Moud treatment
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Medication Treatment for Opioid Use Disorder (MOUD): A Comprehensive Overview
Introduction to MOUD
Medication treatment for opioid use disorder (MOUD) is a critical component in addressing the opioid epidemic. MOUD includes medications such as methadone, buprenorphine, and naltrexone, which are approved by the U.S. Food and Drug Administration (FDA) for treating opioid use disorder (OUD). These medications have been shown to reduce illicit opioid use, mortality, and other opioid-related harms .
Impact on Infectious Disease Outcomes
MOUD has significant benefits for individuals with OUD, particularly in managing infectious diseases. Studies have shown that MOUD is associated with greater adherence to antiretroviral therapy (ART) and improved HIV viral suppression among persons with HIV (PWH) and OUD. Additionally, there is evidence suggesting a positive association between MOUD and sustained virologic response in hepatitis C virus (HCV) treatment. Integrating MOUD with HIV treatment is crucial for improving health outcomes in this population.
Mortality and Overdose Reduction
MOUD is also effective in reducing mortality and the risk of overdose. A systematic review and meta-analysis of observational cohort studies found substantial reductions in all-cause and overdose mortality for individuals receiving methadone and buprenorphine. However, the mortality benefit is primarily observed during the period when patients are actively retained in treatment, with a notably high risk of death in the four weeks following discontinuation. This highlights the importance of continuous engagement in MOUD to sustain its protective effects.
Weight Changes Associated with MOUD
Weight gain is a potential side effect of MOUD, particularly with methadone. A scoping review found that patients on methadone treatment experienced weight gain ranging from 4.2 to 23.4 pounds over six months, with women gaining more weight than men. In contrast, there is limited data on weight changes associated with buprenorphine/naloxone or naltrexone, and the potential associations remain unclear. Providers should discuss the risk of weight gain with patients and consider prevention and intervention strategies.
Comparative Effectiveness of MOUD
Comparative studies have demonstrated the superior effectiveness of MOUD over nonpharmacologic treatments. Treatment with buprenorphine or methadone is associated with reduced risk of overdose and serious opioid-related acute care use compared to other treatment pathways. These findings underscore the need to address the underuse of MOUD and promote its integration into various treatment settings.
Treatment Completion and Retention
MOUD can improve treatment completion and retention in residential programs. In short-term residential treatment, MOUD is associated with a 40% increased likelihood of treatment completion and a 34% increase in retention. However, in long-term residential treatment, MOUD is linked to a reduced likelihood of treatment completion, suggesting the need for further research on integrating MOUD in these settings.
Patient Perceptions and Social Network Support
Patient perceptions of MOUD are generally positive, especially in primary care settings where patients report minimal stigma and strong relationships with prescribers. Social network support, particularly from family, plays a crucial role in improving MOUD treatment retention and reducing drug use. Interventions that enhance social network support could potentially augment MOUD outcomes.
Lessons from COVID-19
The COVID-19 pandemic has led to program changes that may improve MOUD treatment. Increased take-home doses, home medication delivery, and telehealth have been favorably received by patients, reducing travel time to clinics and facilitating retention in care. These changes could be considered for permanent implementation to enhance MOUD accessibility and effectiveness.
Conclusion
MOUD is a vital tool in combating the opioid epidemic, offering significant benefits in reducing mortality, improving infectious disease outcomes, and enhancing treatment retention. Addressing barriers to MOUD access, such as stigma and lack of provider training, and leveraging social network support are essential for optimizing treatment outcomes. The positive changes implemented during the COVID-19 pandemic provide valuable insights for future MOUD strategies.
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