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The Concept of Treatment-Refractory Addiction: A Call to the Field

Not all patients respond to effective and approved treatment interventions, and there has been growing recognition in the medical field of these “resistant” or refractory illnesses (eg, treatment-resistant depression, resistant hypertension). In the field of substance use disorders, there has not been an explicit acknowledgement of treatment-refractory addiction (TRA) despite substantial evidence that many patients do not respond to standard-of-care treatment interventions. This article provides a justification for TRA as a critically important condition to recognize and define. TRA is not conceptualized as a diagnosis, but as a signal that a current treatment approach has not worked. The article addresses areas in need of research and consensus in order to ensure the approach to TRA is uniform, thoughtfully addressed, and data-driven. By explicitly acknowledging TRA, clinicians, researchers, and patients and their families can begin to explore the unique features of this population an...
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Treatment of overdose in the synthetic opioid era

Treatment of overdose in the synthetic opioid era. Skolnick P. Pharmacol Ther. 2021 Oct 9:108019. doi: 10.1016/j.pharmthera.2021.108019. Online ahead of print. PMID:  34637841   Review. Overdose deaths are often viewed as the leading edge of the opioid epidemic which has gripped the United States over the past two decades (Skolnick, 2018a). This emphasis is perhaps unsurprising because  opioid overdose  is both the number-one cause of death for individuals between 25 and 64 years old (Dezfulian et al., 2021) and a significant contributor to the decline in average lifespan (Dowell et al., 2017). Exacerbated by the COVID 19 pandemic, it was estimated there were 93,400  drug overdose  deaths in the United States during the 12 months ending December 2020, with more than 69,000 (that is, >74%) of these fatalities attributed to opioid overdose (Ahmad et al., 2021). However, the focus on mortality statistics (Ahmad et al., 2021; Shover et al., 2020) t...
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CDC’s Draft Clinical Practice Guideline for Prescribing Opioids Now Open for Public Comment

CDC’s National Center for Injury Prevention and Control is in the process of updating the   2016 CDC Guideline for Prescribing Opioids for Chronic Pain . The draft updated Clinical Practice Guideline for Prescribing Opioids is available for public comment in the Federal Register. The public comment period will be open for 60 days, through April 11, 2022. We encourage all patients, caregivers, providers, and others who care about safe, effective, and informed pain treatment options to submit their comments via the Federal Register docket. It is vitally important to CDC that we receive, process, and understand public feedback during the guideline update process. The guideline is intended to be a clinical tool to improve communication between providers and patients and empower them to make informed, patient-centered decisions related to safe and effective pain care. The guideline recommendations are voluntary and are not intended to be applied as inflexible standards of care or replac...
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