NIDA’s Clinical Trials Network (CTN) is investigating whether team-based collaborative care in primary healthcare settings—a common approach to managing chronic conditions—can help reduce polysubstance use and overdose risk. Opioid use disorder is a complex, treatable chronic medical condition from which people can recover. A person is diagnosed with opioid use disorder if they have two or more of the symptoms and behaviors related to their opioid use listed in the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders, 5th Edition. Because addiction can affect so many aspects of a person’s life, treatment should address the needs of the whole person to be successful.
However, diagnosing and treating co-occurring substance use and other mental disorders is complex, because people may have overlapping symptoms. People who have co-occurring disorders often have symptoms that are more persistent, severe, and resistant to treatment compared with patients who have either disorder alone. Comprehensive assessment tools can reduce the chance of a missed diagnosis. Read more on the NIDA website about screening tools for health professionals.
- Because addiction can affect so many aspects of a person’s life, treatment should address the needs of the whole person to be successful.
- It is possible that escalation to a therapeutic dose may need to be more rapid.
- Some studies have found elevated rates of overdose during the induction and stabilization phase of maintenance treatment, potentially due to starting at too high a dose, escalating too rapidly, or drug interactions.
- In wait-list studies, methadone treatment was effective at reducing opioid use on its own, and patients stayed in treatment.
Where can people get methadone treatment?
- Some people use drugs to try to improve their focus in school or at work or their abilities in sports.
- There are many interrelated factors between chronic pain and substance use disorders.
- Over the past two decades, the opioid crisis has accelerated the integration of addiction care in the U.S. with mainstream medicine.
- People in methadone treatment, who must regularly visit an opioid treatment program (OTP), face stigma from their community and from providers.
- NIDA funds research to identify risk and protective factors and seek ways to prevent substance misuse and substance use disorders even when multiple risk factors are present.
While relapse is a normal part of recovery, for some drugs, it can be very dangerous—even deadly. If a person uses as much of the drug as they did before quitting, they can easily overdose because their treatment and recovery national institute on drug abuse nida bodies are no longer adapted to their previous level of drug exposure. An overdose happens when the person uses enough of a drug to produce uncomfortable feelings, life-threatening symptoms, or death. It remains the case that only a fraction of people who could benefit from medication treatment for OUD (MOUD) receive it, due to a combination of structural and attitudinal barriers.
NIH launches program to advance research led by Native American communities on substance use and pain
Today’s landscape of substance use poses both unique challenges and unprecedented opportunities to leverage the profound potential of science toward those goals. Like treatment for other chronic diseases such as heart disease or asthma, addiction treatment is not a cure, but a way of managing the condition. Treatment enables people to counteract addiction’s disruptive effects on their brain and behavior and regain control of their lives.
The emergency and referral resources listed above are available to individuals located in the United States and are not operated by the National Institute on Drug Abuse (NIDA). NIDA is a biomedical research organization and does not provide personalized medical advice, treatment, counseling, or legal consultation. Information provided by NIDA is not a substitute for professional medical care or legal consultation.
A study using data from the National Survey on Drug Use and Health (NSDUH) from 2019—that is, pre-pandemic—found that only slightly more than a quarter (27.8%) of people who needed OUD treatment in the past year had received medication to treat their disorder. But a year into the pandemic, in 2021, the proportion had dropped to just 1 in 5. Read more about how NIDA is advancing the science on effective prevention strategies. Different types of medications may be useful at different stages of treatment to help a patient stop abusing drugs, stay in treatment, and avoid relapse. NIDA is a biomedical research organization and does not provide personalized medical advice, treatment, counselling, or referral services.
Drug Overdose Deaths: Facts and Figures
Critics of expanded access to methadone outside OTPs sometimes argue that the medication should not be offered without accompanying behavioral treatment. In wait-list studies, methadone treatment was effective at reducing opioid use on its own, and patients stayed in treatment. However, counseling may have benefits or even be indispensable for some patients to help them improve their psychosocial functioning and reduce other drug use. How to personalize the intensity and the level of support needed is a question that requires further investigation. Recent trials of models of methadone dispensing in pharmacies and models of care based in other settings than OTPs have not supported concerns that making methadone more widely available will lead to harms like overdose. National Recovery Month is a national observance that is held every September to educate Americans that substance use disorder treatment and mental health services can enable those with a mental and/or substance use disorders to live healthy and rewarding lives.
