"McLellan and Volkow confront one of the most persistent, emotionally-charged addiction questions: What are acceptable treatment outcomes? We have no cures, so what are we trying to achieve with medications for opioid use disorder? The authors propose a three-stage framework-protection, remission, and recovery. Protection emphasizes survival and overdose prevention; remission focuses on stabilization of cravings/use; recovery encompasses long-term health and functioning."
"The authors contend that medication tapering should not be a default goal, and long-term or even lifelong treatment with methadone or buprenorphine may be appropriate for many patients. Using national poison center data from 2015-2023, Fitzgerald et al. document a dramatic rise in nonfatal fentanyl exposures involving stimulant co-use. Cocaine-fentanyl exposures increased nearly sevenfold, while methamphetamine-fentanyl exposures rose more than sixfold."
Major topics include realistic treatment goals, recovery amid fentanyl, neurobiological reversibility of addiction, and roles for GLP‑1 agonists and ketamine in evidence-based care. A three-stage treatment framework—protection, remission, and recovery—prioritizes survival and overdose prevention, stabilization of cravings and use, and long-term health and functioning. Medication tapering should not be the default; long-term or lifelong methadone or buprenorphine may be appropriate for many patients. National poison center data from 2015–2023 show dramatic rises in nonfatal fentanyl exposures with stimulant co-use, indicating polysubstance exposure is now common and clinical and public health responses must adapt.
#opioid-use-disorder #treatment-outcomes-framework #fentanyl-polysubstance-exposure #medication-assisted-treatment
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