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Understanding Addiction and Medication for OUD

According to The ASAM Criteria, addiction is a “treatable, chronic medical disease involving complex interactions among brain circuits, genetics, the environment, and an individual's life experiences. People with addiction use substances or engage in behaviors that become compulsive and often continue despite harmful consequences. Prevention efforts and treatment approaches for addiction are generally as successful as those for other chronic diseases."

Brain changes in addiction lead to severe symptoms of withdrawal that can be debilitating and sometimes life-threatening. These changes result in the chronic compulsion to obtain opioids (or other drugs) to abate withdrawal symptoms.

Addiction reflects physiological change in the brain—not just behavioral patterns. Thus, it is crucial to understand that medications are often necessary to address the underlying changes in brain circuitry and improve outcomes. While psychosocial services are important, they do not prevent opioid withdrawal and may not be enough to prevent recurrence (also known as relapse) or death in those living with OUD.

  • Medications for OUD act by stabilizing brain function, so the person no longer requires opioids to be stable. This enables them to benefit from psychosocial treatment and to focus on other areas of their life in ways that are not possible without the medication. There are multiple FDA-approved medications proven to decrease opioid use and prevent negative outcomes like death for persons with OUD. These medications should be continued as long as the person is deriving benefit. Arrest, incarceration, probation, or involvement in treatment court are not reasons to stop medication for OUD. Stopping these medications can quickly lead to opioid craving, recurrence, overdose, and death. Doing so against the wishes of the participant is also a likely violation of the Americans with Disabilities Act.
  • Medication for OUD treatment should not be interrupted when participants enter a treatment court setting or other part of the justice system.
  • The immediate initiation and maintenance of medication for OUD can prevent recurrence and death, reduce criminal behavior, and otherwise enhance quality of life.

Note: Adult treatment courts accept those at higher risk for treatment and supervision failure who are also classified as high need.

  • High need is equated with those diagnosed with moderate to severe substance use disorder (SUD).
    • The DSM-5 (Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition) is the diagnostic manual used to diagnose persons with any severity of SUD—mild, moderate, or severe. The DSM-5 specifies that moderate SUD requires that 4 to 5 of the 11 criteria be met, and severe SUD requires 6 or more.2 All of those diagnosed with severe SUD and many of those living with moderate SUD are living with addiction, the chronic, recurring form of SUD.
    • Summary of DSM-5's 11 criteria for SUD:
      • Opioids are often taken in larger amounts or over a longer period than was intended
      • Unsuccessful efforts to cut down or control opioid use
      • Too much time spent in obtaining and using opioids
      • Cravings
      • Recurring opioid use that hinders obligations from work, school, or home
      • Continued opioid use, exacerbating social or interpersonal problems
      • Giving up social, occupational, and recreational activities for opioid use
      • Recurring use in physically hazardous situations
      • Continued opioid use despite use causing or worsening physical or psychological problems
      • Exhibits tolerance; needs more to achieve desired effect
      • Exhibits withdrawal