Patients at three rural OTPs in Oregon reported increased self-efficacy, strengthened recovery, and reduced interpersonal conflict. NIDA also supports research to examine the social and economic impact of certain laws and policies in preventing substance use and its negative health effects. Together, this research helps policymakers and public health professionals make informed decisions to promote better health outcomes around substance use.
Find More Resources on Prevention
Although it also binds to the mu-opioid receptor, naltrexone blocks the receptor, rather than activates it.
Yet methadone, the oldest and still one of the most effective medications in our OUD treatment toolkit, remains siloed. In the current era of powerful synthetic opioids like fentanyl dominating the statistics on drug addiction and overdose, it is time to make this effective medication more accessible to all who could benefit. The recent rules making permanent the COVID-19 provisions are an essential step in the right direction, but it will be critical to pursue other ways that methadone can safely be made more available to a wider range of patients with OUD.
Drugs, Brains, and Behavior: The Science of Addiction
Recovery is a process of change through which people improve their health and wellness, live self-directed lives, and strive to reach their full potential. Even people with severe and chronic substance use disorders can, with help, overcome their illness and regain health and social function. Being in recovery is when those positive changes and values become part of a voluntarily adopted lifestyle. While many people in recovery believe that abstinence from all substance use is a cardinal feature of a recovery lifestyle, others report that handling negative feelings without using substances and living a contributive life are more important parts of their recovery. Behavioral therapies help people in drug addiction treatment modify their attitudes and behaviors related to drug use. As a result, patients are able to handle stressful situations and various triggers that might cause another relapse.
Detoxification alone without subsequent treatment generally leads to resumption of drug use. The chronic nature of addiction means that for some people relapse, or a return to drug use after an attempt to stop, can be part of the process, but newer treatments are designed to help with relapse prevention. Relapse rates for drug use are similar to rates for other chronic medical illnesses. If people stop following their medical treatment plan, they are likely to relapse. Explore the different types of medications prescribed for opioid overdose, withdrawal, and addiction.
Buprenorphine treatment may lead to better health outcomes for infants than methadone treatment. Research on the science of addiction and the treatment of substance use disorders has led to the development of research-based methods that help people to stop using drugs and resume productive lives, also known as being in recovery. Substance use disorders are chronic, treatable medical conditions from which people can recover. They are defined in part by continued substance use despite negative outcomes. Substance use disorders may be diagnosed as mild, moderate, or severe based on whether a person meets defined diagnostic criteria. Some people use the term to describe some substance use disorders, especially more serious presentations.
Although more research would be of value, the initial evidence suggests that providing methadone outside of OTPs is feasible, acceptable, and leads to good outcomes. Both methadone and buprenorphine bind to and activate the same mu-opioid receptors in the brain as do other opioid drugs. However, when taken as prescribed by people with opioid use disorder, methadone and buprenorphine prevent drug cravings and withdrawal symptoms without causing the intense feelings of pleasure (or “high”) that other opioid drugs produce. Buprenorphine is another opioid medication that is used to treat opioid use disorder. Buprenorphine also binds to and activates mu-opioid receptors in the brain, but to a lesser degree than methadone; it also can block other opioid drugs from attaching to those receptors. Like methadone, buprenorphine can reduce cravings and withdrawal symptoms without producing intense feelings of pleasure and intoxication in people who have opioid use disorder.
Reduced drug use is a meaningful treatment outcome for people with stimulant use disorders
Methadone may even be preferable for patients considered to be at high risk for leaving OUD treatment and overdosing on fentanyl. Comparative effectiveness evidence is emerging which shows that people with OUD in British Columbia given buprenorphine/naloxone when initiating treatment were 60% more likely to discontinue treatment than those who received methadone (1). More research is needed on optimal methadone dosing in patients with high opioid tolerance due to use of fentanyl, as well as on induction protocols for these patients.