Improving Our Treatment Approach for Opioid Use Disorder

A new national study, directed in part by Roger D. Weiss, MD, chief of McLean Hospital’s Division of Alcohol, Drugs, and Addiction, aims to create a model to predict who can successfully wean off their medication for opioid use disorder while also exploring how to help patients to continue some form of treatment.

“Multiple studies have shown medications are enormously helpful, and in many cases lifesaving, for people with opioid use disorder,” said Weiss, citing buprenorphine as the most commonly used medication.

But, he added, “There are still many questions involved in the treatment of this population: What is the right dose of medication? Are there behavioral treatments that can improve the outcome in addition to medication? How long should people stay on medication? Are there people who can safely stop medication? If so, who are they, and what is the optimal time and way to do it?”

HEAL Grant

To help answer those questions, McLean has received one of 375 grants across 41 states under the National Institutes of Health’s Helping to End Addiction Long-Term Initiative (NIH HEAL). Weiss and his co-principal investigators from Columbia University and New York University aim to enroll more than 2,000 patients across approximately 20 sites nationally in what they are calling Optimizing Retention, Duration and Discontinuation Strategies for Opioid Support or RDD.

In 2016, an estimated 50 million U.S. adults suffered from chronic pain requiring medication, and in 2018, an estimated 10.3 million people aged 12 years and older misused opioids, including heroin. The trans-NIH research effort aims to improve treatments for chronic pain, curb the rates of opioid use disorder and overdose, and achieve long-term recovery from opioid addiction.

Weiss’ trial will recruit patients using several different forms of treatments, including sublingual and injectable buprenorphine and injectable naltrexone.

“We already have medications that are effective at treating opioid use disorder,” Weiss explained. “However, staying on them isn’t always easy, and weaning off them, for those who choose to do so, can be very difficult. In general, we advise patients to stay on medications, but many people want to discontinue them despite that advice. Learning how to advise those patients is very important.”

One focus of the study will be to develop a model that predicts how a patient might respond, relying on an individual’s experiences.

“Did they use just prescription opioids or were they using injectable heroin or fentanyl?” said Weiss. “Do they have a job? Relationships? How long have they been on medication? How long have they been stable? And importantly, what kinds of changes have they made during their recovery that might help them be able to go through the stress of tapering off the medication?”

Thanking Our Donors

With the help of philanthropic support, McLean has partnered with the Opioid Project to use art and storytelling to increase awareness and change public perceptions about recovery.