasure chest. Nature. 2015;525(7570):S6–8. A good read on the pharmacology of medicinal marijuana.

    Article  PubMed  CAS  Google Scholar 

  29. Gupta S. Why I changed my mind on weed. 2013. https://www.cnn.com/2013/08/08/health/gupta-changed-mind-marijuana/. Accessed 23 May 2018.

  30. Gupta S. Dr. Sanjay Gupta to Jeff Sessions: medicinal marijuana could save many addicted to opioids. 2018. https://www.cnn.com/2018/04/24/health/medical-marijuana-opioid-epidemic-sanjay-gupta/. Accessed 23 May 2018.

  31. •• Vigil JM, Stith SS, Adams IM, Reeve AP. Associations between medical cannabis and prescription opioid use in chronic pain patients: a preliminary cohort study. PLoS One. 2017;12(11):e0187795. Evidence of medicinal cannabis reducing prescription opioid use.

    Article  PubMed  PubMed Central  Google Scholar 

  32. •• Powell D, Pacula RL, Jacobson M. Do medical marijuana laws reduce addictions and deaths related to pain killers? J Health Econ. 2018;58:29–42. Evidence of medical cannabis laws reducing addiction and overdose-related deaths.

    Article  PubMed  Google Scholar 

  33. Shapiro GK, Buckley-Hunter L. What every adolescent needs to know: cannabis can cause psychosis. J Psychosom Res. 2010;69(6):533–9.

    Article  PubMed  Google Scholar 

  34. Del Buno MG, O’Quinn MP, Garcia P, Gerszten E, Roberts C, Moeller FG, et al. Cardiac arrest due to ventricular fibrillation in a 23-year-old woman with broken heart syndrome. Cardiovasc Pathol. 2017;30:78–81.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Sade E. Johns PhD.

Ethics declarations

Conflict of Interest

Dr. Moeller has grant support from Indivior pharmaceuticals. Dr. Johns has nothing to disclose.

Additional information

This article is part of the Topical Collection on Substance Use Disorders

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Johns, S.E., Bowman, M. & Moeller, F.G. Future Directions Incorporating Novel Medications to Reduce Repeat Overdose. Curr Treat Options Psych 5, 313–322 (2018). https://doi.org/10.1007/s40501-018-0151-3

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s40501-018-0151-3

Keywords

Navigation