Research Offers Hope Amid Ongoing Opioid Crisis

While attorneys haggle over settlement amounts and politicians argue over treatment approaches (and funding), caregivers and patients persist in the daily struggle that is opioid addiction.

And while the problem isn’t uniquely American, the United States leads the world – by an embarrassing margin. The Institute for Health Metrics and Evaluation’s most recent “Global Burden of Disease” study reveals that the United States boasts 15.4 deaths per 100,000 people annually – more than double our closest competitor, Canada, with 6.9.

But silver linings have begun to peek through.

• A new paper exposes a link between poor pain alleviation in orthopedic patients during recovery and chronic opioid use. Better postsurgical pain management could be the way forward in reducing COU rates before things escalate.
• And although it’s still early, another study showed that cannabis helped reduce opioid use by managing withdrawal symptoms and providing a transition to medication-assisted treatment.

The Journal of Clinical Psychiatry and the Primary Care Companion have published a wealth of research into this lingering public health crisis. This week, we’re offering recaps of some of the more recent research – along with links – for further review.

Most US Opioid Use Disorders Tied to Non-Misuse of Prescriptions

The fight against prescription opioid abuse – simmering quietly across the country – erupted into the forefront over the last decade or so. Despite plateauing since 2012, prescription opioid overdose deaths still make up more than 20 percent of opioid-involved overdose deaths since 2021.

Since its classification in 2013, Prescription Opioid Use Disorder (POUD) typically walks hand-in-hand with prescription opioid misuse. As a result, public health measures historically centered on preventing and screening for misuse to curb POUD.

But long-term opioid therapy in primary care has shown that up to 25 percent of patients can develop POUD without ever reporting misuse.

The 2021 National Survey on Drug Use and Health (NSDUH) has since changed its methodology, assessing POUD among all prescription opioid users. And not just those reporting misuse. This novel approach has since revealed that 62 percent of adults with POUD never reported misuse, highlighting a silent majority of patients that flew under the radar of earlier research.

Data from 47,291 adults showed that 27 percent had used prescription opioids in the past year, with 7 percent of them developing POUD. Among these, those reporting misuse had a significantly higher prevalence of POUD. But even without reported misuse, notable cases of moderate to severe POUD had emerged.

This latest research underscores a growing need for exhaustive screening and treatment of POUD, regardless of misuse status. Researchers argue that those efforts should include distributing naloxone and ensuring better access to Medication for Opioid Use Disorder (MOUD) to mitigate risks.

The survey’s broader criteria unveiled a larger population desperate for intervention, and this approach can prevent critical health risks and improve outcomes for those affected.

Study Suggests Depression Might Hamper OUD Treatment

A new study highlights a critical connection between depressive symptoms and the effectiveness of opioid use disorder (OUD) treatments. Researchers have discovered that individuals with OUD who exhibit greater depressive symptoms experience smaller reductions in drug cravings and brain responses to drug cues when treated with the once-monthly injectable extended-release opioid antagonist naltrexone (XR-NTX).

The science has shown that the nucleus accumbens (NAcc) shows increased activity in response to drug-related cues. Researchers have tied this response – cue reactivity –  to more frequent drug-seeking behavior and relapse. In patients with OUD, a greater NAcc response to opioid cues emerges with heavier drug use. XR-NTX has proven to be an effective bulwark against relapse by slashing NAcc cue reactivity.

The study involved nearly two dozen detoxified OUD patients. Researchers put the participants through functional magnetic resonance imaging (fMRI) scans before and after their first XR-NTX injection. The scans measured brain responses to several stimuli, including drug-related images. 

Participants also reported their opioid cravings on a 10-point scale before and after viewing the series of pictures.

Results showed that participants with higher scores on the Beck Depression Inventory (BDI) exhibited smaller reductions in both cue-induced cravings and NAcc cue reactivity following the XR-NTX treatment. The study’s authors conclude that this suggests that depressive symptoms might interfere with XR-NTX’s ability to normalize incentive processing linked to drug cues. Notably, the researchers observed no such correlation in responses to sexual or aversive stimuli.

Given the high comorbidity of depression and OUD, addressing depressive symptoms could help boost the success of XR-NTX treatment.

Aging Baby Boomers Shape Opioid Use Disorder Treatment Needs

Baby Boomers have been the driving force behind everything from pop culture to the economy for more than 50 years.

Now, as this massive generation creeps toward retirement, they stand poised to wield a similarly outsized influence on health and elder care. And this market shift will almost certainly overlap with the ongoing opioid use epidemic. And that raises critical questions about opioid use disorder (OUD) management in older patients.

In fact, newer studies have started to show a trend that an increasing proportion of adults over 65 years are struggling with OUD. Contributing factors include increased life expectancy, better healthcare access, better visibility into OUD overall, and a growing acceptance of harm reduction strategies.

Older adults living with OUD face challenges unique to their demographic.

• Age-related physiological changes make them more susceptible to organ injury and neurotoxicity.
• Drug interactions are more common, and can exacerbate existing medical conditions.
• Changes in body composition and organ function alter opioid pharmacokinetics and pharmacodynamics. And that means elderly patients simply don’t need as much per dose.

Right now, regulators have approved three medications for OUD treatment: methadone, buprenorphine, and naltrexone. Buprenorphine, a partial agonist, is particularly promising for older adults thanks to fewer withdrawal symptoms and minimal cardiac effects. But access can be a problem. So buprenorphine is usually a more practical option.

This systematic review highlights the need for more research on buprenorphine use in older adults. Given the high comorbidity of depression and OUD, integrated treatments addressing both conditions may enhance the effectiveness of OUD therapies in this growing demographic.