A case study demonstrating how expanded access to this essential medication can help address the opioid overdose epidemic
Partial opioid agonists save lives.
Partial opioid agonists are among three FDA-approved medications to treat opioid use disorder (OUD).
These drugs are used alongside behavioral counseling in a treatment process known as medication-assisted recovery, sometimes referred to as medication-assisted treatment, or MAT for short.
Dr. Nora Volkov, director of The National Institute on Drug Abuse (NIDA), states,
“Medications are irrefutably the most effective way to treat OUD—reducing the likelihood of overdose death by up to three-fold—but fewer than half of patients receive them due to stigma and structural barriers.”
In response to these access challenges and the increasing death toll from the opioid overdose epidemic, several federal initiatives have expanded access to medications to treat OUD while making general substance use recovery services to treat addiction more available.
We’ll explore the results of one of these initiatives in a moment. But first, here’s a quick overview of where partial opioid agonists fit into medication-assisted recovery as a whole.
Partial Opioid Agonists Explained
Partial opioid agonists are a medication used to treat OUD that can be prescribed or dispensed in physicians’ offices.
Before the COVID-19 pandemic, medical practitioners had to obtain a specific waiver to prescribe partial opioid agonists. But in April 2020, those restrictions and several others were lifted.
After promising results that relaxing restrictions improved access to MAT without leading to an increase in partial opioid agonists-related overdoses, the restrictions were permanently lifted in early 2023.
How Do Partial Opioid Agonists Work?
Because they partially bind to the opioid receptor, partial opioid agonists produce some euphoric effects at low to moderate doses but to a lower extent than full opioid agonists.
Partial opioid agonists are safe and effective when taken as required. They have several benefits in treating opioid use disorder, including:
- Reducing withdrawal symptoms and cravings. Its partial activity at the opioid receptor helps manage the overwhelming physical and mental cravings and withdrawal symptoms experienced by people with OUD.
- Increasing safety in the event of an overdose. While full opioid agonists are the most common drug used to reverse opioid overdose, partial opioid agonists can be effective as well. In fact, because of its long half-life, partial opioid agonists may actually be more effective than other drugs at reversing overdose with long-acting opioids.
- Low abuse potential. There is a “ceiling effect” with partial opioid agonists, where even at moderate doses, the opioid effects level off even if more of the drug is taken. This dramatically reduces the risk of misuse, dependency, and side effects.
Are Partial Opioid Agonists the Best Drugs for MAT?
Partial opioid agonists are one of three FDA-approved medications to treat OUD.
No one of these medications is inherently “better” than another. Each has distinct characteristics that may prove either more or less useful in an individual’s situation.
The CDC is currently undertaking a multi-year MAT study, which plans to enroll over 1,188 patients in approximately 65 sites across the country. Participants will be asked to undertake treatment with one of the three medications for treating OUD over a two-year period, so researchers can better understand the unique characteristics of each.
Until the results of the study are released, the main points to be aware of are:
- MAT works. It is by far the most effective treatment for OUD, especially when combined with behavioral counseling.
- The best treatment is the one a client will stick with. All three MAT options are clinically proven to yield positive results, so clients should be encouraged to choose the one that best suits their personal vision for recovery from addiction.
The best way to reduce the risk of opioid overdose in individuals and the wider community is to expand access to MAT.
Because partial opioid agonists can be prescribed by general physicians (unlike others) and do not require a patient to detox from opioids before starting treatment (like others), it has been used in many community-based initiatives to rapidly scale up OUD treatment and substance use recovery services in communities.
One such initiative is the medication-first approach used in Missouri’s NoMoDeaths campaign.
One of the initiatives funded by the Missouri Opioid State Targeted Response (STR) is a statewide campaign to promote a “Medication First” approach to treating OUD.
According to their website, the key principles of the Missouri Medication First Approach are:
- People with OUD receive pharmacotherapy treatment as quickly as possible, prior to lengthy assessments or treatment planning sessions.
- Maintenance pharmacotherapy is delivered without arbitrary tapering or time limits.
- Individualized psychosocial services are continually offered but not required as a condition of pharmacotherapy.
- Pharmacotherapy is discontinued only if it worsens the person’s condition.
In short, Medication First increases access to “low-barrier” medical treatment for OUD.
This approach overcomes the common obstacles that too often delay and prevent people struggling with addiction from getting the treatment they so desperately need.
So far, STR funding has been provided to 69 treatment sites throughout Missouri.
The substance use recovery programs run at these locations are all committed to providing OUD treatment in line with Medication First principles. They follow current best practices and evidence-based guidelines around medication-assisted recovery.
Through the Medication First program, a total of 12,726 people have received MAT.
The most commonly prescribed medications are partial opioid agonists, being used in over 65% of the clients receiving treatment.
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Research into the outcomes of the Medication First initiative in Missouri has demonstrated promising results.
A 2019 study found that as a result of targeted funding:
- Medication-assisted recovery utilization for OUD treatment increased from 44.8% to 85.3%
- Timeliness of MAT initiation improved, from an average wait time to start treatment of eight days to zero days
- Fewer psychosocial services were delivered
- Treatment retention was improved at one, three, and six-month timeframes
- The medium cost per month for service delivery was 21% lower than in the year prior to the initiative
- All differences were driven by increased utilization of partial opioid agonists
These outcomes, along with research on MAT in general, have important implications for overdose prevention by substance use recovery providers.
Firstly, it’s essential to ask all clients screening questions about whether they have a history of overdose.
Opioid overdose survivors are known to have an increased risk of death. But research shows this risk can be reduced by as much as 59% when people addicted to opioids have access to medication-assisted recovery with drugs like partial opioid agonists.
Remember, it’s not uncommon for clients (particularly older adults) to feel a sense of shame about overdose, leading to them not offering this information freely. Therefore, many providers include questions about the history of an overdose in assessment paperwork that’s completed by clinicians and clients.
EchoVantage, our intuitive, flexible, all-in-one behavioral health record software, has patient notes and assessment templates that can be customized to include screening questions about overdose history. This ensures you and your team will never miss this vital piece of information in clients treated by your service.
Second, if you have a client who is struggling with opioid addiction, educate them about MAT.
Now that prescribing restrictions around partial opioid agonists have been lifted, most clients will be able to access medication-assisted recovery. If they have issues with insurance coverage or meeting the cost of a copay, many states now have publicly funded programs to expand access to MAT (like our recently profiled Be Well Texas and Missouri’s Medication First initiative).
Just be sure to remind your client that counseling and behavioral therapy are important parts of medication-assisted recovery, so they should still engage in your services even if they see another provider for MAT.
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