b'Retention Rates Remain LowFor Substance Use Disorder ProgramsA common explanation for the high dropout rate and failure of substance use disorder program is that patients fear symptoms of opioid withdrawal. A new study suggested that is for good reason, since patients who are exposed to full opioid agonists chronically are recommended to already be experiencing moderate withdrawal symptoms before they can get drugs to alleviate them. By Brenda L. MooneyWASHINGTON,DCIntheirsharedclinicalHaven and Yale University in New Haven, CT, is guidelines, the VA and DoD strongly warn againstthatlong-termOUDtreatmentoutcomes,suchas initiating opioid withdrawal management without aretention in the program and abstinence from non-plan for ongoing pharmacotherapy management. medical usage can be affected. 1Why? What the guidelines call high risk of relapseThatcreatesadifficultdilemma,theynoted, and overdose. For good reason, patients fear symp- becausepatientswhoareexposedtofullopioid toms of opioid withdrawal. And, with short-actingagonists chronically are recommended to already be opiates, those symptomsnausea, vomiting, stom- experiencing moderate withdrawal symptoms at the ach cramps, drug cravings, depression, anxiety, irri- time of induction.tabilitycan occur as soon as six hours after the lastArecentstudyprotocolhelpedexplaincurrent dose, while extended-released might take 30 hours.thinkingonopioidusedisorder,whilemakingit Peak discomfort often occurs around three days afterclear that the best way to treat it remains a work in the last dose. progress.AnincreaseintheavailabilityofbuprenorphineResearchers,alsofromtheVAConnecticut (BUP)hasextendedthecapacityofhealthcareHealthcareSystemYaleSchoolofMedicine, systemstotreatpersonswithopioidusedisorderrecountedthattheUnitedStatesannounceda (OUD), but authors of a recent study published in Clinical Drug Investigation pointed out, however, The initiationor inductionof pharmacotherapyWith short-acting opiates, withBUP,however,stillpresentsaconsiderablethose symptomsnausea, challenge: due to its low intrinsic activity at the [mu- vomiting, stomach cramps, opioid receptor] MOR, combined with its capacity to displace agonists from the MOR, BUP has thedrug cravings, depression, potentialtoacutelyprecipitateopioidwithdrawal.anxiety, irritabilitycan occur Multiplestudieshavedemonstratedthatprecipi-tated withdrawal during induction onto BUP occursas soon as six hours aftercommonly, especially when it is preceded by recentthe last dose, whileexposure to full opioid agonistssuch as methadone or heroinwhich is very often the case among per- extended-released mightsons with OUD. 1 take 30 hours. Adding to the issue, according to the authors from theVAConnecticutHealthcareSysteminWest Continued on Page 14 u12'