By Sandy Ong
The United States is suffering from an explosive epidemic. Every day, 44 people die from overdosing on prescription opioid painkillers, a rate that has quadrupled since 1999. To help physicians battling on the frontline, the American Society of Addiction Medicinereleased a National Practice Guideline in September. The ASAM document outlines best practices for treating opioid addiction with the safe and effective prescribing of treatments like methadone, buprenorphine and naltrexone to curb the growing epidemic.
The guideline’s release couldn’t be more timely, given the serious state of the opioid crisis. Nearly 2 million people, aged 12 years and over, abused or were addicted to prescription painkillers such as Vicodin and OxyContin in 2014.
Despite this alarming public health crisis, general physicians receive very little training on addiction medicine, says psychiatrist Kyle Kampman from the Hospital of the University of Pennsylvania, who led the committee behind the guideline. “We hope to give physicians more knowledge so they feel more confident treating the problem.”
Proponents of the new ASAM guideline say it stands apart from previous guidance in many respects. “This is the first guideline that addresses all three medications with FDA approval for treating opioid dependence,” says Margaret Jarvis, director of Marworth Treatment Center, who led the team that selected independent experts responsible for developing the guideline. Combining these medications with psychosocial treatments such as counseling and referral to community services is considered the gold standard of treatment for opioid addiction, she says.
Yet effective use of drug therapy has been limited by a number of factors over the years. “Many physicians don’t believe in using medication because they think you’re just substituting one drug for another,” says Andrew Kolodny, head physician at the Phoenix House, a nonprofit organization that runs rehabilitation programs in 13 states.
This resistance to treating addiction with medication is a barrier to treatment that the developers of the new guideline are hoping to overcome. The recommendations were developed by a team of 11 experts who combined their clinical knowledge with scientific evidence gathered from literature reviews and existing guidelines.
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