How bad are the long-term effects of opioid addiction?

Many regions of the U.S. & other countries are in the midst of an opioid epidemic with sharply increasing rates of use, need for treatment, & related mortality

While clinical studies have been conducted with regard to short term outcomes across several months, few studies have been completed looking at the course of opioid use disorders across years and decades. Given that we know that opioid addiction tends to have a chronic course lasting many years, studies that highlight long-term treatment outcomes and rates of recovery are needed to inform how providers, systems, and policymakers might address this major public health problem more effectively to enhance remission and recovery rates.

Individuals over a three-year span

They reviewed outcomes across several domains including:

• mortality
• abstinence
• further treatment
• other health outcomes
• incarceration and other criminal justice-related events

• The risk of mortality is at least 6 times greater among individuals with opioid use disorder than the general population. However, studies that began to recruit individuals in the year 2000 or later (i.e., after treatment for HIV and AIDS improved dramatically) showed substantially lower mortality rates than earlier cohort studies.
• Regarding abstinence, among studies that followed individuals for 10 or more years, only about 30% were abstinent from opioids at the most recent follow-up. The use of other drugs including alcohol was common among these individuals with opioid use disorder, even if demonstrating ongoing opioid abstinence. Regarding formal treatment, multiple treatment episodes are often needed before long-term abstinence is initiated. However, these episodes appear important, with more cumulative time in treatment predicting greater subsequent periods of abstinence.
• Regarding other health outcomes, opioid users—including those that initiate abstinence—generally have poorer physical health than the general population. Also, while many studies show that the presence of mental health symptomatology is likely, many experience mental health improvements over time. However, co-occurring depressive disorders may pose an added risk to poorer functioning over time.
• With respect to crime, authors note that rates of incarceration are conditional on study location; the United States has traditionally approached opioid use from a criminal justice perspective while European countries implemented more of a public health approach. Although incarceration and criminal justice supervision itself may not lead to improved abstinence and recovery, they can be conduits to the treatment system. Indeed, abstinence initiated after a treatment episode is likely to be sustained for more time than when the following incarceration. Not surprisingly, longer periods of abstinence are associated with greater reductions in crime.

The current review emphasized the chronic nature of opioid use disorders. In addition, results from several of the reviewed studies suggest a public health—rather than criminal justice-based—approach to opioid use may ultimately enhance outcomes.

A substantial majority of studies have necessarily focused on developing, evaluating, and disseminating approaches to help individuals stabilize opioid use disorders in the short-term (e.g., up to 1 year after the index help-seeking episode, via medication-assisted and/or psychosocial treatment). The current study is important in that it provides a macro, longitudinal context to inform treatment and policy decisions.

BOTTOM LINE

• For individuals & families seeking recovery: Opioid use disorder can take several treatments and relapses before sustained abstinence is achieved. This is a statistical average, so one may achieve abstinence quickly, especially if they remain committed to engaging with ongoing recovery support services. The risk of relapse drops substantially after 5 years of continuous remission, but there is always at least some degree of relapse risk.
• For scientists: At present, there is a sufficient body of literature to support development, evaluation, and dissemination of methods to engage individuals with opioid use disorders with continuing care after an initial index episode. Longitudinal cohort studies of addicted individuals who have sought treatment more recently are needed to inform clinical and recovery support service provision given the changing landscape of opioids in the U.S. and globally.
• For policymakers: Strongly consider funding initiatives consistent with a chronic illness model for opioid addiction such as strategies to engage addicted individuals with continuing care and recovery support services following initial stabilization.

For treatment professionals and treatment systems: Strongly consider including continuing care approaches in your treatment program, or partner with providers and/or systems that can help provide ongoing recovery management. Ongoing engagement with formal and informal recovery specific supports is recommended for a minimum of five years.

We’d like to get these stats down with staying up to date on all current recovery methods in conjunction with the principals of the 12 step program!