One of the main challenges to successfully transition patients with OUDs from opioid agonist to antagonist treatment is the discomfort associated with opioid withdrawal. Multiple methods of supervised withdrawal from opioids are being investigated. They include anesthesia assisted and medications such as ketamine, lofexidine, gabapentin, pregabalin, buprenorphine, cannabinoids, and ultra-low doses of oral naltrexone. The purpose of the meeting was to bring together a group of experts from academia, industry and government, from specialties such as psychiatry, internal medicine, anesthesiology, and emergency medicine, to discuss research priorities to treat opioid withdrawal and thus reduce the number and lethality of opioid overdoses. This group of experts recommended:
- To study the characteristics of the patients who overdose and are treated in EDs, including the treatment that they received, any referrals, medications prescribed, outcomes and cost/benefit analysis.
- To study the effect of an “Observation Room” service after overdose. A 24-hour observation period will help identify they type of overdose patient and the medication, including quality of care and cost-effectiveness.
- Studies to accelerate and reduce the discomfort of opioid detoxification, including more research with AAD methods, which patients may benefit from AAD and the cost-benefit.
- Studies to determine how to initiate and sustain patients on buprenorphine, methods to move people in the ED to weekly buprenorphine, methods to transition OD patients to buprenorphine implant (“low hanging fruit”), and a combo of depot buprenorphine and naltrexone for overdose prevention.
- A randomized clinical trial comparing ketamine versus active control to determine its long-term effects on OUD, prevent overdose fatalities, and transition patients to depot naltrexone.
- Studies to determine the safety and efficacy of medications to treat opioid withdrawal and residual opioid withdrawal in patients treated with long-acting naltrexone.
- Studies to evaluate the safety and efficacy of the long-acting naltrexone implants and obtain FDA approval.
- Basic science studies to understands the changes in the opioid receptors after a period of withdrawal and the system returns to homeostasis.
- Long-term comparative effectiveness studies of the current FDA approved medications for OUDs as ways to prevent opioid overdose.
- Increase NIH funding for research to address the current opioid crisis and find the most cost-effective methods to prevent opioid overdose and treat patients after they have overdosed with opioids.
- NIH should have rapid, high-impact funding mechanisms outside the traditional funding cycle to accelerate the science and effectively respond to this crisis.
9:00: Introduction - Iván D. Montoya, M.D., M.P.H.
9:05: Welcome and Meeting Goals - Nora D. Volkow, M.D.
9:15: Introduction of participants
9:30: Anesthesia Supported Opioid Detoxification - Eric D. Collins, M.D. (Columbia University) and Colin Brewer, M.D. (The Stapleford Centre, UK)
10:00: Discussion: future research of anesthesia supported detox
11:00: Ketamine Supported Opioid Detoxification - Elias Dakwar, M.D. (Columbia University)
11:15: Discussion: future research with ketamine for opioid detoxification
12:30: Lunch Break
Other Approaches for Faster Opioid Detoxification
1:30: Lofexidine to Facilitate Opioid Detoxification - Chandu Kasibhatla, Ph.D., M.B.A. Senior Manager, Medical Affairs (US Worldmeds)
1: 45: Low Dose Naltrexone Detoxification - Maria A. Sullivan, M.D., Ph.D. (Alkermes)
2:00: Buprenorphine for Opioid Detoxification - Adam Bisaga, M.D. (Columbia University)
2:15: Gabapentin for Opioid Detoxification - Alison Oliveto, Ph.D. (U. of Arkansas)
2:30: Cannabinoids to facilitate opioid detoxification - Ziva D. Cooper, Ph.D. (Columbia University)
3:00: Discussion of other approaches
4:00: General discussion of future research to shorten and improve opioid detoxification