Prevention and Treatment of Opioid Misuse and Addiction: A Review
Abstract
Importance: More than 42 000 Americans died of opioid overdoses in 2016, and the fatalities continue to increase. This review analyzes the factors that triggered the opioid crisis and its further evolution, along with the interventions to manage and prevent opioid use disorder (OUD), which are fundamental for curtailing the opioid crisis. Observations: Opioid drugs are among the most powerful analgesics but also among the most addictive. The current opioid crisis, initially triggered by overprescription of opioid analgesics, which facilitated their diversion and misuse, has now expanded to heroin and illicit synthetic opioids (fentanyl and its analogues), the potency of which further increases their addictiveness and lethality. Although there are effective medications to treat OUD (methadone hydrochloride, buprenorphine, and naltrexone hydrochloride), these medications are underused, and the risk of relapse is still high. Strategies to expand medication use and treatment retention include greater involvement of health care professionals (including psychiatrists) and approaches to address comorbidities. In particular, the high prevalence of depression and suicidality among patients with OUD, if untreated, contributes to relapse and increases the risk of overdose fatalities. Prevention interventions include screening and early detection of psychiatric disorders, which increase the risk of substance use disorders, including OUD. Conclusions and Relevance: Although overprescription of opioid medications triggered the opioid crisis, improving opioid prescription practices for pain management, although important for addressing the opioid crisis, is no longer sufficient. In parallel, strategies to expand access to medication for OUD and improve treatment retention, including a more active involvement of psychiatrists who are optimally trained to address psychiatric comorbidities, are fundamental to preventing fatalities and achieving recovery. Research into new treatments for OUD, models of care for OUD management that include health care, and interventions to prevent OUD may further help resolve the opioid crisis and prevent it from happening again.
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Management of psychopathology may be critical in the mitigation of subsequent SUD.
“This is of particular importance given that untreated psychopathology robustly increases the risk for later SUDs, and its management may be critical in the mitigation of subsequent SUD (Volkow et al. 2019).”
From The Impact of Pharmacotherapy of Childhood-Onset Psychiatric Disorders on the Development of Substance Use Disorders (2022) · cites this paper as Volkow et al. 2019
Untreated psychopathology robustly increases the risk for later SUDs.
“This is of particular importance given that untreated psychopathology robustly increases the risk for later SUDs, and its management may be critical in the mitigation of subsequent SUD (Volkow et al. 2019).”
From The Impact of Pharmacotherapy of Childhood-Onset Psychiatric Disorders on the Development of Substance Use Disorders (2022) · cites this paper as Volkow et al. 2019
Leading experts are consistently calling for "research into new treatments for OUD" but nutrition therapy has lagged behind.
“Leading experts are consistently calling for “research into new treatments for OUD” (196) but nutrition therapy has lagged behind.”
From A Biopsychosocial Overview of the Opioid Crisis: Considering Nutrition and Gastrointestinal Health (2019) · cites this paper as [196]
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- Authors
- Volkow, N. D., Jones, E. B., Einstein, E. B., & Wargo, E. M.
- Affiliations
- National Institutes of Health (US)
- Venue
- JAMA Psychiatry
- Publisher
- American Medical Association (AMA)
- Published
- 2019-02-01
- Volume
- 76
- Issue
- 2
- Pages
- 208
- ISSN
- 2168-622X (ISSN-L)
- OpenAlex
- W2902748282
- Semantic Scholar
- 4b4829f4fc19d174e1d0750c436a5d0cb3b85225
- Cited by
- 596
- References
- 60
- Citations by year
- 2026: 47 · 2025: 80 · 2024: 86 · 2023: 89 · 2022: 89 · 2021: 82 · 2020: 77 · 2019: 46
- FWCI
- 9.31
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- JAMA Psychiatry (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Opioid Use Disorder Treatment
- Health Sciences › Medicine › Epidemiology › Substance Abuse Treatment and Outcomes
- Health Sciences › Medicine › Anesthesiology and Pain Medicine › Pain Management and Opioid Use
- Keywords
- opioid use disorder, opioid epidemic, opioid overdose, opioid misuse prevention, heroin, fentanyl, synthetic opioids, methadone, buprenorphine, naltrexone, treatment retention, relapse, psychiatric comorbidity, depression, suicidality, mental health screening, models of care
- MeSH terms
- Humans, Opioid-Related Disorders, Primary Prevention, Comorbidity
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